What is Pepto-Bismol and Its Active Ingredient Bismuth Subsalicylate?

Pepto-Bismol (bismuth subsalicylate), commonly called the “pink stuff,” is a short-term antidiarrheal agent for adults and children 12 years of age and older. 

Pepto-Bismol contains bismuth sulfide and subsalicylate. Bismuth is a mineral with antacid, antibacterial, and antidiarrheal effects. Subsalicylate is a medication in the same drug class as aspirin, providing anti-inflammatory and analgesic (pain-relieving) properties.

Together, these two active ingredients work by:

• Decreasing the loss of fluids and electrolytes from the digestive tract

• Reducing intestinal inflammation

• Killing the germs that can cause diarrhea

• Counteracting excess gastric acid

• Relieving intestinal spasms

The active ingredient in Pepto Kids chewable tablets is calcium carbonate, which is an antacid used to treat heartburn, acid reflux, indigestion, and upset stomach in children younger than 12 years old. While Pepto-Bismol may work better to relieve diarrhea, Pepto Kids is safe to use in children younger than 12 since it doesn’t contain bismuth subsalicylate, a risk for Reye’s syndrome. Get your free Pepto-Bismol coupon now.

Common Pepto-Bismol Uses

Pepto Bismol can provide relief from digestive symptoms such as:

• Diarrhea 

• Upset stomach or indigestion due to overindulgence

• Nausea

• Heartburn

• Gas

• Burping or belching

• Bloating or fullness

• Traveler’s diarrhea

Pepto Bismol is also used as an alternative treatment for Helicobacter pylori (H. pylori), an infection linked to peptic ulcers and gastritis (stomach inflammation). Bismuth quadruple therapy includes two antibiotics, a proton pump inhibitor (PPI) and bismuth subsalicylate, and is considered a first-choice treatment for H. Pylori infection. 

Pepto-Bismol Forms

Pepto Bismol is available in many dosage forms, including a liquid and chewable tablet for children and adults who have trouble swallowing pills. 

Pepto Bismol Liquid 

The liquid form of Pepto Bismol comes in the original flavor bottles containing 115 milliliters (mL), 230 mL, and 480 mL, or cherry-flavored bottles containing 230 mL or  480 mL.

Pepto Bismol Chewable Tablets

Chewable tablets are available in two flavors: original (12, 24, or 48 tablets) and cherry (48 tablets). These are to be chewed or dissolved in the mouth.

Pepto Diarrhea Caplets 

Pepto Bismol caplets are to be swallowed with water (not chewed). They come in boxes of 24 caplets. 

Pepto Bismol To-Go Cherry Chewable Tablets 

These cherry-flavored Pepto Bismol tablets are packaged in a convenient travel size to relieve travelers' diarrhea. They are to be chewed or dissolved in the mouth.

Pepto Bismol LiquiCaps 

Pepto Diarrhea LiquiCaps are a convenient way to get relief from gastrointestinal symptoms on the go. They are to be swallowed with water (not chewed).

Pepto Bismol Extra Strength Liquid 

This is a form of extra-strong Pepto Bismol for fast relief from symptoms. It comes in 350 mL bottles in original and cherry flavors.

Pepto Bismol Kids Chewable Tablets Bubblegum

Bubblegum-flavored chewable tablets for kids come in a packaging of 24 tablets.

How Long Does It Take For Pepto Bismol To Work?

Pepto-Bismol usually works within 30-60 minutes to provide relief from nausea, heartburn, indigestion, upset stomach, and diarrhea. You can take another dose after 30-60 minutes if you do not feel better. The maximum number of doses of Pepto Bismol should not be more than 8 doses in 24 hours. Some factors can affect how quickly Pepto-Bismol works, such as:

Alcohol

Drinking alcohol can increase stomach acid production, irritate your stomach, and make your symptoms worse. It can, therefore, counteract some of the benefits of Pepto Bismol. In addition, alcohol can add to the dehydration caused by diarrhea. That’s why it’s best to avoid alcohol until your symptoms are better.

The liver plays a vital role in breaking down alcohol and Pepto-Bismol. Consuming alcohol while taking Pepto-Bismol can increase the risk of liver injury. 

Foods and Beverages

Eating spicy, acidic, or fatty foods can make indigestion worse. This can prevent Pepto- Bismol from providing quick relief. For the same reason, you should also avoid caffeinated beverages such as sodas, tea, coffee, and energy drinks.

