Peptofit

Indications

Bismuth Subsalicylate is used for short-term relief of diarrhoea (including travellers' diarrhoea), indigestion, heartburn, upset stomach and nausea. Doctors also use it as part of combination treatment to clear Helicobacter pylori, a germ that causes stomach and duodenal ulcers.

How It Works

In the gut, it splits into bismuth and salicylic acid. Bismuth coats and protects the irritated stomach lining, has mild antibacterial action (including against Helicobacter pylori) and binds some toxins made by bacteria. The salicylate part reduces fluid secretion and inflammation in the intestine, which helps firm up loose stools.

Dosage and Administration

Adults and children over 12 years: usually 524 mg (two 262 mg tablets, or 30 ml of the regular-strength 262 mg per 15 ml suspension) every 30 to 60 minutes as needed, with no more than 8 doses in 24 hours, or as directed on the label. Do not use for more than 2 days for diarrhoea without medical advice. Shake the suspension well; chewable tablets should be chewed or dissolved in the mouth. For Helicobacter pylori treatment, take as prescribed. Drink plenty of fluids to replace those lost with diarrhoea.

Interactions

• Avoid with Aspirin and other salicylates, as salicylate levels can build up.
• Warfarin and other blood thinners: bleeding risk may increase.
• Tetracyclines (e.g. Doxycycline) and quinolones (e.g. Ciprofloxacin) are absorbed less; separate doses by at least 2 hours.
• Methotrexate, Probenecid and diabetes medicines may be affected by salicylate.
• Ibuprofen and similar pain relievers increase stomach irritation and bleeding risk.

Contraindications

• Allergy to Bismuth Subsalicylate, Aspirin or other salicylates.
• Children and teenagers recovering from or having chickenpox or flu-like illness, because of the risk of Reye's syndrome (a rare, serious illness of the brain and liver).
• Bleeding disorders, stomach ulcer with bleeding, or black or bloody stools not caused by bismuth.
• Severe kidney disease.

Side Effects

It often causes a harmless black colour of the tongue and stools, which goes away a few days after stopping. Constipation and mild nausea may occur. High or long use can cause ringing in the ears.

Get urgent medical help if you have ringing in the ears or hearing loss, vomiting blood, severe stomach pain, confusion, diarrhoea lasting more than 2 days with high fever or bloody stools, or signs of a severe allergic reaction.

Pregnancy and Lactation

Avoid during pregnancy, especially in the last 3 months, because salicylates can affect the baby and labour. Avoid while breastfeeding, as salicylate passes into breast milk.

Precautions and Warnings

Not for children under 12 years unless a doctor advises. Tell your doctor about gout, diabetes, kidney disease or bleeding problems. Black stools from bismuth are harmless, but black tarry stools with weakness may mean bleeding. It may show up on X-rays of the gut.

Overdose

Overdose can cause salicylate poisoning with ringing in the ears, fast breathing, vomiting, confusion and fever, and bismuth toxicity with long use. Seek emergency medical help at once.

Therapeutic Class

Antidiarrhoeal and gastrointestinal protectant.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Do not freeze the suspension.