Prevacid vs. Bismuth subsalicylate for Heartburn: Important Differences and Potential Risks.

Key takeaways

Lansoprazole (Prevacid) and bismuth subsalicylate (Pepto-Bismol) are both used to treat stomach-related issues, but they have several differences. Lansoprazole is a proton pump inhibitor (PPI) that reduces stomach acid and is used for conditions like gastroesophageal reflux disease (GERD), ulcers, and heartburn. It is available both over-the-counter (OTC) and by prescription. Bismuth subsalicylate, on the other hand, is an antidiarrheal medication that treats diarrhea and symptoms of an upset stomach, such as nausea and gas. It is only available OTC. Lansoprazole is typically taken once daily, while bismuth subsalicylate can be taken every 30 minutes to an hour as needed. Lansoprazole can have long-term side effects like bone fractures and low magnesium levels, whereas bismuth subsalicylate can cause dark-colored tongue and stools, and should not be used for more than 2 days. Additionally, bismuth subsalicylate is not recommended for children under 12 due to the risk of Reye's syndrome, while lansoprazole can be prescribed for kids as young as 1 year old for certain conditions.

Lansoprazole

(Prevacid)

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Bismuth subsalicylate

(Pepto-Bismol)

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Summary for Prevacid

Prescription or over-the-counter

Lansoprazole (Prevacid) a proton-pump inhibitor (PPI). It treats heartburn, gastroesophageal reflux disease (GERD), and other similar conditions by lowering the amount of acid produced in the stomach. Lansoprazole (Prevacid) is available over the counter (OTC) for adults only, while providers can prescribe lansoprazole (Prevacid) for children and adults. Lansoprazole (Prevacid) is taken by mouth, typically once daily for most conditions. Although there aren't many noticeable side effects on a day-to-day basis, long-term use of lansoprazole (Prevacid) can raise certain risks like bone fractures.

Indications for Prevacid

For adults only:

Frequent heartburn (2 or more days a week) - OTC only
Stomach or duodenal ulcer
Lower the risk of duodenal ulcer caused by Helicobacter pylori (H. pylori) infection
Lower the risk of stomach ulcer due to nonsteroidal anti-inflammatory drugs (NSAID)
Other medical conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome)

For adults and children:

Pros and Cons for Prevacid

Pros

Can continue to use with antacids, such as calcium carbonate
Available as over-the-counter and lower-cost generic options
Capsules can be opened and sprinkled over soft foods (e.g., applesauce, yogurt)
Typically few to no noticeable day-to-day side effects

Cons

Takes about 3 days for the medication to fully kick in, so not the best choice for immediate heartburn relief
Might cause or worsen lupus
Long-term use might weaken bones and raise the risk of bone fracture
Can lower magnesium and vitamin B12 levels

Common Side Effects for Prevacid

Diarrhea (4%)
Belly pain (2%)

Warnings for Prevacid

Risk of hiding symptoms of a more serious problem
Sudden kidney problems
Severe infectious diarrhea
Bone fractures
Skin reactions
Lupus
Low vitamin B12 and magnesium levels
Interaction with other medications
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only

Summary for Bismuth subsalicylate

Over-the-counter

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.

Indications for Bismuth subsalicylate

Diarrhea
Travelers' diarrhea
Symptoms of upset stomach (e.g., heartburn, indigestion, nausea, gas, belching (burping), fullness)

Pros and Cons for Bismuth subsalicylate

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