Can you take Tums and Pepto Bismol together

Tums and Pepto Bismol together

Tums vs Pepto Bismol basic facts

Tums is a brand name for over-the-counter supplement containing antacid calcium carbonate and sugar sucrose. It is used as an antacid for relieving the symptoms of acid indigestion, heartburn, indigestion (sour stomach) or gas such as stomach upset and burning chest pains. It can also be used as a daily calcium supplement.

Tums products on the market are: Tums Extra, Tums Chewy Delights, Tums Freshers, Tums Regular, Tums Ultra, Tums Kids, Tums Smoothies, and Children’s Pepto.

Pepto-Bismol is a brand name for over-the-counter medication containing bismuth subsalicylate as an active ingredient. It used for the treatment of temporary discomforts of gastrointestinal tract such as: diarrhea, upset stomach, nausea, indigestion, and heartburn. Bismuth subsalicylate can be also used for the prevention of traveler’s diarrhea and for the treatment of Helicobacter pylori infection of gastrointestinal tract as a part of a quadruple drug therapy that also contain two antibiotics, and either of antagonist of histamine H2 receptor or inhibitor of a proton pump. Bismuth subsalicylate has also other therapeutic benefits in the body including anti-bacterial, anti-inflammatory and anti-secretory actions.

Other products on the market containing bismuth subsalicylate are: Kaopectate, Kaopectate Extra Strength, Maalox Total Relief, Pepto-Bismol Maximum Strength and other.

How does Tums and Pepto Bismol work in the body

Bismuth subsalicylate is antacid and antidiarrheal agent that is used for relieving many gastro-intestinal symptoms but it also has many other actions in the body. It can: protect irritated tissues by coating them and by reducing the expulsion of fluids into the digestive system, stimulate absorption of fluids and electrolytes, as a salicylate it can reduce inflammation of GIT through inhibition of prostaglandin synthesis and it can reduce the hypermotility of the stomach. Bismuth subsalicylate can be also used as an antibacterial agent by binding the toxins that are produced produced by E. coli. It also contains bactericidal properties.

Calcium carbonate has antacid properties that work by neutralizing hydrochloric acid in gastric secretions. This process can increase the pH value that may also inhibit the action of pepsin. It also has cytoprotective properties by increasing the bicarbonate ions and prostaglandins. Calcium carbonate may also be used as a nutritional supplement or for the treatment of hypocalcemia. Calcium may be a good protection against renal calculi formation by chelating with oxalate and preventing its intestinal absorption.

Can patients take Tums with Pepto Bismol

Patients can take Tums and Pepto-Bismol together since there are no interactions between them. Together they work well and they are safe for short term use. However, prolonged use can lead to problems.

Both medicines work primarily by coating the stomach tissue to help acid effects. With long term use the normal (good) bacteria in the gastrointestinal tract can be depleted and abnormal (bad) bacteria can overgrow in. Also long term use of Pepto-Bismol can cause intestinal tract discoloration along with elevated toxic levels of bismuth. So, patients always need to consult their doctors or pharmacists first before they take these drugs together. It is not a good idea to take any medication, unless it is needed.

The table below shows the incidence of side effects after Tums and Pepto-Bismol administration in recommendable doses. This incidence can be significantly increased if these drugs are taken together for a long term and in high doses.


Side effects

Frequency Not Defined Flatulence, Anorexia, Constipation, Hypercalcemia, Nausea, Vomiting, Hypophosphatemia, Milk-alkali syndrome, Diarrhea, Abdominal pain, Melena, Upper respiratory tract infection, Asthenia, Discolored tongue, Dizziness, Stool abnormality, Sinusitis, Insomnia, Paresthesia, Gray-black stool, Muscle spasm, Tinnitus

Special precautions and warnings during Tums and Pepto-Bismol administration:

  • Before taking calcium carbonate, patients need to tell their doctor or pharmacist if they are allergic to it or if they have any other allergies.
  • They should not use Pepto-Bismol if they are allergic to aspirin or any other nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, diclofenac, celecoxib)
  • They shouldn’t use Pepto-Bismol if they already use aspirin or any other salicylate medicine.
  • They should also consult their doctor or pharmacist if they have: high calcium levels, or stomach or intestinal blockage, kidney disease such as kidney stones before using Tums.
  • Some products may contain aspartame, so patients with phenylketonuria or any other condition that requires restriction of aspartame intake should consult their doctor or pharmacist about using this drug safely.
  • Patients should tell their doctor if they are pregnant, before using these medications. Salicylates use during pregnancy has been associated with serious adverse effects on the fetus; therefore use of bismuth subsalicylate during pregnancy should be avoided. These medications may pass into breast milk. Nursing mothers should avoid these medications.
  • If patients have bleeding problems (such as hemophilia), black or bloody stools, active bleeding ulcer, Von Willebrand disease they shouldn’t use Pepto-Bismol.
  • Bismuth subsalicylate should be used cautiously in patients who are on methotrexate (Trexall) therapy. It is known that in the body bismuth subsalicylate is broken down to salicylic acid which is known to increase methotrexate blood levels. Patients at high risk are: elderly patients, patients on high-dose methotrexate therapy, and patients with reduced kidney function.
  • Pediatric patients should not be given Pepto-Bismol for 6 weeks after receiving the varicella-zoster virus live vaccine, because they are at high risk of developing a serious liver disease called Reye’s syndrome.
  • Pepto-Bismol can cause black tongue and black stool. It may also interfere with gastrointestinal radiographic tests.
  • Patients should be advised to limit intake of oxalate-rich foods such as: soy; green, leafy vegetables and animal protein, to avoid reduced absorption through calcium oxalate formation.

Information retrieved from:

Can you take Probiotics and Vitamins together”