Bismuth Compounds

What are bismuth compounds?

Bismuth compounds (brand names: Pepto-Bismol®, Equi-Phar®, Gastrocote®, Kaopectate®, others) are antidiarrheal and stomach protectants used to treat diarrhea and infections caused by the bacteria Helicobacter in dogs, cats, and other animals.

It is labeled to treat diarrhea in dogs, cats, horses, and cattle. Use to treat other conditions or in other species is off label (extra label). Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, they may be significantly different from those on the label.

How are bismuth compounds given?

• Bismuth compounds come in liquid suspension, tablet, and paste form.
• All forms are given orally (by mouth).
• Bismuth compounds may be given with or without food.
• Measure liquids carefully.
• Follow your veterinarian’s instructions on administering this medication carefully and give for the entire time prescribed by your veterinarian, even if your pet is feeling better.

This supplement should take effect within 1–2 days.

What if I miss giving my pet the medication?

If you miss a dose, give it as soon as you remember, and then wait the recommended time for the next dose, as prescribed by your veterinarian. Do not give the pet two doses at once.

Are there any potential side effects?

Bismuth compounds may cause the following side effects:

• Grey-black or green-black stool
• Constipation

Serious adverse reactions may occur. If any of the following signs develop, stop giving bismuth compounds and contact your veterinarian immediately:

• An allergic reaction such as irregular breathing, rash, fever, puffiness and swelling around the face

Drug sensitivities can develop over time with repeated exposure. Your pet may have no reaction after the first few doses, but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment.

This medication may interfere with certain diagnostic test results (e.g., X-rays). Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This short-acting medication should stop working within 24 hours, although effects may last longer in pets with kidney or liver disease.

Are there any risk factors for this medication?

DO NOT USE bismuth compounds in:

• Pets that are allergic to any component or similar medications (e.g., NSAIDs, Aspirin)
• Pets with stomach or intestinal ulcers

USE WITH CAUTION in:

• Pets that are pregnant or nursing
• Pets with bleeding disorders
• Pets that are debilitated
• Pets that are young
• Cats

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with bismuth compounds:

• Antacids
• Aspirin
• Certain blood pressure and cardiac medications (e.g., ACE inhibitors, loop diuretics, amlodipine)
• Corticosteroids
• Insulins
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Opioids
• Tetracycline and other antibiotics (e.g., ciprofloxacin)

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Follow your veterinarian’s directions for follow-up visits and diagnostics.
• At home, monitor for any abnormal changes. If any occur, discontinue the medication and contact your veterinarian.

How do I store bismuth compounds?

• Store the medication at room temperature 59°F–86°F (15°C–30°C).
• Protect from light and do not freeze.
• Keep the container out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet's weight and symptoms. Report any adverse effects to the FDA or Health Canada.