Names and pronunciation
(bis′muth sub-sal-iss′uh-late) Bismatrol, Kaopectate, Kao-Tin, Peptic Relief, Pepto-Bismol, Pink Bismuth, Kaopectolin, K-Pek, Maalox Total Stomach Relief, Stomach Relief
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Drug reference
(bis′muth sub-sal-iss′uh-late) Bismatrol, Kaopectate, Kao-Tin, Peptic Relief, Pepto-Bismol, Pink Bismuth, Kaopectolin, K-Pek, Maalox Total Stomach Relief, Stomach Relief
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Func. class.: Antidiarrheal, weak antacid
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Chem. class.: Salicylate
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Do not confuse: Kaopectate/Kayexalate
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ACTION: Inhibits the prostaglandin synthesis responsible for GI hypermotility, intestinal inflammation; stimulates absorption of fluid and electrolytes; binds toxins produced by Escherichia coli
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USES: Relief of diarrhea, heartburn, indigestion, nausea, upset stomach
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CONTRAINDICATIONS: Chil- dren <3 yr, children with chickenpox, history of GI bleeding, flulike symptoms, hypersensitivity to product or salicylates, PUD Precautions: Pregnancy, breastfeeding, geriatric patients, gout, diabetes mellitus, bleeding disorders, previous hypersensi- tivity to NSAIDs, Clostridium difficile– associated diarrhea when used with anti- infectives for Helicobacter pylori
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SIDE EFFECTS CNS: Confusion, twitching, neurotoxicity (high doses) EENT: Hearing loss, tinnitus, metallic taste, blue gums, black tongue GI: Increased fecal impaction (high doses), dark stools, constipation, diarrhea, nausea HEMA: Increased bleeding time MISC: Reye’s syndrome
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INTERACTIONS Increase: toxicity—salicylates, metho- trexate Increase: effect of anticoagulants (PO), antidiabetics (PO) Decrease: absorption of tetracycline, qui- nolones, phenytoin; separate for ≥2 hr Drug/Lab Test Interference: radiographic studies of GI system
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DOSAGE AND ROUTES Antidiarrheal/gastric distress • Adult/adolescent: PO 524 mg (2 tab- lets or 30 mL) q30-60min as needed, max 8 doses/day; or 1050 mg (30 mL) hourly as needed, max 4 doses/day H. pylori • Adult/adolescent: PO 525 mg qid, max 4.2 g/24 hr; given with metroNIDAZOLE or tetracycline and acid-suppressive ther- apy × 14 days Traveler’s diarrhea (unlabeled) • Adult: PO 30 mL q30min (8×/day regular strength, 4×/day max strength)
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Available forms: Tablets 262 mg; chewable tablets 262 mg; liquid 262 mg/15 mL, 525 mg/15 mL
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Administer: • Increase fluids to rehydrate patient • Suspension: shake liquid before using; use measuring cup, syringe • Tablets can be chewed, dissolved in mouth; caplets to be swallowed whole with water
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Assess: • Diarrhea: bowel pattern before prod- uct therapy, after treatment • GI status: abdominal pain, nausea, heartburn, bowel sounds • Pregnancy/breastfeeding: avoid in pregnancy; do not breastfeed • Electrolytes K, Na, Cl if diarrhea is se- vere or continues long term; assess skin turgor, other signs of dehydration
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Evaluate: • Therapeutic response: decreased diar- rhea, absence of diarrhea when traveling; resolution of ulcers
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To chew, dissolve tablets in mouth; not to swallow whole; to shake liquid before using, maintain hydration • To avoid other salicylates unless di- rected by prescriber; not to give to chil- dren, possibility of Reye’s syndrome • That stools may turn black; that tongue may darken; that impaction may occur in debilitated patients • To stop use if symptoms do not im- prove within 2 days or become worse, or if diarrhea is accompanied by high fever • To separate quinolones, phenytoin, tetracyclines by ≥2 hr HIGH ALERT
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PHARMACOKINETICS PO: Onset 1 hr, peak 2 hr, duration 4 hr
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• Adult/adolescent: PO 524 mg (2 tab- lets or 30 mL) q30-60min as needed, max 8 doses/day; or 1050 mg (30 mL) hourly as needed, max 4 doses/day H. pylori
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• Adult/adolescent: PO 525 mg qid, max 4.2 g/24 hr; given with metroNIDAZOLE or tetracycline and acid-suppressive ther- apy × 14 days Traveler’s diarrhea (unlabeled)
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