Bismuth Subsalicylate

Bismuth Subsalicylate Brand Names

Bismatrol | Geri-Pectate | Kaopectate | Kaopectolin | Kao-Tin | K-Pek | Maalox Total Stomach Relief | Peptic Relief | Pepto-Bismol | Pink Bismuth | Stomach Relief

What is Bismuth Subsalicylate

Bismuth subsalicylate (BSS) is an oral antidiarrheal agent. It is effective for control of nonspecific diarrhea and prophylactic treatment of traveler’s diarrhea.

Although bismuth salts were first used in infectious disease (e.g., for treatment of syphilis) in 1889, the beneficial actions of bismuth in treating infectious diarrhea were not recognized until the mid-1970s.

BSS has the distinction of being the only OTC stomach remedy proven clinically effective in the relief of both upper and lower GI symptoms. In addition, bismuth subsalicylate can be used as a component of quadruple-drug therapy that usually includes BSS plus 2 antimicrobials and either an H₂-antagonist or gastric-acid pump inhibitor to effectively treat Helicobacter pylori (H. pylori) gastrointestinal infection.

Bismuth subsalicylate was first approved by the FDA in 1939.

Helidac (a combination therapy including BSS, metronidazole, and tetracycline) was approved by the FDA in August 1996 for the eradication of H. pylori infection associated with duodenal ulcer disease.

A final rule by the FDA in April 2004 eliminated labeling for the non-prescription (OTC) administration of bismuth subsalicylate in children < 12 years old due to lack of adequate data to support use in this age group.

Indications

1. diarrhea
2. dyspepsia
3. Helicobacter pylori (H. pylori) eradication
4. pyrosis (heartburn)
5. traveler’s diarrhea
6. traveler’s diarrhea prophylaxis

For over-the-counter (non-prescription) treatment of nonspecific diarrhea

Side Effects

1. abdominal pain
2. anxiety
3. confusion
4. constipation
5. diaphoresis
6. dizziness
7. drowsiness
8. encephalopathy
9. headache
10. hearing loss
11. lethargy
12. myasthenia
13. nausea
14. polydipsia
15. Reye’s syndrome
16. stool discoloration
17. tinnitus
18. tongue discoloration
19. tremor
20. vomiting

Monitoring Parameters

• serum salicylate concentrations

Contraindications

• alcoholism
• anticoagulant therapy
• breast-feeding
• children
• coagulopathy
• dehydration
• diabetes mellitus
• dysentery
• esophagitis
• fever
• G6PD deficiency
• gastritis
• geriatric
• GI bleeding
• gout
• hearing impairment
• hematological disease
• hemophilia
• hepatic disease
• hypoprothrombinemia
• infants
• influenza
• labor
• laboratory test interference
• neonates
• obstetric delivery
• peptic ulcer disease
• pregnancy
• renal disease
• renal failure
• renal impairment
• Reye’s syndrome
• salicylate hypersensitivity
• thrombotic thrombocytopenic purpura (TTP)
• tinnitus
• tobacco smoking
• varicella
• viral infection
• vitamin K deficiency

