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bismuth subsalicylate (Pepto-Bismol, BSS, Kaopectate)

Tradenames: Pepto-Bismol, Kaopectate*. * Kaopectate has been reformulated to contain bismuth subsalicylate Indications: 1) diarrhea 2) abdominal cramps 3) indigestion 4) Helicobacter pylori peptic ulcer Contraindications: 1) children recovering from viral infection 2) allergy to salicylates Dosage: 1) adults: 2 tabs or 30 mL PO every 1 hour up to 8 doses/day 2) pediatrics: a) 10 mL/dose if 6-9 yo b) 5 mL/dose if 3-5 yo Tabs: 262 mg. Suspension: 262 mg/5 mL & 524 mg/15 mL. Adverse effects: 1) common (> 10%) - discoloration of tongue (black tongue) - grayish black stools 2) uncommon (< 1%) - anxiety, confusion*, slurred speech, headache, mental depression, impactation (especially in infants & debilitated patients, muscle spasms, weakness, loss of hearing, tinnitus 3) allergic reactions in aspirin-sensitive patients 4) other [4] - seizures, hallucinations, psychosis, myoclonic jerks# * confusion & memory impairment may be progressive over a period of weaks & precede gait & balance impairment [5] EEG shows bilateral frontotemporal slowing. * Neuroimaging & CSF are normal # myoclonus generally not a feature of other heavy metal toxicity Toxicity resolves over a period of weeks after the drug is discontinued Drug interactions: 1) rarely may increase activity of warfarin 2) may decrease absorption of tetracycline & quinolones, separate concurrent dosing by at least 2 hours 3) increased toxicity of aspirin Laboratory: -> serum or blood bismuth levels (if toxicity suspected) Test interactions: - interferes with radio-contrast studies of the GI tract Mechanism of action: 1) antisecretory, antimicrobial & anti-inflammatory effects 2) subsalicylate decreases inflammation 3) bismuth has antimicrobial effects

Related

Helicobacter pylori

General

bismuth salt

Properties

MISC-INFO: elimination route KIDNEY pregnancy-category D safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  5. Prescriber's Letter 10(4):24 2003

Component-of

attapulgite/bismuth subsalicylate/kaolin/pectin (Kaopectate) bismuth subsalicylate/kaolin bismuth subsalicylate/metronidazole/tetracycline Helidac kit (triple therapy) Maalox Total Relief metronidazole/subsalicylate/tetracycline (Pylera)