Pepto-Bismol Side Effects: Common, Severe, Long Term (2024)

Generic name: bismuth subsalicylate

Medically reviewed by Drugs.com. Last updated on Feb 17, 2024.

Note: This document contains side effect information about bismuth subsalicylate. Some dosage forms listed on this page may not apply to the brand name Pepto-Bismol.

Applies to bismuth subsalicylate: oral capsule liquid filled, oral suspension, oral tablet, oral tablet chewable.

Serious side effects of Pepto-Bismol

Along with its needed effects, bismuth subsalicylate (the active ingredient contained in Pepto-Bismol) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking bismuth subsalicylate:

In some patients bismuth subsalicylate may cause dark tongue and/or grayish black stools. This is only temporary and will go away when you Stop taking bismuth subsalicylate.

  • Anxiety
  • any loss of hearing
  • confusion
  • constipation (severe)
  • diarrhea (severe or continuing)
  • difficulty in speaking or slurred speech
  • dizziness or lightheadedness
  • drowsiness (severe)
  • fast or deep breathing
  • headache (severe or continuing)
  • increased sweating
  • increased thirst
  • mental depression
  • muscle spasms (especially of face, neck, and back)
  • muscle weakness
  • nausea or vomiting (severe or continuing)
  • ringing or buzzing in ears (continuing)
  • stomach pain (severe or continuing)
  • trembling
  • uncontrollable flapping movements of the hands (especially in elderly patients) or other uncontrolled body movements
  • vision problems

For Healthcare Professionals

Applies to bismuth subsalicylate: compounding powder, oral capsule, oral suspension, oral tablet, oral tablet chewable.

Nervous system

Rare (less than 0.1%): Myoclonic encephalopathy

Frequency not reported: Weakness, fatigue, depression, anxiety, irritability, insomnia, unsteady gait, motor incoordination, loss of memory, jerky movements, mental confusion, disorientation, difficulty in walking and speaking, tremor, myoclonic jerks, incontinence[Ref]

Nervous system toxicity is a common feature of bismuth toxicity. Bismuth toxicity is characterized by the insidious onset of weakness and fatigue, depression, anxiety, irritability, insomnia, unsteady gait, motor incoordination, loss of memory, and jerky movements. Acute toxicity may result in the development of mental confusion, disorientation, difficulty in walking and speaking, tremor, myoclonic jerks, and incontinence.

Myoclonic encephalopathy has occurred in patients who have ingested bismuth for several months to years, but the incidence is very rare. Recovery of patients from bismuth encephalopathy may take several months following discontinuation of use. Bismuth encephalopathy has generally been reported in patients ingesting salts other than subsalicylate.[Ref]

Other

Frequency not reported: Salicylism[Ref]

Salicylism has been reported in patients who chronically ingest bismuth subsalicylate. Common complaints include vertigo, diminished hearing, lethargy, CNS dysfunction, confusion, tinnitus, vomiting, and abdominal pain. Patients may present with respiratory alkalosis and metabolic acidosis, azotemia, and hypoprothrombinemia and platelet dysfunction. The elderly may be particularly vulnerable to the development of salicylism.[Ref]

Gastrointestinal

Very common (10% or more): Black stool

Common (1% to 10%): Black tongue

Frequency not reported: Nausea, vomiting[Ref]

Frequently asked questions

  • Can you give Pepto Bismol to kids?
  • Why does Pepto-Bismol turn your tongue black?
  • Does Pepto-Bismol help with diarrhea?
  • How long does it take for Pepto Bismol to work?
  • What causes black hairy tongue?
  • Pepto-Bismol - How long will your stool be dark for?
  • How to stop diarrhea - any medicine or remedy suggestions?
  • My stool has changed color. What does it mean?
  • Is using expired Pepto-Bismol a hazard or health risk?

