USMLE

Bismuth Subsalicylate

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GI Drugs
  1. Ondansetron
  2. Sucralfate
  3. Docusate (Stool Softener)
  4. Bulk Forming Laxatives (Psyllium, Methylcellulose)
  5. Stimulant Laxatives (Senna, Bisacodyl)
  6. Osmotic Laxatives (Lactulose, PEG)
  7. Bismuth Subsalicylate
  8. Antidiarrheals (Loperamide, Diphenoxylate-Atropine)
  9. Antacids
  10. Metoclopramide
  11. H2 Blockers
  12. Misoprostol
  13. Proton Pump Inhibitors (PPIs)
  14. Orlistat
  15. Octreotide

Summary

Bismuth subsalicylate, commonly known as Pepto Bismol, is used to treat diarrhea, GERD, and nausea. It can cause Reye syndrome, a rare form of acute liver failure and encephalopathy in children, so it should not be given to children. A benign but expected side effect of bismuth subsalicylate is dark or black-colored stools.

Key Points

  • Bismuth Subsalicylate
    • Mechanism
      • Antidiarrheal
      • Antacid
      • Antiemetic
      • Prevents bacterial binding to the mucosal cells in the GI tract, promoting fluid absorption and reducing inflammation
    • Clinical Use
      • Diarrhea
        • Including traveler’s diarrhea
      • Gastroesophageal Reflux Disease (GERD)
      • Nausea
      • H. Pylori infection
        • Used in combination with an antibiotic and proton pump inhibitor
    • Side Effects and Adverse Reactions
      • Reye Syndrome (in children)
        • Acute liver failure and encephalopathy when given to children
        • Should not be given to children as it contains an aspirin-like compound
      • Dark stools
        • An expected side effect; not a reason to discontinue the medication
      • Tinnitus
        • Similar to aspirin, this is a sign of toxicity
      • Drowsiness
      • Headache