Bismuth subsalicylate is the active ingredient of many anti-diarrhea products. You should avoid it if you have gout.

Most products that contain bismuth subsalicylate carry warnings about gout. Salicylates are found in many plants, where they give beneficial protection against pests. Most famously, salicylates from willow was used to develop aspirin, though it is produced artificially now.

I mentioned salicylates in Beware Gout Cures You Do Not Need. That article lists many medicines that can cause gout, or make it worse.

Brands that use bismuth subsalicylate include:

  • Bismusal®
  • Kaopectate®
  • Peptic Relief®
  • Pepto-Bismol®
  • Pink Bismuth®
  • Stomach Relief®

Other brands may be available. Maalox is complicated, as some formulations include bismuth subsalicylate, but others do not. You must check the label. FDA warnings about certain Maalox formulations include:

Bismuth subsalicylate could interact with anticoagulants, hypoglycemic agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and other anti-inflammatory medica­tions. Medical conditions such as gout, stomach ulcer, kidney disease, and bleeding problems could become more problematic with the use of a salicylate-containing product.

Got Gout? Stop Pepto

In Canada, the Department of National Health and Welfare has warned against Pepto-Bismol and similar products for gout sufferers[1]:

Products containing bismuth subsalicylate are sold in Canada under the following brand names: Pepto-Bismol liquid and tablets, Rawleigh Pleasant Relief and Watkins Settelz. A product called Stress Liquid may soon appear on the market. These products should be avoided by patients undergoing oral therapy with anticoagulants, sulfinpyrazone, probenecid, methotrexate or medications with high levels of salicylate

Pepto-Bismol is one of the most popular, so I have had a quick look at alternative anti-diarrheal agents. Most other popular choices use Loperamide HCl as the active ingredient. I have not found any studies to indicate that Loperamide HCl adversely affects gout. [see comments below]

Any gout sufferer needing anti-diarrhea products should always buy from a reputable pharmacist. You should ask for confirmation that the product does not contain bismuth subsalicylate.

What’s the best anti-diarrhea product you have found? Ask about bismuth subsalicylate in the gout forum.

Leave Pepto-Bismol and Gout to read more Gout Blog articles.


Stomach and Gout Comments

GoutPal visitor responses and associated research include:

Loperamide and Uric Acid

I reviewed the loperamide information following a question about Stomach Upset and Gout. Now, I’ve found an investigation that found loperamide has no effect on uric acid[2].

Blood and urine analyses, ECG, and ophthalmic examinations revealed no significant alterations during the study period from values and observations which were obtained before loperamide therapy. (Blood analysis: […] uric acid.)

For safety, you should confirm that loperamide is OK for you to take alongside your gout medications or other treatments.

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Pepto-Bismol and Gout References

  1. Henderson, I. W. “Warning against products containing bismuth subsalicylate.” Canadian Medical Association Journal 123, no. 9 (1980): 848.
  2. Galambos, John T., Theodore Hersh, Spalding Schroder, and Julius Wenger. “Loperamide: a new antidiarrheal agent in the treatment of chronic diarrhea.” Gastroenterology 70, no. 6 (1976): 1026-1029.

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