From the Guidelines
Pepto-Bismol (bismuth subsalicylate) is mildly effective in helping with diarrhea, as stated in the 2017 guidelines for the diagnosis and management of infectious diarrhea 1.
Key Points to Consider
- The standard adult dose is two tablets or 30 mL of liquid every 30-60 minutes as needed, not exceeding 8 doses in 24 hours.
- For children, it is recommended to consult a doctor for appropriate dosing.
- Pepto-Bismol works by coating the intestinal lining, reducing inflammation, and killing certain bacteria that cause diarrhea.
- It also has mild antisecretory effects that decrease fluid accumulation in the intestines.
- While using Pepto-Bismol, be aware that it may cause temporary darkening of the tongue and stool, which is harmless.
- If diarrhea persists beyond 2 days, is accompanied by high fever, or contains blood, seek medical attention.
- Stay hydrated while experiencing diarrhea by drinking plenty of fluids.
- Those with aspirin allergies, bleeding disorders, or who are taking blood thinners should avoid Pepto-Bismol as it contains salicylates related to aspirin.
Comparison with Other Treatments
- Loperamide is a locally acting opioid receptor agonist that decreases the muscular tone and motility of the intestinal wall, and is considered the treatment of choice for acute diarrhea in adults 1.
- Oral rehydration solutions are essential in infantile diarrhea, but not necessary in otherwise healthy adult sufferers.
- Probiotics are not widely available and the available evidence does not support their use in early treatment.
- Antimicrobial drugs are reserved for prescription-only in residents' diarrhea or for inclusion, with loperamide, in travel kits.
Important Considerations
- Patients should be advised about medications with the potential to increase the risk of complications from diarrhea, particularly antidiarrheal and antimicrobial agents.
- Limited reports suggest that routine use of medications with anticholinergic properties may lead to increased risk of severe outcomes, including death, from diarrhea caused by C. difficile and Clostridium perfringens, a toxin-mediated illness 1.
From the FDA Drug Label
Uses relieves Traveler's diarrhea Diarrhea Upset stomach due to overindulgence in food or drink, including: Heartburn Indigestion Nausea Gas Belching Fullness Directions Fully chew before swallowing Adults and children 12 years and over: 2 chewable tablets every 1/2 hour or 4 chewable tablets every hour as needed for diarrhea Use until diarrhea stops but not more than 2 days
Yes, Pepto Bismol (bismuth subsalicylate) helps with diarrhea. The drug label states it relieves diarrhea and provides dosage instructions for its use in treating diarrhea 2 2.
- It is recommended to use until diarrhea stops but not more than 2 days.
- It is also advised to drink plenty of clear fluids to help prevent dehydration caused by diarrhea.
From the Research
Effectiveness of Pepto Bismol in Diarrhea Treatment
- Pepto Bismol, which contains bismuth subsalicylate, has been shown to be effective in reducing the duration and severity of diarrhea in several studies 3, 4, 5, 6.
- A study published in 2016 found that the use of colloidal bismuth hydroxide gel plus oral rehydration salt significantly reduced the duration of acute diarrhea, the number of stools, and the percentage of children with persistent diarrhea after 24 hours of treatment compared to the control group 3.
- Another study published in 1993 found that bismuth subsalicylate decreased the duration of diarrhea and was a safe and effective adjunct to oral rehydration therapy for infants and young children with acute watery diarrhea 4.
- A systematic review and meta-analysis published in 2021 found that bismuth subsalicylate can be beneficial for those at risk or affected by food and waterborne diarrheal disease, and may decrease the risk of inappropriate antibiotic utilization 6.
Mechanism of Action
- The exact mechanism of action of bismuth subsalicylate in treating diarrhea is not fully understood, but it is thought to have antisecretory and antimicrobial effects 5, 6.
- The salicylate moiety of bismuth subsalicylate may exert antisecretory effects, while the bismuth and intestinal hydrolysis products may have direct antimicrobial effects 5.