Indigestion and heartburn are presently commonly experienced by more people in the US and globally. This has been attributed to various conditions, with the most common reason being dietary preferences. Individuals who do not consume food on time are also among those who more frequently experience indigestion and heartburn, apart from those who overeat. Medications, including prescription and OTC formulations are presently available to help alleviate the condition, and offer fast relief. Following subsections offer a detailed look at Pepto Bismol side effects to help users identify, prevent and mitigate undesirable effects of the medication.

Overview of Pepto Bismol

A branded formulation, belonging to the category of antidiarrheal and anti-inflammatory agents, the medication is medically known as Bismuth subsalicylate.  It is used for treating symptoms of conditions such as nausea and indigestion, apart from upset stomach. It is also used by individuals with diarrhea as well as for offering relief from other discomforts related to stomach and gastrointestinal tract issues. The medication is also used for treating infections linked to bacteria H. pylori. Travelers to various locations are often known to end up with diarrhea due to the local bacteria entering the system, and this is known as Traveler’s diarrhea. Pepto Bismol is also used in treating traveler’s diarrhea.

The antacid is known to deliver antibacterial and gastroprotective properties, and is known to be one of the oldest formulations. It has been in use for more than 100 years, since being originally used when handling cholera outbreaks. Its role in treating the conditions mentioned above began after FDA approval in 1939. While the actual mechanism of action of the medication is not known, the overall actions and properties help to understand how it delivers relief. The formulation is known as an insoluble complex comprising salicylic acid and trivalent bismuth, and it gets absorbed in the bloodstream after being taken orally.

This interacts with other compounds, and this interaction results in the formation of bismuth salts that possess bactericidal and antimicrobial activity. The outcomes are attributed to the property of these salts that prevent bacteria from binding and from developing on mucosal cells present in the stomach. The highlight of the medication is the absence of any effect on healthy gut flora. This action of preventing bacteria from binding, helps in the reduction of gastrointestinal inflammation and also helps in healing stomach ulcers. Additionally, the anti-inflammatory properties inhibit prostaglandins, which helps deliver significant relief from discomfort.

Available formulations, dosage and intake recommendations

The medication is presently available as oral liquid capsules, tablets, liquid, and as chewable tablets.  It is necessary to note that different formulations may have different strengths and it is necessary to note the difference in strengths and adjust the intake according to the recommended intake. The strength of the dosages is altered to deliver faster relief and this makes it necessary to seek the advice of a doctor and avoid self-medication.

Here is a quick compilation of the ideal dosage of Pepto Bismol for various conditions. It is necessary to note that this is only a compilation of ideal dosages and is not to be treated as recommended dosages. This is mainly for the purpose helping readers understand the maximum permitted dosages and the actual dosages may vary from individual to individual. It is best to seek medical advice regarding the dose, notwithstanding its classification as an OTC product.

Liquid form dosage

Pepto Bismol in liquid form comes in a 30 ml cup. This is essentially a single dose, and has been calculated to deliver around 525 mg of the formulation. Ideally, individuals are advised to take one such dose, once in every thirty minutes when looking for symptomatic relief from various conditions. This includes stomach upset, feelings of nausea, heartburn, and indigestion also.

When taken for treating diarrhea, it is advised to be taken in a similar manner – one dose in every thirty minutes.  However, it is extremely important to note that the maximum permitted doses should not exceed more than 08 doses in a day.

Chewable tablet dosage

The medication, as mentioned above is also available as chewable tablets. Two tablets comprise a single dose. The ideal dosage of the chewable tablets when treating diarrhea is one dose (of two tablets each) once in every thirty minutes. When treating nausea, indigestion or heartburn, the dosage is similar, one dose twice an hour. Chewable tablets also come with an upper limit in terms of maximum permitted dosage. Individuals are not to take more than sixteen tablets in a day.

