Generic
Bismuth Subsalicylate
6 brands available in the market
At a glance
Bismuth Subsalicylate is a medicine used in the treatment of diarrhea, nausea, heartburn, indigestion, and upset stomach. It works through antimicrobial, anti-inflammatory, and antisecretory actions.
Description
Bismuth Subsalicylate is indicated for upset stomach, indigestion, heartburn, nausea, and diarrhea. It works through the antimicrobial and anti-inflammatory action of bismuth and the antisecretory effect of salicylate.
Bismuth Subsalicylate coats the ulcer surface, protecting it from acid and pepsin. It stimulates mucus and bicarbonate secretion and reacts with HCl to produce bismuth oxychloride and salicylic acid, reducing HCl. In diarrhea, it stimulates absorption of water and electrolytes across the intestinal wall and binds with E.coli toxin, disrupting cells and preventing H.pylori adhesion to the intestinal wall.
Indications
- Upset stomach
- Indigestion
- Heartburn
- Nausea
- Diarrhea
Therapeutic class
Gastrointestinal Agent
Pharmacological class
Antidiarrheal / Antacid / Anti-inflammatory
Pharmacology
Bismuth Subsalicylate has antacid, antidiarrheal, and anti-inflammatory actions. It coats ulcer surfaces, protects from acid and pepsin, stimulates mucus and bicarbonate secretion, and reacts with HCl to reduce it. In diarrhea, it stimulates fluid and electrolyte absorption and binds with E.coli toxin. Hydrolyzed to salicylic acid, it inhibits prostaglandin G/H synthase ½, reducing inflammation.
Mechanism of action
- Antimicrobial and anti-inflammatory action (bismuth): Binds with bacterial toxins, causes H.pylori lysis, and prevents H.pylori adhesion to intestinal wall.
- Antisecretory effect (salicylate): Inhibits prostaglandin synthesis, reducing inflammation and fluid secretion.
- Antacid action: Coats ulcer surface and reduces HCl.
- Antidiarrheal action: Stimulates water and electrolyte absorption across intestinal wall.
Dosage
Adults (>16 years): 30 ml (in dosing cup or 6 spoonfuls) 3-4 times daily, 30 minutes before meals. Repeat every ½ to 1 hour if needed. Maximum 8 doses in 24 hours.
Children (10-14 years): 15 ml (3 teaspoons)
Children (5-9 years): 7.5 ml (1.5 teaspoons)
Children (3-4 years): 5 ml (1 teaspoon)
Under 3 years: Ask a doctor.
Note: Do not use for more than 2 days. Do not use if symptoms are severe or persist for more than 2 days.
Administration
Shake the bottle well before use. For oral use only. Drink plenty of clear fluids to prevent dehydration caused by diarrhea. Take as advised by your doctor.
Missed dose
If you miss a dose, take it as soon as you remember. Skip the missed dose if it is almost time for your next dose. Do not double the dose.
Side effects
>10%: Nausea (12%)
1-10%: Diarrhea (7%), Abdominal pain (7%), Melena (3%), Upper respiratory tract infection (2%), Constipation (2%), Anorexia (2%), Vomiting (2%), Asthenia (2%), Discolored tongue (2%), Headache (2%), Dyspepsia (2%), Dizziness (2%), Stool abnormality (1%), Duodenal ulcer (1%), Sinusitis (1%), Taste perversion (1%), Flatulence (1%), GI hemorrhage (1%), Pain (1%), Insomnia (1%), Anal discomfort (1%), Paresthesia (1%)
Frequency Not Defined: Anxiety, Confusion, Depression, Tinnitus, Weakness, Gray-black stool, Impaction, Muscle spasm, Neurotoxicity (rare)
Precautions & warnings
- May cause black tongue and/or black stool (common and harmless).
- Do not take with aspirin or other salicylates.
- Caution should be exercised in patients taking anticoagulants (blood thinners), diabetes medications, or gout/arthritis medications.
- Do not use for more than 2 days.
- Do not use if symptoms are severe or persist for more than 2 days.
- Do not exceed the recommended dose.
Contraindications
- Hypersensitivity to bismuth, aspirin, or other salicylates
- Infectious diarrhea
- High fever
- von Willebrand disease
- Hemorrhage
- Ulcer or GI bleeding with black or bloody stool
- Hemophilia
- In pediatric patients: Chicken pox or influenza (risk of Reye syndrome)
Drug interactions
- Contains salicylates; caution with anticoagulant therapy, diabetes medications, or gout/arthritis medications.
- Do not take with aspirin or other salicylates.
Food interactions
Adequate information on alcohol interaction is not available. Please consult your doctor.
Use in pregnancy
Pregnancy category: C; D in 3rd trimester. Adequate data not available. Animal studies insufficient. Potential risk for humans unknown. Consult your doctor before use during pregnancy.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Adequate data not available. Salicylates enter breast milk. Should not be used during lactation unless clearly necessary. Use with caution.
Pediatric use
5-9 years: 7.5 ml (1.5 teaspoons)
3-4 years: 5 ml (1 teaspoon)
Under 3 years: Ask a doctor.
Geriatric use
No special precaution is needed for elderly, but general caution should be exercised.
Renal / hepatic impairment
Hepatic impairment: Limited information available. Consult your doctor.
Overdose effects
Bismuth intoxication: May present as acute encephalopathy (confusion, myoclonic movements, tremor, dysarthria, walking and standing disorders), gastrointestinal disturbances, skin reactions, discoloration of mucous membranes, and renal dysfunction (acute tubular necrosis). Treatment includes gastric lavage, purgation, and hydration. Chelating agents and hemodialysis may be necessary.
Salicylate intoxication: Dizziness, tinnitus, sweating, nausea, headache. Discontinue use if symptoms occur and consult a doctor.
Storage conditions
Store below 30°C, away from light and moisture. Keep out of reach and sight of children.
Chemical structure
Bismuth Subsalicylate