More about Pepto-Bismol (bismuth subsalicylate)

  • Check interactions
  • Compare alternatives
  • Reviews (30)
  • Drug images
  • Latest FDA alerts (1)
  • Dosage information
  • During pregnancy
  • Support group
  • Drug class: antidiarrheals
  • Breastfeeding
  • En español

Patient resources

  • Pepto-Bismol drug information
  • Pepto-Bismol (Bismuth Subsalicylate Chewable Tablets)
  • Pepto-Bismol (Bismuth Subsalicylate Suspension)
  • Pepto-Bismol (Bismuth Subsalicylate Tablets)

Other brands

Kaopectate, Pink Bismuth, Peptic Relief, Bismatrol, ... +6 more

Related treatment guides

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  • Diarrhea
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  • Diarrhea, Chronic

References

1. Dipalma JR (1988) "Bismuth toxicity." Am Fam Physician, 38, p.244-6

2. Gorbach SL (1990) "Bismuth therapy in gastrointestinal diseases." Gastroenterology, 99, p.863-75

3. Hasking GJ, Duggan JM (1982) "Encephalopathy from bismuth subsalicylate." Med J Aust, 2, p.167

4. Jungreis AC, Schaumburg HH (1993) "Encephalopathy from abuse of bismuth subsalicylate (Pepto-Bismol)." Neurology, 43, p.1265

5. Weller MP (1988) "Neuropsychiatric symptoms following bismuth intoxication." Postgrad Med J, 64, p.308-10

6. Molina JA, Calandre L, Bermejo F (1989) "Myoclonic encephalopathy due to bismuth salts: treatment with dimercaprol and analysis of CSF transmitters." Acta Neurol Scand, 79, p.200-3

7. Bradley B, Singleton M, Po AL (1989) "Bismuth toxicity--a reassessment." J Clin Pharm Ther, 14, p.423-41

8. Supino-Viterbo V, Sicard C, Risvegliato M, Rancurel G, Buge A (1977) "Toxic encephalopathy due to ingestion of bismuth salts: clinical and EEG studies of 45 patients." J Neurol Neurosurg Psychiatry, 40, p.748-52

9. Malfertheiner P (1993) "Compliance, adverse events and antibiotic resistance in Helicobacter pylori treatment." Scand J Gastroenterol Suppl, 196, p.34-7

10. (1980) "Salicylate in pepto-bismol." Med Lett Drugs Ther, 22, p.63

11. DuPont HL (1987) "Bismuth subsalicylate in the treatment and prevention of diarrheal disease." Drug Intell Clin Pharm, 21, p.687-93

12. Bierer DW (1990) "Bismuth subsalicylate: history, chemistry, and safety." Rev Infect Dis, 12 Suppl 1, s3-8

13. Gordon MF, Abrams RI, Rubin DB, Barr WB, Correa DD (1994) "Bismuth toxicity." Neurology, 44, p.2418

14. Vernace MA, Bellucci AG, Wilkes BM (1994) "Chronic salicylate toxicity due to consumption of over-the-counter bismuth subsalicylate." Am J Med, 97, p.308-9

15. Sainsbury SJ (1991) "Fatal salicylate toxicity from bismuth subsalicylate." West J Med, 155, p.637-9

16. Cerner Multum, Inc. "UK Summary of Product Characteristics."

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circ*mstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

Pepto-Bismol Side Effects: Common, Severe, Long Term (2024)

FAQs

Pepto-Bismol Side Effects: Common, Severe, Long Term? ›

Less commonly, Pepto-Bismol can also cause tiredness, mood changes, or a blackening of your tongue or teeth. People have also experienced a ringing in the ear (tinnitus) from this medication. These less common side effects typically happen when you take large amounts of Pepto-Bismol or take it for a long time.

What are the long-term side effects of Pepto-Bismol? ›

Less commonly, Pepto-Bismol can also cause tiredness, mood changes, or a blackening of your tongue or teeth. People have also experienced a ringing in the ear (tinnitus) from this medication. These less common side effects typically happen when you take large amounts of Pepto-Bismol or take it for a long time.

Is Pepto-Bismol hard on your body? ›

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.