Interactions

• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Acetazolamide
• Acidifying Agents
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alkalinizing Agents
• Alogliptin
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Alosetron
• Alpha-glucosidase Inhibitors
• Amantadine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminoglycosides
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amoxapine
• Amoxicillin; Clarithromycin; Omeprazole
• Amphotericin B
• Amphotericin B cholesteryl sulfate complex (ABCD)
• Amphotericin B lipid complex (ABLC)
• Amphotericin B liposomal (LAmB)
• Angiotensin-converting enzyme inhibitors
• Antithrombin III
• Antithymocyte Globulin
• Apixaban
• Ardeparin
• Ascorbic Acid, Vitamin C
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atenolol; Chlorthalidone
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Azilsartan; Chlorthalidone
• Bacitracin
• Barbiturates
• Benazepril
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benztropine
• Beta-blockers
• Bethanechol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bromocriptine
• Bumetanide
• Calcium Carbonate
• Calcium Carbonate; Magnesium Hydroxide
• Calcium Carbonate; Risedronate
• Calcium Carbonate; Simethicone
• Canagliflozin
• Canagliflozin; Metformin
• Candesartan; Hydrochlorothiazide, HCTZ
• Capreomycin
• Captopril
• Captopril; Hydrochlorothiazide, HCTZ
• Cefixime
• Cefotetan
• Celecoxib
• Chlorothiazide
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Cidofovir
• Cimetidine
• Citalopram
• Citric Acid; Potassium Citrate
• Citric Acid; Potassium Citrate; Sodium Citrate
• Clozapine
• Colchicine; Probenecid
• Colistimethate, Colistin, Polymyxin E
• Corticosteroids
• Crofelemer
• Cyclobenzaprine
• Cyclosporine
• Dabigatran
• Dalteparin
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Deferasirox
• Diclofenac
• Diclofenac; Misoprostol
• Dicyclomine
• Diflunisal
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Doravirine; Lamivudine; Tenofovir disoproxil fumarate
• Drotrecogin Alfa
• Edoxaban
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Emtricitabine; Tenofovir disoproxil fumarate
• Enalapril, Enalaprilat
• Enalapril; Felodipine
• Enalapril; Hydrochlorothiazide, HCTZ
• Enoxaparin
• Eprosartan; Hydrochlorothiazide, HCTZ
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Escitalopram
• Esomeprazole; Naproxen
• Ethacrynic Acid
• Ethanol
• Ethotoin
• Etodolac
• Famotidine
• Famotidine; Ibuprofen
• Fenoprofen
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurbiprofen
• Fluvoxamine
• Fondaparinux
• Foscarnet
• Fosinopril
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Furosemide
• Gallium Ga 68 Dotatate
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide; Metformin
• Glyburide; Metformin
• Griseofulvin
• H2-blockers
• Heparin
• Hyaluronidase
• Hyaluronidase, Recombinant; Immune Globulin
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Ibuprofen
• Ibritumomab Tiuxetan
• Ibuprofen
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Immune Globulin IV, IVIG, IGIV
• Incretin Mimetics
• Indapamide
• Indomethacin
• Inotersen
• Insulins
• Ketoprofen
• Ketorolac
• Lamivudine; Tenofovir Disoproxil Fumarate
• Lansoprazole; Naproxen
• Linaclotide
• Linagliptin
• Linagliptin; Metformin
• Lisinopril
• Loop diuretics
• Low Molecular Weight Heparins
• Lubiprostone
• Macimorelin
• Mannitol
• Maprotiline
• Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
• Meclofenamate Sodium
• Mefenamic Acid
• Meglitinides
• Meloxicam
• Mesoridazine
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methazolamide
• Methotrexate
• Methyclothiazide
• Metolazone
• Moexipril
• Mycophenolate
• Nabumetone
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nateglinide
• Nitazoxanide
• Nizatidine
• Olanzapine
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Opiate Agonists
• Oxaprozin
• Oxybutynin
• Paroxetine
• Pentosan
• Perindopril
• Perindopril; Amlodipine
• Perphenazine
• Perphenazine; Amitriptyline
• Phentermine; Topiramate
• Phenytoin
• Phosphorated Carbohydrate Solution
• Phosphorus
• Photosensitizing agents (topical)
• Pioglitazone
• Piroxicam
• Polymyxins
• Potassium Bicarbonate
• Potassium Chloride
• Potassium Citrate
• Potassium Phosphate
• Potassium Phosphate; Sodium Phosphate
• Pramlintide
• Probenecid
• Prochlorperazine
• Psyllium
• Quinapril
• Ramipril
• Ranitidine
• Repaglinide
• Rituximab; Hyaluronidase
• Rivaroxaban
• Rosiglitazone
• Salicylic Acid
• Saxagliptin
• Selective serotonin reuptake inhibitors
• Serotonin norepinephrine reuptake inhibitors
• Sertraline
• Simvastatin; Sitagliptin
• Sitagliptin
• Sodium Hyaluronate, Hyaluronic Acid
• Sodium Thiosulfate; Salicylic Acid
• Spironolactone
• Sulfinpyrazone
• Sulfonamides
• Sulfonylureas
• Sulindac
• Tacrolimus
• Tapentadol
• Telavancin
• Tenofovir Alafenamide
• Tenofovir, PMPA
• Tetracyclines
• Thiazide diuretics
• Thiazolidinediones
• Thioridazine
• Thrombin Inhibitors
• Thrombolytic Agents
• Tinzaparin
• Tolmetin
• Topiramate
• Torsemide
• Trandolapril
• Trandolapril; Verapamil
• Trastuzumab; Hyaluronidase
• Trazodone
• Treprostinil
• Triamterene
• Trifluoperazine
• Valproic Acid, Divalproex Sodium
• Vancomycin
• Varicella-Zoster Virus Vaccine, Live
• Vilazodone
• Vortioxetine
• Warfarin