Pepto-Bismol
Encyclopedia
Pepto-Bismol is an over-the-counter drug
Over-the-counter drug
Over-the-counter drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription...

 currently produced by the Procter and Gamble company in the United States of America and in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

 to treat minor digestive system upset. Its active ingredient is bismuth subsalicylate
Bismuth subsalicylate
Bismuth subsalicylate, with a nominal chemical formula of C7H5BiO4, It is a colloidal substance obtained by hydrolysis of bismuth salicylate . The actual structure is unknown and the formulation is only approximate. Recent evidence indicates that it is composed of a bismuth oxide core structure...

. The primary symptoms aided by Pepto-Bismol are nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

, heartburn
Heartburn
Heartburn, also known as pyrosis or acid indigestion is a burning sensation in the chest, just behind the breastbone or in the epigastrium...

, indigestion, upset stomach, diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

, and other temporary discomforts of the stomach and gastrointestinal tract. It has been nicknamed the pink stuff in various advertising campaigns.

Children should not take medication with bismuth subsalicylate while recovering from influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...

 or chicken pox, as epidemiologic evidence points to an association between the use of salicylate-containing medications during certain viral infections and the onset of Reye's syndrome
Reye's syndrome
Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing a lower than usual level of blood sugar . The classic features are liver damage, aspirin use and a viral infection...

. For the same reason, it is typically recommended that nursing mothers not use medication containing bismuth subsalicylate (such as Pepto-Bismol) because small amounts of the medication are excreted in breast milk and pose a theoretical risk of Reye's syndrome to nursing children.

Pepto-Bismol is made in chewable tablets and swallowable caplets, but is best known for its original formula which is a thick liquid. This original formula is a medium pink color with a strong wintergreen
Wintergreen
Wintergreen is a group of plants. Wintergreen once commonly referred to plants that continue photosynthesis throughout the winter...

 or cherry
Cherry
The cherry is the fruit of many plants of the genus Prunus, and is a fleshy stone fruit. The cherry fruits of commerce are usually obtained from a limited number of species, including especially cultivars of the wild cherry, Prunus avium....

 flavor.

Mechanism of action

Bismuth subsalicylate
Bismuth subsalicylate
Bismuth subsalicylate, with a nominal chemical formula of C7H5BiO4, It is a colloidal substance obtained by hydrolysis of bismuth salicylate . The actual structure is unknown and the formulation is only approximate. Recent evidence indicates that it is composed of a bismuth oxide core structure...

 (the active ingredient
Active ingredient
An active ingredient is the substance of a pharmaceutical drug or a pharmaceutical ingredient and bulk active in medicine; in pesticide formulations active substance may be used. Some medications and pesticide products may contain more than one active ingredient...

 in Pepto-Bismol and (modern) Kaopectate
Kaopectate
Kaopectate, known medically as bismuth subsalicylate, is an orally taken medication from Chattem, Inc. for the treatment of mild diarrhea. It is also sometimes used to treat indigestion, nausea and stomach ulcers...

) is used as an antidiarrheal
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

 and to treat some other gastro-intestinal diseases (oligodynamic effect
Oligodynamic effect
The oligodynamic effect was discovered in 1893 by the Swiss Karl Wilhelm von Nägeli as a toxic effect of metal ions on living cells, algae, molds, spores, fungi, viruses, prokaryotic and eukaryotic microorganisms, even in relatively low concentrations...

).
The means by which this appears to work is still not well documented. It is thought to be some combination of:
  • Retarding the expulsion of fluids into the digestive system by irritated tissues, by "coating" them.
  • Reducing inflammation/irritation of stomach and intestinal lining
  • Killing some bacteria that cause diarrhea

Side effects

Children are usually more sensitive to the effects of salicylates, especially if they have a fever or have lost large amounts of body fluid because of vomiting, diarrhea, or sweating.

The bismuth in this medicine may cause severe constipation in children. In addition, it can combine with trace amounts of sulfur in saliva and the gastrointestinal tract, blackening the user's tongue and stool. This condition is harmless and subsides within a few days.

In addition, Pepto-Bismol should not be used to treat nausea or vomiting in children or teenagers who have or are recovering from the flu or chickenpox, because there is circumstantial evidence of an association with Reye's syndrome
Reye's syndrome
Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing a lower than usual level of blood sugar . The classic features are liver damage, aspirin use and a viral infection...

.

History

Pepto-Bismol was invented in 1901 by a doctor in New York. It was originally sold as a remedy for infant diarrhea by Norwich Pharmacal Company under the name Bismosal: Mixture Cholera Infantum, changing to Pepto-Bismol in 1919, and transferring to Procter and Gamble with their 1982 acquisition of Norwich Eaton Pharmaceuticals.

Disaster usage

Pepto-Bismol is utilized in the treatment of birds inundated by crude oil. For example, birds coated with oil from the Deepwater Horizon disaster received forced gastric infusions of Pepto-Bismol in efforts to rid their intestinal tracts of oil ingested while preening feathers of the contaminant.
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