Question

Pepto- Bismol

How the drug is supplied and given (dosage form, strength, frequency, and ROA), how the drug works (MOA). Then, describe the possible side effects with corresponding warning labels. Speak of adverse reactions and any special considerations while taking this medication. Do you have it in your medicine cabinet? Why?

Answer 1

Dosage Forms ,Strengths and frequency ( In Adults ):-

tablet, chewable

• 262mg
• 525mg

caplet

• 262mg

oral suspension

• 262mg/15mL
• 525mg/15mL
• 525 mg/30 mL
• 1050 mg/30 mL

Diarrhea, Gas, Upset Stomach, Indigestion, Heartburn, Nausea:-

2 tablets (262 mg/tab) or 30 mL (regular strength) PO q½-1hr PRN; maximum daily dose: 8 regular-strength doses or 4 extra-strength doses

Traveler's Diarrhea

Prophylaxis:-

2 tablets (262 mg/tab) q6hr for up to 3 weeks

Helicobacter Pylori:-.

525 mg (2 regular-strength tablets or 1 extra-strength tablet) + 250 mg metronidazole + 500 mg tetracycline PO q6hr for 14 days, plus an H2 antagonist (Helidac Therapy pack)

Dosing Modifications:-

Renal impairment: Overdose may cause nephrotoxicity

Administration:-

Drink plenty of clear fluids to prevent dehydration caused by diarrhea

Do not use for >2 days

Helidac Therapy pack: Bismuth subsalicylate tablets should be chewed and swallowed; if a dose is missed, double doses should not be taken

Dosage Forms, Strengths and frequency( For Pediatrics ):-

tablet, chewable

• 262mg

oral suspension

• 262mg/15mL
• 525mg/15mL
• 525 mg/30 mL
• 1050 mg/30 mL

Diarrhea, Gas, Upset Stomach, Indigestion, Heartburn, Nausea:-

<3 years: Safety and efficacy not established

3-6 years: 1/3 tablet or 5 mL (regular strength) or 2.5 mL (extra strength) PO q½-1hr PRN

6-9 years: 2/3 tablet or 10 mL (regular strength) or 5 mL (extra strength) PO q½-1hr PRN

9-12 years: 1 tablet or 15 mL (regular strength) or 7.5 mL (extra strength) PO q½-1hr PRN

>12 years: 2 tablets or 30 mL (regular strength) or 15 mL (extra strength) PO q½-1hr PRN; maximum daily dose: 8 regular-strength doses or 4 extra-strength doses

Chronic Infantile Diarrhea:-

<2 years: 2.5 mL (regular strength) q4hr

2-4 years: 5 mL (regular strength) q4hr

4-6 years: 10 mL (regular strength) q4hr

Mechanism of action:-

The primary mode of action of BSS, the active ingredient of Pepto-Bismol, is as an antimicrobial agent. BSS disassociates in gastric acid to form bismuth salts, such as bismuth oxychloride. In addition to antimicrobial properties BSS has antisecretory properties and a potential for toxin adsorption.

Bismuth subsalicylate may exert its antidiarrheal action not only by stimulating absorption of fluid and electrolytes across the intestinal wall (antisecretory action) but also, when hydrolyzed to salicylic acid, by inhibiting synthesis of a prostaglandin responsible for intestinal inflammation and hypermotility. In addition, bismuth subsalicylate binds toxins produced by Escherichia coli. Both bismuth subsalicylate and the intestinal reaction products, bismuth oxychloride and bismuth hydroxide, are believed to have bactericidal action. As an antacid, bismuth has weak antacid properties.

Adverse 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%)

Warnings:-

Contraindications:-

Hypersensitivity to bismuth, aspirin, 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).

Cautions:-

Bismuth subcitrate potassium may cause temporary and harmless darkening of tongue and/or black stools, generally reversible within several days after treatment stopped; stool darkening should not be confused with melena

Bismuth absorbs x-rays and may interfere with x-ray diagnostic procedures of gastrointestinal tract

Cases of neurotoxicity associated with excessive doses of various bismuth-containing products reported; effects have been reversible with discontinuation of bismuth therapy

Medicine cabinet:-

Yes, Pepto bismol is an over the counter tablet and is kept in medication cabinet for an upset stomach!!

Please, keep in mind ;

• Read the labels
• Follow all directions for dosage
• Check the expiration dates occasionally
• Keep your medicine chest in a cool, dry place, away from sunlight
• Inform your healthcare provider about any over-the-counter medications you are taking, including vitamins and supplements.