Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations

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Generic Name

Bismuth subsalicylate

Trade Name

Kaopectate, Pepto-Bismol


Diarrhea, heartburn, indigestion, H. pylori associated ulcer


Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins.

Therapeutic Class

Antidiarrheal, antiulcer, antacid

Pharmacologic Class


Nursing Considerations

• Contraindicated in aspirin hypersensitivity
• Increase risk for impaction with geriatric and pediatric patients
• Monitor liver profile
• Bismuth may interfere with radiologic exams

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Hi guys, let’s talk about Bismuth Subsalicylate, more commonly known as Pepto Bismol. This is an oral medication, as you can see here, the bottle that I am sure a lot of us are familiar with. So when we talk about the therapeutic class and the pharmacologic class of a medication, remember that the therapeutic class is what the drug does in the body while the pharmacologic class is the actual chemical effect. So the therapeutic class of Bismuth Subsalicylate or Pepto-Bismol is it is an antidiarrhea anti-ulcer and an antacid. And the pharmacologic class is an absorbent. 

So how does Bismuth Subsalicylate work? Well, it stimulates the absorption of fluid and electrolytes in the intestinal wall. There’s a reduction of hypermotility of the stomach, and it binds to toxins. This medication is indicated for diarrhea, heartburn, indigestion, and H. pylori-associated ulcer. So some side effects that are important to mention, and a little bit interesting, are tongue discoloration, dark black stool, constipation, and sometimes anxiety. So let’s look at some important nursing considerations for Pepto Bismol. Monitor the patient’s liver profile. Bismuth Subsalicylate or Pepto Bismol is contraindicated in patients with aspirin hypersensitivity. There is an increased risk of impaction in older patients and in younger patients. So keep that in mind. It’s important to know that this medication may interfere with radiologic exams and patients should be taught to report constipation and aspirin sensitivity to their provider. So, guys, this is a true story because of the side effect of that black stool I was talking to you about, we had a patient once that ended up having a colonoscopy due to the black stool because it can create alarm in providers, all to realize that the patient had been taking Pepto Bismol regularly. 

So this was the reason for the black stool. So be sure to ask your patients about this if this occurs to them. So that’s it for Bismuth Subsalicylate or Pepto Bismol. Now go out and be your best self today and as always happy nursing.

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