Concentrated liquid form dosage

The medication is also available in a more potent or concentrated liquid form. This delivers the same amount of medication, but from a smaller quantity of intake.  The dosage is the same as that of the liquid form. For instance, in the liquid form mentioned above, 30 ml comprised a single dose, whereas in the concentrated liquid form, 15 ml comprised a single dose.

Possible Pepto Bismol side effects

All medications come with the possibility of undesirable effects, and Pepto Bismol is no exception. Unwanted outcomes of medications are mainly due to the mechanism of action or the properties of the compounds. The effects may not necessarily be the same for all users of medications; for instance, some may experience strong effects, while others may experience mild effects. It is also possible that some users may not experience any effects whatsoever. The actual intensity and duration of effects depend on various factors – the strength of the medication, the frequency of intake, the condition being treated, the duration of intake of the medication, the overall health of the patient, other existing health conditions and medications in use.

Mild or moderate effects are known to be more frequent in occurrence when compared with serious effects that may be rarely occurring. Similarly, mild effects are known to resolve naturally, without the need for treatment or any medical intervention. However, serious effects may require medical attention, and this may sometimes be necessary on an urgent basis, to prevent it from turning into an emergency. Here is a compilation of commonly known side effects of Pepto Bismol; this is not a complete or exhaustive compilation and is intended to only serve as a broad reference of the possible undesirable outcomes.

Commonly reported effects

Commonly reported effects include discoloration of stools, where the feces appear dark or black in color. Individuals may also experience a similar discoloration on the tongue.  This is not a cause for alarm and is a temporary outcome, and will resolve naturally, when the antacid is stopped.

Allergic reactions are possible

There is the possibility of allergic reactions, wherein individuals who are allergic to salicylate may end up experiencing allergies. It is possible to predict this outcome; any individual who has reported any allergies when on aspirin, is likely to experience allergies. This is because both the medications contain salicylate.

Other effects

Other effects that may be experienced include a ringing sensation in the ears. This could sometimes develop to hearing disabilities, and it is therefore necessary that patients discontinue the product if there is any change in hearing abilities.

In addition to this there is also the possibility of internal bleeding in the stomach or in the intestines. Indicative symptoms include cramps, traces of blood in stool, and vomit that appears like coffee grounds. This is a serious effect and requires discontinuation of the medication.


Children recovering from chicken pox, and the flu are not to take the product. Similarly, pregnant women and breastfeeding women are to seek medical advice before taking the product, to ensure that there are no undesirable outcomes.

Possible drug interactions of Pepto Bismol

In addition to the above Pepto Bismol side effects there is also the possibility of drug interactions with other medications or OTC formulations. Interactions are mainly due to the conflicting mechanism of actions of two or more medications or products. Unlike undesirable effects of medications that impact people differently, drug interactions are the same between two different medications or products. Interactions ore broadly classified into three different types. The first possibility of interactions is amplification of outcomes of either of the two products. In other words, the outcomes may be more than the expected outcomes, that may have been experienced if the medication was taken alone. The second interaction is a decrease in potency of either of the two medications or products. The third is aggravation of possible side effects, wherein the possible undesirable side effects of either or both the medications increase.

Possible remedial actions to counter the effects of interaction include replacement of either of the two conflicting medications or products, and this is determined on the basis of the importance of each medication. The second option is to modify the dosage and intake schedule in such a manner so as to increase the gap between the two conflicting products. Alternatively, the specialist may also decide to temporarily discontinue either of the two medications to ensure that there are no interactions. The following is a compilation of commonly reported interactions and there may be other interactions in addition to this.

Commonly reported interactions and precautions

Pepto Bismol is known to interact with blood thinners/anticoagulants. Similarly, as Pepto Bismol works like NSAIDs, there is the possibility of aggravation of effects of the NSAIDs. Individuals on medications to control bleeding disorders are to avoid Pepto Bismol, as there is a likelihood of aggravation of the bleeding. Patients on medications to treat gout, diabetes are also to seek medical advice before taking the medication as this could aggravate the condition.

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