bismuth subsalicylate
Bismuth subsalicylate (Pepto-Bismol) is a salicylate antidiarrheal medication. It's used to ease diarrhea and symptoms of an upset stomach (e.g., gas, nausea) in adults and kids ages 12 years and older. This medication is taken by mouth, typically once every 30 minutes to an hour, as needed. Bismuth subsalicylate (Pepto-Bismol) is found over the counter in several different formulations, such as chewable tablets and oral solutions. Side effects of this medication include nausea, changes in taste, dark-colored tongue, and black stool.
What is Bismuth subsalicylate (Pepto-Bismol)?
What is Bismuth subsalicylate (Pepto-Bismol) used for?
- Diarrhea
- Travelers' diarrhea
- Symptoms of upset stomach (e.g., heartburn, indigestion, nausea, gas, belching (burping), fullness)
How Bismuth subsalicylate (Pepto-Bismol) works
Bismuth subsalicylate (Pepto-Bismol) is a salicylate that's an antidiarrheal medication. It treats diarrhea and stomach irritation in a few different ways, including slowing down movement in your stomach and intestines, lowering the amount of secretions in your gut, and helping your body reabsorb fluids and electrolytes.
Drug facts
Side effects of Bismuth subsalicylate (Pepto-Bismol)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea
- Bitter taste in mouth
- Diarrhea
- Dark-colored stools
Less Common Side Effects
- Tiredness
- Mood changes
- Dark-colored tongue or teeth
- Ringing in the ears
Bismuth subsalicylate (Pepto-Bismol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe allergic reaction: trouble breathing, blisters, hives, swelling of your tongue or lips
- Salicylate toxicity: headache, dizziness, confusion, ringing in the ears, trouble breathing, nausea, vomiting, stomach pain
More on Bismuth subsalicylate (Pepto-Bismol) side effects
The following Bismuth subsalicylate (Pepto-Bismol) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, red or purple spots on skin, unusual bruising or bleeding
- Hearing loss, ringing in ears
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Black stools
- Constipation
- Dark or black tongue
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Pros and cons of Bismuth subsalicylate (Pepto-Bismol)
Pros
- Treats a wide variety of stomach-related symptoms
- Available as a lower-cost generic medication
- Available in chewable tablets or liquid for people who have difficulty swallowing pills
- Can be taken with or without food
Cons
- Shouldn’t be taken for longer than 2 days
- Can cause darkening of the tongue or stools
- Might need to take it multiple times per day
- Not for children less than 12 years of age due to higher risk of Reye's syndrome
Pharmacist tips for Bismuth subsalicylate (Pepto-Bismol)
- You can take bismuth subsalicylate (Pepto-Bismol) with or without food. If it upsets your stomach, try taking the medication with food.
- If you're taking bismuth subsalicylate (Pepto-Bismol) for diarrhea, make sure to drink plenty of fluids to stay hydrated. If you feel faint, lightheaded, or dizzy, seek medical help right away because these are signs of dehydration.
- Check the ingredients of your other medications, including OTC medications, to see if they also contain salicylate. Taking too much bismuth subsalicylate (Pepto-Bismol) or other products containing salicylate, including aspirin or Salonpas pain relieving patches (camphor / menthol / methyl salicylate), can lead to symptoms of salicylate toxicity, including headache, dizziness, and ringing in the ear.
- Tell your provider and pharmacist about all the medications you're taking, especially if you're taking a blood thinner or an NSAID like aspirin. Taking bismuth subsalicylate (Pepto-Bismol) with these medications raises your risk for bleeding and side effects. Additionally, don't use bismuth subsalicylate (Pepto-Bismol) if you have a history of a bleeding problem without asking your provider first.
- Tell your provider if you notice a ringing in the ears or loss of hearing after you start using bismuth subsalicylate (Pepto-Bismol). If so, you'll probably need to stop taking bismuth subsalicylate (Pepto-Bismol). The ringing sound should go away and your hearing should return after you stop taking this medication.
- You shouldn’t take bismuth subsalicylate (Pepto-Bismol) for more than 2 days. If you still have diarrhea or stomach problems after 2 days of taking the medication, talk with your provider. You'll need to be seen and examined for a more serious medical problem.
More tips for bismuth subsalicylate oral suspension:
- The oral suspension comes in two strengths, 525 mg/30 mL (e.g., Pepto Bismol, Kaopectate) and 525 mg/15 mL (e.g., Pepto Bismol Ultra, Kaopectate Max). Make sure to carefully double check the strength and recommended dose of your bismuth subsalicylate product carefully to avoid taking the wrong dose.
- Shake well before each dose. Then, use a medication dose cup or an oral syringe to measure your dose. Don't use household spoons because they might not be accurate and might cause you to take the wrong dose. Ask your pharmacy to provide you with one if the product doesn't include it in its packaging or if you need extras.
- Store the oral suspension at room temperature in the original bottle.
Common questions about Bismuth subsalicylate (Pepto-Bismol)
While the effects of bismuth subsalicylate (Pepto-Bismol) doesn't last very long (you might need to take it every half hour to an hour), traces of this medication can be found in the body for a long time. Talk with your provider if you have questions about how long bismuth subsalicylate (Pepto-Bismol) might stay in your body.
