Pepto-Bismol (bismuth subsalicylate)

Bismuth subsalicylate is the main ingredient in Pepto-Bismol. This medicine is used for heartburn and acid reflux, indigestion, diarrhoea and feeling sick (nausea).

It works by forming a protective coating in your stomach, the lower part of your food pipe and your gut.

Pepto-Bismol comes as tablets and a liquid that you swallow. You can buy it from pharmacies and shops.

Most adults and young people aged 16 years and over can take Pepto-Bismol.

Do not take this medicine if you are pregnant or breastfeeding.

Pepto-Bismol is not suitable for some people. To make sure this medicine is safe for you, tell your doctor or pharmacist if you have:

• ever had an allergic reaction to bismuth subsalicylate or any of the other ingredients in Pepto-Bismol or Pepti Calm
• ever had an allergic reaction to aspirin or any other medicine
• diabetes
• gout
• a rare inherited condition called phenylketonuria where you cannot have aspartame – the chewable tablets contain aspartame
• have a blood clotting disorder

Pepto-Bismol liquid and tablets both contain a colouring called amaranth. Some people can have an allergic reaction to amaranth.

A single dose of Pepto-Bismol is either:

• 30ml of liquid
• 2 tablets

If you need to, repeat this dose every 30 to 60 minutes. Do not take more than 8 doses in 24 hours.

You can take Pepto-Bismol with or without food.

Chew the tablets or let them dissolve on your tongue.

If you're taking the liquid, shake the bottle, then use the measuring cup that comes with the medicine to make sure you get the right amount. If you do not have a cup, ask your pharmacist for one. Do not use any other cup as it will not measure the right amount.

If you're taking Pepto-Bismol for diarrhoea, make sure you drink plenty of fluids to avoid dehydration.

You can take Pepto-Bismol for up to 2 days. Do not take it for more than 2 days as this will increase your risk of getting side effects.

If your symptoms are no better or are getting worse after 2 days, contact your doctor.

• you have severe diarrhoea and a high temperature or stomach pain
• you have blood or mucus in your poo

Go to 111.nhs.uk or call 111

Taking too much Pepto-Bismol can increase the risk of side effects, including feeling or being sick, feeling confused, dizzy or tired, deafness, or ringing or buzzing in your ears.

• you take more than the recommended dose of Pepto-Bismol

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the Pepto-Bismol packet or leaflet inside it, any remaining medicine, and any other medicines you take.

You're unlikely to get any side effects from Pepto-Bismol if you follow the instructions for taking it.

One common side effect is your poo or your tongue turning black. This is harmless.

This happens when bismuth (the active ingredient in this medicine) comes into contact with small amounts of sulphur in your saliva and digestive system. They combine to form bismuth sulfide, a black substance. As it slowly makes its way out of your body you may see black poo.

This side effect usually goes away when you stop taking the medicine but it may take several days.

If your tongue or your poo is still black after you've stopped taking Pepto-Bismol for several days, speak to your doctor or a pharmacist.

Tell your doctor or a pharmacist if you have any other side effects that bother you or do not go away.

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to Pepto-Bismol.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of Pepto-Bismol. For a full list see the leaflet inside your medicines packet.

Do not take Pepto-Bismol if you're pregnant as it might affect your baby, particularly if you take it regularly after 30 weeks of pregnancy.

You may find that you can treat indigestion without taking a medicine. It can help to:

• eat smaller meals and more often
• avoid fatty or spicy foods, and avoid alcohol and cigarettes
• prop your head and shoulders up when you go to bed, so your head is higher than your stomach
• avoid lying down immediately after eating

However, heartburn or indigestion are common during pregnancy. If these changes do not work, or if you would prefer to take a medicine, speak to your doctor or a pharmacist. They will be able to recommend the most suitable treatment for you and your baby.

Do not take Pepto-Bismol if you're breastfeeding.

If you do need a medicine, speak to you doctor or pharmacist who will be able to advise on other options that are more suitable.

There's no evidence to suggest that taking Pepto-Bismol reduces fertility in either men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Pepto-Bismol contains salicylates (also found in aspirin) and can affect some other medicines.

To make sure Pepto-Bismol is safe for you, tell your doctor or a pharmacist if you are taking:

• an anticoagulant – medicines that help to prevent blood clots
• tablets or other oral medicines for diabetes
• medicine for gout
• doxycycline or minocycline, or any other tetracycline antibiotics

If you're taking tetracycline antibiotics, leave a 2-hour gap before taking Pepto-Bismol.

It's safe to take paracetamol at the same time as Pepto-Bismol.

Do not take other painkillers, like ibuprofen or aspirin, with Pepto-Bismol without talking to your doctor or pharmacist first. This could cause side effects.

Do not combine different medicines for indigestion without asking a pharmacist or doctor for advice.

If Pepto-Bismol is not helping with your symptoms, speak to your doctor or a pharmacist. They may be able to recommend a different medicine.

It's not possible to say whether complementary medicines, herbal remedies and supplements are safe to take with Pepto-Bismol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.