capsules, or in liquid form it is available in 1mg/5mL or 1mg/7.5mL. Dosing for adults (12 years
and older) with acute or chronic diarrhea is 4mg initially with 2mg given after each loose stool.
A person should not exceed 8mg/day for OTC use and 16mg/day for RX use. In children 9-11
years old (30-47kg), 2mg is the initial dose with 1mg after each loose stool, not to exceed 6mg in
24 hours. In children 6-8 years old (24-30kg), 1mg initially is given, with 1mg given after each
loose stool, not to exceed 4mg in 24 hours. In children 2-5 years old (13-20kg), the initial dose is
1mg with 0.1mg/kg given after each loose stool, not to exceed 3mg in 24 hours. All individuals
should discontinue use and seek medical advice if symptoms do not resolve within two days.
The second type of drug used to treat diarrhea is bismuth compounds. This class is used
to protect gastric mucosal erosions as well as being approved for use with diarrhea. The
prototype for this class is bismuth subsalicylate, which is commonly known as Pepto-Bismol,
Pink Bismuth, or Kaopectate. Their mechanism of action is unclear, but it acts by binding and
absorbing toxins and inhibit intestinal prostaglandin and chloride secretion (Smith, 2020). It
decreases the flow of fluids into the bowel and reduces inflammation in the intestine (
Bismuth
Subsalicylate: MedlinePlus Drug Information
, n.d.). Bismuth subsalicylate is absorbed poorly
and distributed in the gut. It is minimally metabolized and excreted in the urine. Indications for
this drug include diarrhea, heartburn, nausea, indigestion, gas, and upset stomach.
Contraindications of its use include hypersensitivity, and if you are already taking aspirin this
should be used cautiously. It also may impair absorption of tetracyclines. Bismuth subsalicylate
should not be used with children under three, especially if they have just received their
immunizations for varicella or influenza, because salicylate has been shown to possibly cause
Reye’s Syndrome (Smith, 2020). This drug is pregnancy risk C and should be used with caution.
The expected outcome is to relieve the symptoms of diarrhea. There are few adverse effects