Learn about what to eat when you have diarrhea.

Other Medications

Pepto-Bismol interacts with other drugs, including anticoagulants, anti-diabetes medications, certain antibiotics, and medications used to treat gout and arthritis. 

Give your healthcare provider a full list of your medications. Always check with your doctor before taking Pepto Bismol with other prescription drugs, over-the-counter indigestion medicines, dietary supplements, or herbal products.

Your provider may advise you to take Pepto-Bismol away from certain medicines to help the medications work properly. For example, you should take Pepto Bismol at least 2 hours away from tetracycline antibiotics.

Pepto-Bismol contains salicylates, which are also found in aspirin. Do not take other NSAIDs (nonsteroidal anti-inflammatory drugs), such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve), without talking to your doctor. Acetaminophen (Tylenol) is considered a safer choice when taking Pepto Bismol if there’s no concern for liver disease or injury.

Pepto-Bismol Dosage and Administration

Recommended Dosage for Adults and Children

• Pepto-Bismol Liquid: One dose is 30 mL.

• Pepto-Bismol Chewable Tablets: One dose is 2 tablets.

• Pepto-Bismol Caplets: One dose is 2 caplets.

• Pepto-Bismol LiquiCaps: One dose is 2 LiquiCaps.

• Pepto-Bismol Extra Strength Liquid: One dose is 15 mL in adults. Check the label for children’s dosage.

Recommended Dosing of Pepto-Bismol:

• For diarrhea or traveler’s diarrhea: 1 dose every 30 minutes or 2 doses every hour as needed. Repeat until the diarrhea stops. Stop taking Pepto Bismol and call your doctor if diarrhea continues after 2 days.

• For nausea, heartburn, indigestion, and upset stomach: 1 dose every 30 minutes as needed.

• Maximum dose: 8 doses in 24 hours.

Read the dosage instructions on the package carefully. Do not give Pepto-Bismol to children under 12 years of age without talking to a healthcare provider.

Bismuth subsalicylate is for short-term relief from stomach trouble. Do not take Pepto-Bismol to treat diarrhea caused by chronic conditions such as irritable bowel syndrome (IBS) without your doctor’s approval. 

Always use the dosing cup provided with Pepto-Bismol to measure liquid medicine. Do not use a regular household spoon from your kitchen - this can result in incorrect dosing.

One dose cup of Pepto-Bismol liquids is one dose. If you lose the dosing cup that came with Pepto Bismol, you can use any other dose measuring cup or syringe. One dose of Pepto-Bismol liquid is 30 mL for the original liquid and 15 mL for Pepto-Bismol Ultra Strength. 

Guidelines for Chewable Tablets and Caplets

Two LiquiCaps are one dose of Pepto Bismol for adults. However, you should give 1 LiquiCap per dose to children 10-14 years of age. Consult a healthcare provider before giving Pepto Bismol LiquiCaps to children under 10 years of age. 

Check the correct dose of Pepto Bismol Kids Chewable Tablets Bubblegum Flavor on the package. Do not give more than 3 tablets to kids between 2 and 5 years of age or 6 tablets to kids between 6 and 11 years of age in 24 hours. Do not use Pepto Bismol for more than 2 weeks unless advised by a doctor or pharmacist.

Potential Side Effects and Warnings

Common Pepto Bismol side effects include:

• Constipation

• Dark or black stool

• Black tongue or black hairy tongue

Rarely, Pepto Bismol (bismuth subsalicylate) can cause more serious side effects. You should seek medical advice if you have:

• High fever

• Diarrhea that lasts more than 2 days

• Severe vomiting

• Tinnitus (ringing in the ears)

• Signs of an allergic reaction (check with your doctor before you use Pepto Bismol if you have an aspirin allergy)

Reye’s Syndrome

Reye’s syndrome is a rare but serious condition that causes swelling in the brain and liver. It can occur at any age but is common in children and teenagers, especially after viral infections such as the flu or chickenpox. Aspirin use has been linked to Reye’s syndrome. 

Because Pepto Bismol has an active ingredient that is in the aspirin family, you should not give this medication to children or teenagers recovering from viral infections. Signs and symptoms of Reye’s syndrome include vomiting, drowsiness, confusion, convulsions, yellowing of the skin or eyes, flu-like symptoms, or loss of consciousness. 

