bismuth subsalicylate (Pepto Bismol, Kaopectate, Bismatrol Maximum Strength, and others) (cont.)

Pharmacy Author:
Medical and Pharmacy Editor:

STORAGE: Bismuth subsalicylate products should be stored at room temperature, between 59 F to 86 F (15 C to 30 C).

DOSING:

Over-the-counter treatment of nonspecific diarrhea in adults and adolescents (= 12 years):

  • Chewable tablets, caplets, liquids containing 262 mg/15 ml: 524 mg by mouth every 30-60 minutes as needed. Not to exceed 8 doses in 24 hours.
  • Liquids containing 525 mg/15 ml: 1050 mg by mouth every hour as needed. Not to exceed 4 doses in 24 hours.
  • Over-the-counter treatment of upset stomach, heartburn, indigestion, nausea, and related symptoms in adults and adolescents (= 12 years):
  • Chewable tablets, caplets, liquids containing 262 mg/15 ml: 524 mg by mouth every 30-60 minutes as needed. Not to exceed 8 doses in 24 hours.
  • Liquids containing 525 mg/15 ml: 1050 mg by mouth every hour as needed. Not to exceed 4 doses in 24 hours.
  • For the prevention of traveler's diarrhea due to Escherichia coli (E. coli) and viral infections in adults and adolescents (≥ 12 years):
  • 524 mg by mouth four times daily, starting 1 day before departure and continuing for 2 days after returning. Generally, treatment duration should not exceed 3 weeks.
  • For the eradication of helicobacter pylori as part of quadruple-drug regimen in adults and adolescents (≥ 12 years):
  • 525 mg by mouth 4 times daily.

The safety and effectiveness of bismuth subsalicylate use in children <12 years has not been established.

DRUG INTERACTIONS:

Combining bismuth subsalicylate with sulfinpyrazone (Anturane) or probenecid is not recommended because bismuth subsalicylate may suppress the therapeutic effects of both drugs.

Tetracycline and quinolone antibiotics may form insoluble complexes with bismuth subsalicylate. While bismuth subsalicylate should be avoided in patients taking these antibiotics if possible, separating administration by 2 hours may be sufficient to avoid this interaction.

Bismuth subsalicylate should be used cautiously in patients taking methotrexate (Trexall). Bismuth subsalicylate is broken down to salicylic acid which is known to increase blood levels of methotrexate. Patients especially at risk for this interaction include those on high-dose methotrexate therapy, elderly patients, and patients with reduced kidney function.

Medically Reviewed by a Doctor on 5/12/2015


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