Classifications: antidiarrheal; salicylate; Therapeutic: antidiarrheal
Pregnancy Category: C
262 mg tablets/caplets; 130 mg/15 mL, 262 mg/15 mL, 524 mg/15 mL liquid
Hydrolyzed in GI tract to salicylate, which is believed to inhibit synthesis of prostaglandins responsible for GI hypermotility
and inflammation. It is also a direct mucosal protective agent.
Effectiveness as an antidiarrheal also appears to be due to direct antimicrobial action and to an antisecretory effect on
intestinal secretions exposed to toxins.
Prophylaxis and treatment of traveler's diarrhea (turista) and for temporary relief of indigestion.
Helicobacter pylori associated with peptic ulcer disease.
Hypersensitivity to aspirin or other salicylates; concurrent use with aspirin; coagulopathy, severe hepatic impairment;
use for more than 2 d in presence of high fever or in children <3 y unless prescribed by physician; chickenpox or flu; dysentery;
pregnancy (category C).
Diabetes and gout; concurrent use with salicylates and anticoagulants; alcoholism; renal impairment; elderly; smoking; lactation.
Route & Dosage
Adult: PO 30 mL or 2 tab q3060min prn (max: 8 doses/d)
Child: PO 36 y, 5 mL or ? tab q3060min prn (max: 8 doses/d); 69 y, 2/3 tab or 10 mL q3060min prn (max: 8 doses/d); 912 y, 15 mL or 1 tab q3060min prn (max: 8 doses/d)
Adult: PO 24 tab or 1530 mL q.i.d. for 3 wk
Peptic Ulcer Disease
Adult: PO 2 tablets q.i.d. with 2 additional antibiotics for 1014 d
Child (<10 y): PO 15 mL q.i.d. times 6 wk
- Ensure chewable tablets are chewed or crushed before being swallowed and followed with at least 8 oz water or other liquid.
- Store at 15°30° C (59°86° F) unless otherwise directed.
Adverse Effects (≥1%)GI:
Temporary darkening of stool
and tongue, metallic taste, bluish gum line; bleeding tendencies. With high doses: fecal impaction. CNS:
Encephalopathy (disorientation, muscle twitching). Hematologic:
Bleeding tendency. Special Senses:
Tinnitus, hearing loss.
Diagnostic Test Interference
Because bismuth subsalicylate is radiopaque, it may interfere with radiographic studies of GI tract.
Bismuth may decrease the absorption of tetracyclines
, quinolones (ciprofloxacin, norfloxacin, ofloxacin).
May increase level of aspirin.
Undergoes chemical dissociation in GI tract to bismuth subcarbonate and sodium salicylate; bismuth is minimally absorbed,
but the salicylate is readily absorbed.
Assessment & Drug Effects
- Monitor bowel function; note that stools may darken and tongue may appear black. These are temporary effects and will disappear
- Lab tests: H. pylori breath test when used for peptic ulcers.
Patient & Family Education
- Note: Bismuth contains salicylate. Use caution when taking aspirin and other salicylates. Many OTC medications for colds, fever,
and pain contain salicylates.
- Consult physician if diarrhea is accompanied by fever or continues for more than 2 d.
- Note: Temporary grayish black discoloration of tongue and stool may occur.