Bismuth Subsalicylate 262 mg Chewable Tablets Dosing
For adults and adolescents 12 years and older, take 2 chewable tablets (524 mg) every 30-60 minutes or 4 chewable tablets (1,048 mg) every hour as needed for diarrhea, not exceeding 8 doses (16 tablets or 4,192 mg) in 24 hours, and do not use for more than 2 days. 1
Standard Dosing by Indication
For Acute Diarrhea
- 2 tablets (524 mg) every 30 minutes to 1 hour as needed
- Alternative: 4 tablets (1,048 mg) every hour as needed
- Maximum: 8 doses (16 tablets total = 4,192 mg) in 24 hours
- Duration: Do not exceed 2 days 1
For Upset Stomach, Heartburn, Indigestion, or Nausea
- 2 tablets (524 mg) every 30 minutes to 1 hour as needed
- Same maximum limits apply 1
For H. pylori Eradication (Bismuth Quadruple Therapy)
When used as part of H. pylori treatment regimens:
- Bismuth ~300 mg four times daily (approximately 1 tablet per dose, though formulations vary)
- Combined with metronidazole 500 mg three times daily, tetracycline 500 mg four times daily, and PPI twice daily
- Duration: 14 days 2, 3
Critical Safety Considerations
Do not use in children under 12 years without physician guidance due to Reye's syndrome risk 1. The FDA labeling explicitly restricts use to those 12 years and older for self-medication.
Common Side Effects
Serious Toxicity Risk
Chronic overuse can cause salicylate toxicity, presenting with confusion, tinnitus, hearing impairment, and falls, particularly in elderly patients 6. Each 262 mg tablet contains 123 mg of salicylate 1. Patients must strictly adhere to the 2-day maximum duration for self-treatment to avoid accumulation.
Drug Interactions
Since bismuth subsalicylate contains salicylate, consider interactions with:
- Anticoagulants (increased bleeding risk)
- Other salicylate-containing products
- Medications affected by salicylates
Clinical Pearls
Ensure adequate hydration during diarrheal illness to prevent dehydration 1. The short 2-day limit exists because persistent diarrhea requires medical evaluation for underlying causes.
For H. pylori treatment, bismuth quadruple therapy remains a recommended first-line option, particularly in penicillin allergy or areas with high clarithromycin resistance 2, 3. The dosing in this context is higher and longer (14 days) than for symptomatic diarrhea treatment.
Storage: Keep at temperatures not exceeding 25°C (77°F) and avoid excessive heat over 40°C 1.