Reye’s syndrome is an emergency. Seek emergency medical attention if your child develops these symptoms.

Contraindications

Pepto Bismol may not be safe for people with certain health conditions. Check with your doctor before taking this medicine if you have a history of stomach ulcers, bleeding problems, bloody or black stools, mucus in your stool, kidney disease, or fever. Also, talk to your doctor before taking Pepto Bismol if you are pregnant or breast-feeding.

Drug Interactions

Give your doctor a complete list of all your prescription medications, over-the-counter medicines, dietary supplements, and herbal products. Pepto Bismol can interact with anticoagulants (blood thinners), certain antibiotics, medications used to treat gout, arthritis, and diabetes, and other salicylates such as aspirin.

Common Questions and Concerns

How Quickly Does Pepto-Bismol Work?

Pepto Bismol usually works within 30-60 minutes. 

How Effective is Pepto Bismol for Diarrhea?

Pepto Bismol is an effective treatment for diarrhea and traveler’s diarrhea in adults and children 12 years of age and older. It can decrease the frequency of loose, watery stools. Pepto Bismol also provides relief from other digestive symptoms such as nausea, heartburn, burping, belching, and fullness.

How Many Doses of Pepto-Bismol Until It's Effective?

One or two doses of Pepto-Bismol are usually effective. You can repeat a dose of Pepto-Bismol after 30-60 minutes if your digestive symptoms persist after the first dose. Make sure you take no more than 8 doses in 24 hours. Call your doctor if your diarrhea lasts more than 2 days.

What Happens If You Take Pepto-Bismol 3 Days in a Row?

Taking Pepto-Bismol for 3 days in a row can increase your risk of side effects. Check with your doctor before taking this medicine for more than 2 days.

Do You Need to Take Pepto-Bismol with Food?

You do not need to take Pepto-Bismol with food. However, you should drink plenty of water to replace fluids lost with diarrhea and prevent dehydration.

Alternatives to Pepto-Bismol

Antacids

Antacids can provide relief from heartburn and indigestion. They contain ingredients such as calcium carbonate (Tums) or magnesium hydroxide and aluminum hydroxide (Milk of Magnesia, Maalox, Mylanta, others). These medications are available over-the-counter and relieve heartburn by neutralizing gastric acid. They work quickly, but their effects only last for a few hours. 

Antidiarrheals

Antidiarrheals stop or slow diarrhea but do not treat the underlying cause. Examples include loperamide (Imodium) and atropine/diphenoxylate (Lomotil).

Proton Pump Inhibitors (PPIs) 

Proton pump inhibitors reduce the amount of acid made by your stomach. They are available by prescription and over-the-counter (OTC). PPIs take longer to work than antacids, but their effects last longer. Examples of PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and others. 

H2 Blockers

H2 blockers or histamine antagonists also reduce the amount of gastric acid, but they work differently than PPIs. Examples include cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). They are available both over-the-counter and by prescription.

When to Consider Seeing a Healthcare Provider for Stomach Pain

Contact your healthcare provider for medical advice if you have severe stomach pain, diarrhea for more than 2 days, mucus in your stool, bloody stools, severe vomiting, or high fever. 

Call your doctor immediately or seek emergency medical attention in case of overdose symptoms. Call 911 if a person has collapsed, stopped breathing, had a seizure, or is not responding.

Lifestyle and Dietary Adjustments for Ongoing Digestive Health

The following lifestyle changes and dietary adjustments can boost digestive health:

• Eat a healthy, well-balanced diet that is rich in fresh fruits and vegetables, whole foods, fiber, and healthy fats.

• Stay well hydrated.

• Get regular exercise.

• Manage stress.

• Quit smoking. 

• Reduce alcohol consumption.

• Discuss with your doctor to see if taking gut-supporting supplements like prebiotics and probiotics may be beneficial for you.

References:

1. https://pepto-bismol.com/en-us/faq/dosage

2. https://pepto-bismol.ca/en-ca/article/faq

3. https://medlineplus.gov/druginfo/meds/a607040.html

4. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67006e82-870d-8d63-e053-2991aa0a02d1

5. https://pepto-bismol.ca/en-ca/products

6. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=673c45dc-84fd-5b45-e053-2a91aa0adea8&type=display

7. https://www.nhs.uk/medicines/pepto-bismol/common-questions-about-pepto-bismol/