Pepto-Bismol

Uses

Peptocid is used for indigestion, gastric fullness, bloating, belching, growling stomach, sour stomach and diarrhea.

Pepto-Bismol is also used to associated treatment for these conditions: Diarrhoea, Dyspepsia, Flatulence, Heartburn, Helicobacter Pylori Infection, Nausea, Traveler's Diarrhea, Upset stomach, Belching, Gastrointestinal fullness

How Pepto-Bismol works

The exact mechanism of bismuth subsalicylate is not fully understood. Bismuth subsalicylate is an insoluble complex that constitutes salicylic acid and trivalent bismuth. Once orally administered, bismuth subsalicylate hydrolyzes in the stomach into bismuth oxychloride, which is minimally absorbed into the bloodstream, and salicylic acid, which is almost completely absorbed. Bismuth interacts with other anions and compounds, such as hydrochloric acid, bicarbonate, phosphate, and hydrogen sulfide, in the gastrointestinal tract to form bismuth salts such as bismuth oxychloride, bismuth subcarbonate, bismuth phosphate, and bismuth sulfide. Bismuth salts possess bactericidal and antimicrobial activity, mainly by preventing bacteria from binding and growing on the mucosal cells of the stomach. It has no effects on normal gut flora. By preventing bacteria from binding to mucosal cells, bismuth subsalicylate prevents intestinal secretion and fluid loss, promotes fluid and electrolyte reabsorption, reduces gastrointestinal inflammation, and promotes the healing of pre-existing ulcer in the stomach. Salicylic acid from dissociated bismuth subsalicylate adds to the anti-inflammatory actions of bismuth salts by inhibiting the cyclooxygenase enzyme and limiting the formation of prostaglandin, a pro-inflammatory mediator. Bismuth subsalicylate exhibits cytoprotective and demulcent activity, which makes it an effective drug in peptic ulcer disease. It blocks the adhesion of H. pylori to the gastric epithelial cells and blocks the bacteria's enzyme activities, including phospholipase, protease, and urease.

Dosage

Pepto-Bismol dosage

12 years and above: 30 ml at a time.Dose can be repeated after 1-2 hours if necessary. Daily maximum intake should not exceed 8 doses.Less than 12 years: Please contact with physician.

Side Effects

Black stool and black tongue are common with use of Peptocid. Peptocid should not be used if black stool and black tongue are severe or persist for more than 2 days.

Toxicity

Lowest Lethal Dose (LDLo) in humans is 700 mg/kg. LD₅₀ in rats is 1200 mg/kg via oral route, 542 mg/kg via intraperitoneal route, and 980 mg/kg via subcutaneous route.

Overdose of bismuth subsalicylate over an extended period of time and consequently, bismuth toxicity, can lead to blackening of the tongue and teeth, fatigue, mood changes, deterioration of mental status, and neurotoxicity. Other signs and symptoms include impaired cognition, tremors, lethargy, somnolence, insomnia, delirium, myoclonus, seizures, depressed mood, anxiety, and a depressed mood. Salicylate toxicity can occur from chronic bismuth subsalicylate use : it mostly occurs from ingestion of more than 150 mg/kg of salicylates (or >6.5 g of aspirin equivalent). As there are no specific antidotes for bismuth salicylate toxicity, overdose should be managed with supportive care, with or without decontamination with activated charcoal. Hemodialysis may be considered in more severe cases and with the presence of altered mental status and metabolic acidosis.

Precaution

Do not take with aspirin or other salicylates. Caution should be exercised by patients taking medicines for anti-coagulation, diabetes or gout.For elderly patients suffering from renal insufficiency, caution should be taken.

Interaction

There are no known drug interactions and none well documented.

Food Interaction

Volume of Distribution

There is no information available.

Elimination Route

Following oral administration, bismuth subsalicylate hydrolyzes into bismuth and salicylic acid in the stomach. Salicylic acid is almost completely absorbed in the small intestine and reaches plasma peak levels one to two hours after dosing. In one study involving healthy male subjects, oral administration of 60 mL Pepto-Bismol, a common over-the-counter product of bismuth subsalicylate, equivalent to 1050 mg of bismuth subsalicylate, resulted in the peak plasma concentration of salicylate of 40.1 μg/mL, with a time to peak concentration (T_max) of 1.8 hours.

Less than 1% of bismuth from bismuth subsalicylate is absorbed from the gastrointestinal tract into the systemic circulation. In one study, oral administration of 787 mg bismuth subsalicylate in the chewable tablet form for two weeks resulted in the mean trough blood bismuth concentration was 5.1 ± 3.1 ng/mL. In another study, the mean trough blood bismuth concentration ranged from five to 32 ng/mL following oral administration of 525 mg bismuth subsalicylate in the liquid suspension form.

Half Life

The terminal half-life of salicylic acid following a single oral dose of 525 mg bismuth subsalicylate is ranges from two to five hours. Bismuth has an intermediate half-life of 5 to 11 days and a terminal half-life of 21 to 72 days.

Clearance

The renal clearance of bismuth is 50 ± 18 mL/min.

Elimination Route

Following oral administration, salicylate dissociated from bismuth subsalicylate is excreted in the urine. Bismuth is primarily eliminated via urinary and biliary routes.

Pregnancy & Breastfeeding use

There are no adequate data concerning the use of Peptocid in pregnant women. Peptocid should be avoided during pregnancy and lactation.

Contraindication

Hypersensitivity to bismuth, aspirin, other salicylates, Infectious diarrhea, high fever, von Willebrand disease, hemorrhage, ulcer or Gl bleeding with black or bloody stool, hemophilia, chicken pox or influenza (risk of Reye syndrome); changes in behavior with nausea and vomiting may be early sign of Reye syndrome.

Acute Overdose

Bismuth intoxication may be present as an acute encephalopathy with confusion, myoclonic movements, tremor, dysarthria and walking and standing disorders. Bismuth intoxication may also cause gastrointestinal disturbance, skin reactions, discoloration of mucus membranes and renal dysfunction as a result of acute tubular necrosis. Treatments include gastric lavage, purgation and hydration. Overdose of Peptocid may also give symptoms of salicylate intoxication e.g. dizziness, tinnitus, sweating, nausea, headache. If symptoms occur, use of Peptocid should be avoided.

Storage Condition

Store in a cool (25 o C) and dry place.Keep out of the reach of children.Shake well before use.

Innovators Monograph

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