How to administer Pepto Bismol (Bismuth subsalicylate) liquid?

How to Administer Pepto Bismol Liquid

For adults and children 12 years and over, administer 30 mL (2 tablespoons) of Pepto Bismol liquid every 30-60 minutes as needed, not exceeding 8 doses (240 mL total) in 24 hours. 1

Standard Dosing Regimen

For Diarrhea

• Adults and children ≥12 years: 30 mL every 30 minutes OR 60 mL every hour as needed 1
• Maximum: 8 doses (240 mL) in 24 hours 1
• Duration: Use until diarrhea stops but not more than 2 days 1
• Children <12 years: Consult a physician before use 1

For Upset Stomach, Heartburn, Indigestion, or Nausea

• Adults and children ≥12 years: 30 mL every 30-60 minutes as needed 1
• Maximum: Same 8-dose limit applies 1

Administration Technique

Oral Administration

• Measure the dose accurately using the dosing cup provided with the product 1
• Shake the bottle well before each use to ensure proper suspension of bismuth subsalicylate 2
• Administer the liquid directly by mouth 1
• Encourage patients to drink plenty of clear fluids to prevent dehydration, especially when treating diarrhea 1

Timing Considerations

• For H. pylori treatment (when used as part of quadruple therapy): Administer 30 minutes before meals, four times daily 2
• For acute symptoms: Can be taken without regard to meals 1
• Peak plasma salicylate levels occur 0.5-3 hours after ingestion 3

Special Administration Scenarios

Via Enteral Feeding Tube (If Necessary)

While the liquid formulation is already in solution, if administration via feeding tube is required:

• Flush the tube with at least 30 mL of water before and after medication administration 2
• Use appropriate ENFit-standard syringes to prevent misconnection errors 2
• Administer medications individually, never mixing with other drugs 2
• Consult with a pharmacist before administering through enteral tubes 2

Important Clinical Considerations

Absorption and Pharmacokinetics

• The salicylate component is extensively absorbed (>90%) from the gastrointestinal tract 4
• Bismuth absorption is minimal (<0.005%) 4
• After a 60 mL dose, approximately 500 mg of salicylate is recovered in urine, representing 95% of the salicylic acid content 3
• Salicylate kinetics become nonlinear with multiple dosing (every 6 hours for 5 doses) 3

Safety Parameters

• Peak plasma salicylate concentrations after standard dosing (60 mL) average 40 micrograms/mL, well below toxic levels 3
• Extended dosing for up to 6 weeks produces mean blood bismuth concentrations of 16.1 ng/g, considerably below neurotoxic levels 4
• The maximum daily dose (240 mL containing 4.2 g bismuth subsalicylate) results in salicylate levels well below toxicity thresholds 4

Critical Warnings and Contraindications

Do Not Use In:

• Children under 12 years without physician consultation 1
• Patients with salicylate allergy 1
• Patients taking anticoagulants (due to salicylate content) 4

Monitor For:

• Salicylate toxicity symptoms, especially with concurrent aspirin or NSAID use 4, 3
• Black discoloration of tongue or stool (benign and expected) 4
• Tinnitus or hearing changes (may indicate salicylate toxicity) 4

Common Pitfalls to Avoid

• Do not exceed 8 doses in 24 hours - this is a hard limit to prevent salicylate accumulation 1
• Do not use for more than 2 days for diarrhea without medical evaluation 1
• Do not assume the liquid form eliminates absorption concerns - the salicylate component is still extensively absorbed 4, 3
• Do not forget to account for salicylate content when patients are taking other salicylate-containing medications 4, 3
• Avoid in patients with renal impairment without dose adjustment consideration, as salicylate is renally excreted 3