Bismuth subsalicylate (Bismol) has got antisecretory, anti-inflammatory, and anti-diarrheal properties. It is used to treat the following conditions:

• For the symptomatic treatment of diarrhea.

• For the treatment of indigestion, relief of gas, heartburn, upset stomach, and nausea.

• As a part of combination therapy for the eradication of H.pylori infection.

• For the treatment and prophylaxis of travelers diarrhea.

Bismuth subsalicylate Dose in Adults

Dose in the treatment of Dyspepsia and Diarrhea:

• 524 mg orally every half to one hour or 1,050 mg every one hour as needed for up to 2 days
• The maximum dose should not exceed 4,200 mg per day [8 doses (regular strength); 4 doses (maximum strength)]

Dose in the prophylaxis of Traveler's diarrhea ( off-label use):

• 524 mg orally four times a day with meals and at bedtime.
• Safety beyond 3 weeks has not been established.

Dose in the treatment of Traveler's diarrhea (as off-label use):

• 524 mg orally every half to one hour as needed up to 8 doses/24 hours

Off label use as a part of a combination regimen for the eradication of Helicobacter pylori infection:

• Bismuth quadruple therapy:
  • 300 mg orally four times a day (in combination with tetracycline 500 mg four times a day, either metronidazole 500 mg 3 or 4 times a day, and standard-dose proton pump inhibitor two times a day) for 10 - 14 days.

Bismuth subsalicylate Dose in Childrens

Note: Patients allergic to aspirin should avoid bismuth subsalicylate. Furthermore, it should not be used during a viral illness such as chickenpox or flu due to the risk of Reye syndrome.

Dose in the treatment of Diarrhea:

• Children 3 - 12 years:
  • Regular strength:
    • 3 - 6 years:
      • 87 mg orally every half to one hour as needed.
    • 6 - 9 years:
      • 175 mg orally every half to one hour as needed.
    • 9 - 12 years:
      • 262 mg orally every half to one hour as needed
    • Note: Do not exceed 8 doses/day
• Children older than 12 years and Adolescents:
  • Regular strength:
    • 524 mg orally every half to one hour as needed.
  • Maximum strength:
    • 1,050 mg orally every hour as needed
  • The total dose  should not exceed 8 doses per day (regular strength) or four doses per day (maximum strength)

Dose in the treatment of Dyspepsia:

• Children older than 12 years and Adolescents:
  • Regular strength:
    • 524 mg orally every half to one hour as needed.
  • Maximum strength:
    • 1,050 mg orally every hour as needed
  • The total dose  should not exceed 8 doses per day (regular strength) or four doses per day (maximum strength)

Dose in the treatment of chronic Diarrhea:

• Infants older than 2 months:
  • 44 mg orally every 4 -  6 hours
• Children less than 2 years:
  • 44 mg orally every 4 hours or 87 mg four times a day.
• Children 2 to 3 years of age:
  • 87 mg orally every 4 - 6 hours
• Children 3 to 4 years of age:
  • 87 mg orally every four hours
• Children 4 - 6 years:
  • 175 mg orally every four hours

Bismuth Subcalicylate dose in the treatment of Helicobacter pylori-associated antral gastritis (as part of combination therapy):

• Children and Adolescents:
  • 8 mg/kg/day orally in two divided doses for 10 - 14 days.
  • The dose may be administered four times a day.

Pregnancy Risk Factor: C

• The drug's salicylates component crosses the placental boundary.
• It should not be used for acute diarrhea during pregnancy.
• It is also not recommended for the prevention or treatment of traveler's diarrhea.

Use of bismuth subsalicylates during breastfeeding

• Breastmilk is a source of the drug's salicylate component. Case reports have reported adverse reactions.
• Avoid it while breastfeeding.
• It is not recommended to treat or prevent traveler's diarrhoea while breastfeeding

Bismuth subsalicylate Dose in Renal Disease:

• Adjustment in the dose has not been recommended in patients with renal disease.

Bismuth subsalicylate Dose in Liver Disease:

•  Adjustment in the dose has not been recommended in patients with liver disease.

Side Effects Frequency not defined

• Central Nervous System:
  • Anxiety
  • Confusion
  • Depression
  • Headache
  • Slurred Speech
• Gastrointestinal:
  • Grayish black fecal Discoloration
  • Tongue Discoloration
• Neuromuscular & Skeletal:
  • Muscle Spasm
  • Weakness
• Otic:
  • Hearing Loss
  • Tinnitus

Contraindication to Bismuth subsalicylate include:

• Patients allergic to salicylates or those who take other salicylates should not use it.
• Patients suffering from peptic ulcer disease
• Melena and black tarry stool are signs of gastrointestinal bleeding.

Warnings and Precautions

• Neurotoxicity:
  • Neurotoxic effects may occur if you take large amounts. Patients with neurological diseases should be cautious.

Bismuth subsalicylate: Drug Interaction

How to take Bismuth subsalicylate?

• The oral formulation should be shaken well before its use.
• The chewable tablets should be chewed thoroughly and allowed to dissolve in the mouth before swallowing.
• The non-chewable tablets should be swallowed with a full glass of water. 

Mechanism of action of Bismuth subsalicylate:

• It is antimicrobial, antisecretory and has some anti-inflammatory properties.
• Bismuth is antimicrobial and can be used to fight both bacterial pathogens and viruses. 
• The salicylate component has antisecretory properties.

Bismuth is less than 1%absorbedHowever, over 80% of subsalicylate components are absorbed. More than 90% is absorbed.

Proteins bound. It isMetabolizedIn the gastrointestinal tract, and converted into bismuth or salicylic acid in there.

The terminalHalf-life eliminationThe time it takes to make bismuth from bismuth is between 21 and 72 days, while the time it takes to make salicylate is between 2 and 5 hours.

The urine excretes the salicylate, while the urine excretes the bismuth.

International Brands of Bismuth subsalicylate:

• Bismatrol Maximum Strength
• Bismatrol
• Diotame
• Geri-Pectate
• Kao-Tin
• Peptic Relief
• Pepto-Bismol InstaCool
• Pepto-Bismol
• Pink Bismuth
• Stomach Relief Max St
• Stomach Relief
• Bisbacter
• Bismucar
• Bismutol
• Bitni X Forte Suspension
• Facidmol
• Gastro-Bismol
• Gastro-Bismol L
• Kalbeten
• Peptolite
• Pink Bismuth
• Stobiol

Bismuth subsalicylate brands in Pakistan: