Kaopectate vs. Pepto-Bismol

What is Kaopectate? What is Pepto-Bismol?

Kaopectate is oral medicine that is used for mild diarrhea treatment. It can be also used for the treatment of indigestion, stomach ulcers and nausea. It displays anti-inflammatory action because of salicylic acid and it can also act as an antacid and mild antibiotic.

Over time the active ingredients have varied, and they are now different between the United States and Canada. The original Kaopectate active substances were kaolinite and pectin. In the U.S. the active ingredient is now bismuth subsalicylate which is the same as in Pepto-Bismol. In Canada, Kaopectate active ingredient is attapulgite.

Pepto-Bismol is a Brand name for antidiarrheal, antacid and anti-bacterial drug that contains bismuth subsalicylate as an active ingredient. Commonly known as a “pink bismuth” it is used for the treatment of temporary stomach and gastrointestinal tract discomforts such as indigestion, diarrhea,  heartburn and nausea.

kaopectatepepto bismol

Are Kaopectate and Pepto-Bismol same thing?

Yes they are. They are direct parallels that contain bismuth subsalicylate as active ingredient. The only difference is in Brand name. However, Kaopectate for Canadian market contain attapulgite – magnesium aluminium phyllosilicate as active ingredient.   Pepto-Bismol and Kaopectate are primarily used for the treatment of diarrhea, though it may also relieve upset stomach, heartburn, and other gastrointestinal symptoms.

How does  Kaopectate and Pepto-Bismol work?

Bismuth subsalicylate is an active ingredient in Kaopectate and Pepto-Bismol products. This drug displays anti-inflammatory action because it contains salicylic acid and also has antacid and mild antibiotic properties. The exact mechanism of antidiarrheal actions has not been established.

General opinion is that antidiarrheal actions can is not only exceeded by stimulating absorption of electrolytes and fluids across the intestinal wall but also, when bismuth subsalicylate is hydrolyzed to salicylic acid, due inhibition prostaglandin synthesis responsible for intestinal hypermotility and inflammation.

In addition, bismuth subsalicylate can also bind toxins produced by Escherichia coli. Both, bismuth subsalicylate and its metabolized products, bismuth hydroxide and bismuth oxychloride are believed to have bactericidal action. As an antacid, bismuth has weak antacid properties.

Bismuth subsalicylate may cause a black stools and black tongue in some patients, when it gets in interaction with trace amounts of sulfur in saliva and gastrointestinal tract. This discoloration is harmless and temporary.

Until 2003, attapulgite was used as active ingredient in Kaopectate, before that product was reformulated with bismuth subsalicylate. Attapulgite is a magnesium aluminium phyllosilicate which only occurs in a type of clay soil typical for the Southeastern United States.

When it is used as a medicine, it binds toxic substances and acids in the digestive tract reducing fluid loss from diarrhea and contributing to firmer stools. For that reason, it has often been used in antidiarrheal medications. In Canada, McNeil Consumer Healthcare continues to market kaopectate using attapulgite as the active ingredient.

Kaopectate and Pepto-Bismol uses

Kaopectate and Pepto-Bismol are used for treating and relieving the symptoms of upset stomach, heartburn, nausea, indigestion, diarrhea or symptoms associated with eating or drinking too much. It may be also used to decrease the number of intestine movements and make the stool firmer.

Kaopectate and Pepto-Bismol have following indications:


Traveler’s Diarrhea


Helicobacter pylori Infection

Kaopectate and Pepto-Bismol available dosages and forms

  • Kaopectate is available in the form of: oral suspension 600mg and 750mg, oral liquid 600mg, chewable tablets 300mg and oral tablets 600 and 750mg.
  • Pepto-Bismol is available in the form of: oral suspension 525 mg/30mL, oral liquid 17.6mg/ml, chewable tablet 262mg and tablet 262 and 525mg.

Kaopectate and Pepto-Bismol side effects

  • Nausea (12%)
  • Diarrhea (7%)
  • Abdominal pain (7%)
  • Melena (3%)
  • Upper respiratory tract infection (2%)
  • Constipation (2%)
  • Anorexia (2%)
  • Vomiting (2%)
  • Asthenia (2%)
  • Discolored tongue (2%)
  • Headache (2%)
  • Dyspepsia (2%)
  • Dizziness (2%)
  • Stool abnormality (1%)
  • Duodenal ulcer (1%)
  • Sinusitis (1%)
  • Taste perversion (1%)
  • Flatulence (1%)
  • GI hemorrhage (1%)
  • Pain (1%)
  • Insomnia (1%)
  • Anal discomfort (1%)
  • Paresthesia (1%)
  • Anxiety very rare <1%
  • Confusion <1%
  • Depression <1%
  • Tinnitus <1%
  • Weakness <1%
  • Gray-black stool <1%
  • Impaction <1%
  • Muscle spasm <1%
  • Neurotoxicity (rare) <1%

Can you buy Kaopectate and Pepto-Bismol over the counter?

