Bismuth subsalicylate

Administration

• Type: Anti-diarrheal
• Dosage Forms:
• Routes of Administration: PO
• Common Trade Names: Pepto Bismol, Maalox

Adult Dosing

• Diarrhea, gas, indigestion, heartburn, nausea: 524mg (2 tabs regular strength) PO q30m PRN, max 8 doses regular strength or 4 doses extra-strength daily
• H. pylori: 524mg (2 regular-strength tablets or 1 extra-strength tablet) + 250 mg metronidazole + 500 mg tetracycline PO q6hr x14d, plus H2 antagonist

Pediatric Dosing

• <3y: safety/efficacy not established
• 2-6y: 87mg PO q30-60m PRN
• 6-9y: 175mg PO q30-60m PRN
• 9-12y: 262mg PO q30-60m PRN
• >12y: adult dose

Special Populations

Pregnancy Rating

• Category C, Category D in 3rd trimester

Lactation risk

• Salicylates enter breastmilk; use with caution

Renal Dosing

• Caution: overdose may cause nephrotoxicity

Contraindications

• Allergy to class/drug
• Infectious diarrhea (fever)
• von Willebrand disease, hemorrhage, ulcer, GI bleeding, hemophilia
• In pediatric patients; chicken pox or influenza (risk of Reye syndrome)

Adverse Reactions

Serious

• Duodenal ulcer, GI hemorrhage
• Neurotoxicity
• Renal failure

Common

• Nausea, diarrhea, abdominal pain, constipation, anorexia, dyspepsia, flatulence, anal discomfort
• Black stool, melena
• URI, sinusitis
• Asthenia
• Discolored tongue, taste perversion
• Headache, dizziness
• Paresthesia
• Anxiety, depression
• Tinnitus
• Muscle spasm

Pharmacology

• Half-life: Bismuth- 21-72 days, salicylate- 2.5h
• Metabolism: GI tract, liver
• Excretion: Bismuth- feces, salicylate- urine

Mechanism of Action

• Bismuth: antimicrobial, anti-inflammatory action
• Salicylate: antisecretory effect

See Also

• Bismuth toxicity

References

https://reference.medscape.com/drug/kaopectate-pepto-bismol-bismuth-subsalicylate-342037#10