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		bismuth Pepto-Bismol Tablets Liquid This drug is available in the U.S. as bismuth subsalicylate. It is also present in the tablet Tritec as bismuth citrate. What is bismuth? Bismuth is a mineral which has certain beneficial effects within the intestinal tract. These include antidiarrheal, antibacterial and antacid effects. Subsalicylate is a non-aspirin salicylate which means it is related to aspirin. What is it used for? This bismuth preparation is used primarily to treat diarrhea. It can be used as an antacid. Interestingly, it does have some antibacterial effects and has been found to be useful in treating the stomach bacterial infection, Helicobacter pylori, when used together with antibiotics. How do I take it? Follow your physician's instructions carefully. Shake the liquid well before using. Chew the tablets or allow them to dissolve slowly in your mouth. For diarrhea, the appropriate dose may be taken every 30 to 60 minutes as needed, with a maximum of 8 doses in 24 hours. Keep all medications away from children. Never share your medications with anyone else. What do I do for a missed dose? Because this is used for symptomatic relief only, there is no need to be concerned about a missed dose and no need to ever double up on the medication. Are there interactions with food or beverages? There are no interactions with food or beverages. Drink plenty of clear liquids to help prevent dehydration which may accompany diarrhea. Are there interactions with other drugs? An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Bismuth subsalicylate is a form of salicylate. If taken with aspirin and if ringing in the ears occurs, discontinue use. Interactions with this drug may occur with the following: blood thinners (Coumadin) tetracycline antibiotics (Achromycin, Sumycin) Is there a problem if I have another disorder or disease? At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. If you have diabetes or gout, discuss the use of this drug with your physician. What about allergies? People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient's allergy history. Signs of an allergic reaction are skin rash, hives and itching. Of course, a person should not take bismuth if there has been a previous reaction to this drug, aspirin or any other salicylates. What if I'm pregnant, considering pregnancy or breast-feeding? Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Bismuth is ranked C. Always consult your physician before taking any drug during or when planning pregnancy. What are the effects on sexual function? There are no known adverse effects of bismuth on sexual function. Are there other precautions? Bismuth may cause a temporary and harmless darkening of the tongue and stool. Because bismuth may interfere with x-ray examinations of the GI tract, it should not be taken for several days before an abdominal x-ray exam. If diarrhea is accompanied by high fever or if it continues for more than 2 days, consult your physician. Children or teenagers who have or are recovering from chicken pox or flu should not use bismuth subsalicylate because of the possibility of Reye's Syndrome, a very serious liver condition. How long is it safe to take bismuth? Bismuth preparations should not be taken long-term. If it does not control diarrhea, it should be stopped. Consult your physician if diarrhea continues for more than 2 days or is accompanied by fever or abdominal pain. How about side effects? Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately. For bismuth, the following are the observed side effects: Minor: temporary gray-black darkening of stool Major: stool impaction or blockage in infants or elderly patients A physician's comment... Bismuth is a mild antidiarrheal agent for temporary diarrhea. Persistent diarrhea should always be evaluated by the physician. Bismuth is not recommended long-term as an antacid since there are much more effective antacids and, especially, drugs to reduce stomach acid. In treating the stomach infection, Helicobacter pylori, this drug together with tetracycline and metronidazole is one of the best and cheapest forms of therapy, although there may be frequent minor side effects. Posted: July 1998 Peptic Ulcer Disease | Helicobacter Pylori | Diarrhea
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