Yes, bismuth subsalicylate (Pepto-Bismol) is a medication that can cause black or dark-colored stools (and tongue). Sometimes, this side effect can last for several days after your last dose, but it should go away with time. But if you feel other symptoms, like dizziness, weakness, stomach pain, or blood when wiping or red streaks on the outside of your stool, seek medical help right away because these are potential signs of a stomach bleed.
Typically, you can take a dose of bismuth subsalicylate (Pepto-Bismol) every 30 minutes to an hour as needed. Be sure to check the product you're taking for the maximum amount of tablets or oral solution you can take total per day. This can differ depending on which strength of bismuth subsalicylate (Pepto-Bismol) you're taking.
No, don't take bismuth subsalicylate (Pepto-Bismol) during pregnancy because it can affect the development of your unborn baby. If you're having diarrhea or upset stomach, talk to your provider or pharmacist about other treatment options.
Children under 12 years of age shouldn't take bismuth subsalicylate (Pepto-Bismol) because doing so raise their risk of a serious condition called Reye's syndrome. This typically occurs when children who are recovering from flu-like symptoms or other viruses take medications containing a salicylate (like bismuth subsalicylate). If your child has stomach upset or diarrhea, ask their provider what medications are appropriate for them.
No, bismuth subsalicylate (Pepto-Bismol) doesn't typically help with constipation; it helps with diarrhea. If you're having constipation, try eating foods high in fiber and drinking more fluids. Ask your provider whether it's safe for you to take any over-the-counter stool softeners or laxatives. If your constipation doesn't improve, let your provider know.
Yes, bismuth subsalicylate (Pepto-Bismol) is medication with an expiration date written on the product. Don't use bismuth subsalicylate (Pepto-Bismol) past the expiration date, otherwise it might not be safe or work well enough to treat your symptoms.
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Risks and warnings for Bismuth subsalicylate (Pepto-Bismol)
Bismuth subsalicylate (Pepto-Bismol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Reye's syndrome in children
- Risk factors: Children recovering from chickenpox or flu-like symptoms
Bismuth subsalicylate use in children is linked to a rare but serious condition called Reye's syndrome. It typically occurs when children who are recovering from flu-like symptoms or other viruses take salicylates, like bismuth subsalicylate or aspirin. Early symptoms of Reye's syndrome include vomiting, headache, confusion, and distress. But it can progress to seizures and loss of consciousness. Don't give bismuth subsalicylate (Pepto-Bismol) to a child who has an upset stomach due to the flu. Ask your child's provider for medication recommendations for children who are sick.
Salicylate toxicity
Taking too much bismuth subsalicylate (Pepto-Bismol) or other products containing salicylate, including aspirin or Salonpas pain relieving patches (camphor / menthol / methyl salicylate), can lead to salicylate toxicity. Check the ingredients of your other medications, including OTC medications, to see if they also contain salicylate. Let your provider know if you have symptoms of salicylate toxicity, include headache, dizziness, and ringing in the ear.
Allergic reactions
- Risk factors: Aspirin or NSAID allergy
Severe allergic reactions to bismuth subsalicylate (Pepto-Bismol) are possible, including anaphylaxis (closing of the throat). Call 911 if you experience hives, trouble breathing, or swelling of your lips or tongue. Let your provider know if you have an allergy to aspirin or other NSAIDs before you start taking bismuth subsalicylate (Pepto-Bismol).
Bismuth subsalicylate (Pepto-Bismol) dosage
Typical dosage for Bismuth subsalicylate (Pepto-Bismol)
There are several strengths and formulations of bismuth subsalicylate (Pepto-Bismol) available. Each product might have different instructions and dose recommendations. Make sure to follow the instructions on the package labeling or your provider’s directions.
Some examples include:
Bismuth subsalicylate 262 mg chewable tablets (Pepto Bismol Chewable)
- Age 12 years and older:
- Diarrhea: The typical dose is to chew or dissolve 2 tablets every 30 minutes, or 4 tablets every hour, as needed. Don't take more than 16 tablets in a 24-hour period.
- Upset stomach or nausea: The typical dose is to chew or dissolve 2 tablets every 30 minutes as needed. Don't take more than 16 tablets in a 24-hour period.
- Age under 12 years: Ask your child's provider or pharmacist.
Bismuth subsalicylate 525 mg caplets (Pepto Bismol Ultra)
- Age 12 years and older:
- Diarrhea: The typical dose is to take 1 caplet by mouth every 30 minutes, or 2 caplets every hour, as needed. Don't take more than 8 caplets in a 24-hour period.
- Upset stomach and nausea: The typical dose is to take 1 caplet by mouth every 30 minutes as needed. Don't take more than 8 caplets in a 24-hour period.
- Age under 12 years: Ask your child's provider or pharmacist.
More on Bismuth subsalicylate (Pepto-Bismol) dosage
How much does Bismuth subsalicylate (Pepto-Bismol) cost?
$3.78
Bismuth subsalicylate (Pepto-Bismol) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Bismuth subsalicylate (Pepto-Bismol) will not be safe for you to take.
- Stomach ulcer
- Bleeding problems
- Bloody or black stools
- Allergy to, or taking, other medications containing salicylates (e.g., aspirin)
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