Bismuth Subsalicylate
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Trade Name
Pepto-Bismol, Kaopectate (common brand names); generic bismuth subsalicylate
Classification
Antidiarrheal, anti-ulcer agent; salicylate derivative
Dosage/Route
- * Dosage:
- – Liquid: 262 mg/15 mL, 525 mg/15 mL (regular or max strength)
- – Chewable tablets: 262 mg
- – Caplets: 262 mg
- * Route: Oral (PO)
Usual Dosage
- * Adults:
- – Diarrhea/Upset Stomach: 524 mg (2 tablets or 30 mL) every 30-60 min PRN; max 8 doses/day (4,192 mg)
- – H. pylori (with antibiotics): 524 mg PO 4 times daily (QID) for 10-14 days
- * Children (≥12): Same as adults; adjust by age/weight for <12 (e.g., 9-12 yrs: 262 mg q30-60 min, max 8 doses)
- * Short-term use (≤48 hr unless prescribed)
Mechanism of Action
Exhibits antimicrobial activity (against H. pylori, enteropathogens), coats GI mucosa (protective barrier), and has mild anti-inflammatory effects via salicylate. Reduces diarrhea by slowing intestinal secretions and motility; aids ulcer healing with combo therapy
Side Effects & Adverse Effects
- * Side Effects: Black tongue/stool (harmless), nausea, constipation
- * Adverse Effects:
- – Salicylate toxicity (rare, overdose; tinnitus, confusion, hyperventilation)
- – Reye’s syndrome risk (children/teens with viral illness; boxed warning)
- – Allergic reactions (rare; rash, anaphylaxis from salicylate)
Nursing Management (Implications & Teachings)
- * Implications:
- – Assess for aspirin allergy (cross-reactivity risk) or viral illness in kids (Reye’s)
- – Monitor stool color (black = normal; bloody = problem)
- – Avoid in bleeding disorders or with anticoagulants (salicylate effect)
- – Shake liquid well; chew tablets fully
- * Teachings:
- – Take every 30-60 min PRN; don’t exceed 8 doses/day
- – Expect black tongue/stool—not harmful
- – Report ringing in ears, confusion, or rash
- – Avoid in kids with flu/chickenpox; check with MD if pregnant
Indication for This Patient
- * Traveler’s diarrhea, acute diarrhea, upset stomach (nausea, indigestion)
- * H. pylori infection (adjunct with antibiotics/PPI for ulcer treatment)
Time
- * Timing: Every 30-60 min PRN (diarrhea); QID (H. pylori)
- * Onset: Symptom relief in 30 min-1 hr
- * Duration: Short-term (≤48 hr unless prescribed)