Can Pepto-Bismol cause heart palpitations? ›

Warnings. Improper use of this medication (overuse or abuse) may cause serious harm, such as fast/irregular heartbeat or death. Do not increase your dose, take it more often, or take it for longer than directed.

How to get Pepto-Bismol out of your system? ›

A few days after you stop using Pepto-Bismol, your tongue discoloration should go away on its own, so you don't really need to do anything. Pepto-Bismol is usually out of your system in one day, but it can take several days for the side effect to go away.

Can you take Pepto-Bismol indefinitely? ›

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.

Why is Pepto-Bismol illegal in France? ›

Over-the-counter medicine for traveler's diarrhea is regulated, too. Pepto-Bismol is not sold in France due to a health scare in the 1970s.

What does Pepto-Bismol do to your gut? ›

It works by protecting your stomach and the lower part of your food pipe from stomach acid. It is also a mild antacid, which helps reduce too much stomach acid and eases any discomfort. Pepto-Bismol comes as tablets and a liquid that you swallow.

What is bismuth toxicity? ›

In the clinic, depending on the administration time of bismuth, its toxicity can be roughly divided into acute and chronic exposures. Both exposure doses can cause neurotoxicity, gastrointestinal toxicity, nephrotoxicity, hepatotoxicity, and increased bismuth concentration in blood.

Who should not take Pepto-Bismol? ›

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.

Is anxiety a side effect of Pepto? ›

This is only temporary and will go away when you Stop taking bismuth subsalicylate.
  • Anxiety.
  • any loss of hearing.
  • confusion.
  • constipation (severe)
  • diarrhea (severe or continuing)
  • difficulty in speaking or slurred speech.
  • dizziness or lightheadedness.
  • drowsiness (severe)
Feb 17, 2024

Can Pepto cause toxic megacolon? ›

Atropine; Difenoxin: (Moderate) Diphenoxylate/difenoxin use may cause constipation; cases of severe GI reactions including toxic megacolon and adynamic ileus have been reported.

How much is too much Pepto-Bismol? ›

For diarrhea or upset stomach: Adults and teenagers—The usual dose is 2 tablespoonfuls every half-hour to one hour if needed. You should not take more than 16 tablespoonfuls of the regular-strength suspension or 8 tablespoonfuls of the concentrate in twenty-four hours.

Can you take Pepto everyday? ›

Don't take Pepto-Bismol for more than two days and avoid taking if you have health conditions like an aspirin allergy, if you're taking certain medications, or you are pregnant.

Should you not drink water after taking Pepto-Bismol? ›

You can eat and drink normally while taking Pepto-Bismol. However, it's best to avoid foods that seem to make your indigestion worse, like rich, spicy and fatty foods. Try to cut down on caffeinated drinks, such as tea, coffee, cola and energy drinks. Reduce or try to avoid alcohol.

How to avoid black tongue with Pepto? ›

Rinse Your Mouth: After taking Pepto Bismol, rinse your mouth thoroughly with water or a mild mouthwash to help remove any lingering medication residue and reduce the risk of discoloration.

Is it possible to take Pepto too often? ›

Is Pepto Bismol overdose possible? Overdose is possible, and toxic effects are most often due to the salicylate content. People who already take aspirin or other salicylates, the elderly, and people with kidney disease might be at higher risk for adverse effects.

Does bismuth accumulate in the body? ›

Bismuth accumulates in kidney, liver, spleen, bone (metaphysis), lung, heart, and muscle. Bismuth in bone is turned over very slowly, with a half–life of months to years.

When should you not use Pepto? ›

Who may not be able to take Pepto-Bismol
  1. ever had an allergic reaction to bismuth subsalicylate or any of the other ingredients in Pepto-Bismol or Pepti Calm.
  2. ever had an allergic reaction to aspirin or any other medicine.
  3. diabetes.
  4. gout.

What medications should not be taken with Pepto-Bismol? ›

Cautions with other medicines
  • 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.

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