Pepto Bismol Versus the World

Aug 13, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Twoallbeefpattiesspecialsaucelettucecheesepicklesonionsonasesameseedbun. This was in ads for McDonalds Big Mac in the 1980s. I am a sucker for a good slogan and this one has stuck. It is entirely possible I will be babbling that to a nurse in my care home long after I have forgotten the names of my children. Apparently Jim Delligatti, one of the earliest franchisees of McDonald'sfounder, Ray Kroc, invented the Big Mac in his Uniontown, Pa. restaurant and introduced it for 45 cents in 1967. The Big Mac quickly gained popularity and was introduced on the national U.S. menu in 1968. It still tastes good. So good slogan equals good burger. Does the same hold true for over the counter medicines?

Nausea, heartburn, indigestion, upset stomach, diarrhea. I really like these series of commercials for Pepto Bismol. They usually consisted of people dancing around, and grabbing their butts. The videos of the commercials are on YouTube. There are facebook sites dedicated to the slogan. Does Pepto Bismol live up to the hype?

Pepto Bismol contains bismuth subsalicylate. It has been shown to reduce sores in the stomach of animals. It even has been used in combination with antibiotics and other drugs to kill the bacteria H. pylori which we think causes some ulcers. It is not an antacid. It doesnt actual neutralize stomach acid. On the down side, it is in the same family of drugs as ASA. It can thin the blood, so it shouldnt be used by people on blood thinners. It can also give you a black tongue and black stool.

It isnt that that Pepto Bismol is bad. Its just that I dont recommend it for nausea, heartburn, indigestion, upset stomach or diarrhea. Here are the products I usually recommend in the pharmacy.

Nausea. Gravol or dimenhydrinate, is what I recommend most for nausea. It is inexpensive. It comes in many forms. It comes in tablets you swallow, long acting capsules, chewables for adults, chewables for kids, liquid for kids, and suppositories for adults and kids if the person really cant keep down pills. One problem with gravol is it does make people drowsy. There is a non-drowsy gravol. However, it doesnt have any dimenhydrinate in it. It contains ginger which I dont think is as good as dimenhydrinate for nausea.

Heartburn, Indigestion and upset stomach. I have two favorite recommendations: Ranitidine and Diovol. Ranitidine is called an H2 antagonist and it stops the acid pumps in your stomach from producing acid. Within the last couple of years we are now allowed to sell 150 mg tablets of ranitidine without a prescription. That is a very big dose and should control your stomach acid for at least 12 hours. The problem with ranitidine is it can take 15-30 minutes to start working. If I want heart burn relief quickly, I turn to Diovol tablets. They are chewable tablets that contain an antacid. Antacids actually neutralize the acid that is in the stomach. So they work quickly, but dont last that long.

Diarrhea. Imodium or loperamide is hands down the best medication available without a prescription for diarrhea. It is so much better than pepto bismol or kaopectate. Loperamide is in the narcotic family, like codeine or morphine. If I gave you morphine, it would kill your pain, make you drowsy and make you constipated. Loperamide wont effect your pain. It wont make you drowsy, but it will make you constipated. So it takes a side effect of the narcotic pain killers and turns it into a beneficial effect when we give it to someone with diarrhea.

Nausea. Heartburn. Indigestion. Upset Stomach. Diarrhea. Is still a good a slogan. And Pepto Bismol is the only product I know that at least helps all those conditions. But it isnt the best product for those conditions. What about twoallbeefpattiesspecialsaucelettucecheesepicklesonionsonasesameseedbun. Maybe no product is as good as its slogan. Lately McDonalds Angus Burger with Bacon and Cheddar has been tasting really good.

As always if you have any questions or concerns about these or other products, ask your pharmacist.


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