Yes, both products are available over the counter.

Kaopectate and Pepto-Bismol price

  • Kaopectate 236ml average price is about $5.00
  • Pepto-Bismol 473ml average price is about $5.40

Who should not take Kaopectate and Pepto-Bismol?

There are no absolute contraindications for Kaopectate and Pepto-Bismol use, but some patients have to tell their doctor if they are using these drugs as they can interact with some medical conditions and medicines.

Pregnant women, or woman who are planning to become pregnant, or are breast-feeding should tell their doctor if they are using these drugs. Kaopectate and Pepto-Bismol may possibly cause harm to a fetus. Women who have passed their twentieth week of pregnancy should avoid taking Kaopectate or Pepto-Bismol.

Patients who have allergies to these medicines, or any other medicine, foods, or other substances should talk with their doctors before using these products.

Patients with diabetes, fever, mucus in the stool, gout, arthritis, inflammation of the stomach, Kawasaki syndrome, chickenpox, the flu, kidney problems, or joint problems or those with dehidratation.

Patients who have a history of stroke or aneurysm in the brain should talk with their doctors first before using these drugs.

What medicines can interact with Kaopectate and Pepto-Bismol?

Insulin, valproic acid or methotrexate may interact with bismuth subsalicylate, so its actions and side effects may be increased.

Angiotensin-converting enzyme inhibitors such as lisinopril or sulfinpyrazone may interact with bismuth subsalicylate. Effectiveness of these drugs may be decreased after bismuth subsalicylate use.

Salicylates such as aspirin may interact with bismuth subsalicylate so the risk of side or toxic effects may be increased

Bismuth subsalicylate may increase the risk of bleeding during anticoagulants therapy.

How should Kaopectate and Pepto-Bismol be used?

  1. Kaopectate and Pepto-Bismol may be taken with or without food.
  2. Patients should not take tetracyclines such as doxycycline within 2 hours before or after taking Kaopectate and Pepto-Bismol.
  3. Patients should use Kaopectate and Pepto-Bismol exactly as directed on the package, unless it is instructed differently by the doctor.
  4. Drinking extra fluids while taking Kaopectate and Pepto-Bismol is recommended.

Kaopectate and Pepto-Bismol dosage

Adult dose for dyspepsia: 524 mg orally on every 30 to 60 minutes if it is needed. Patients should not to exceed 8 doses in 24 hour period. Alternatively, 1048 – 1050 mg may be given orally every hour not to exceed 4 doses in 24 hour period.

Adult dose for Traveler’s Diarrhea: 524 mg orally on every 30 to 60 minutes if it is needed. Patients should not to exceed 8 doses in 24 hour period. Alternatively, 1048 – 1050 mg may be given orally every hour not to exceed 4 doses in 24 hour period. Patients should use until diarrhea stops but not longer than 2 days. Bismuth subsalicylate may be also useful in the prevention of traveler’s diarrhea during periods of risk. The duration of use for traveler’s diarrhea should not exceed approximately 3 weeks.

Adult dose for Diarrhea: 524 mg orally on every 30 to 60 minutes if it is needed. Patients should not to exceed 8 doses in 24 hour period. Alternatively, 1048 – 1050 mg may be given orally every hour not to exceed 4 doses in 24 hour period.

Adult dose for Helicobacter pylori Infection: 524 mg orally 4 times a day.

Pediatric dose for Non-specific diarrhea:

  • <3 years: use with caution
  • 3 to 6 years: 87 mg every 30 minutes to 1 hour as needed.
  • 6 to 9 years: 175 mg every 30 minutes to 1 hour as needed.
  • 9 to 12 years: 262 mg every 30 minutes to 1 hour as needed.

Pediatric dose for Chronic Infantile Diarrhea:

  • 2 to 24 months: 44 mg every 4 hours
  • 24 to 48 months: 87 mg every 4 hours
  • 48 to 70 months: 175 mg every 4 hours

Pediatric Dose for Helicobacter pylori Infection:

  • Dosage for children with Helicobacter Pylori is not well established, the following doses have been used in conjunction with ampicillin and metronidazole.
  • Younger than10 years: 262 mg four times a day for six weeks
  • Older than 10 years: 524 mg four times a day for six weeks

What if I overdose Kaopectate and Pepto-Bismol?

If patients overdose Kaopectate or Pepto-Bismol, they have to contact 1-800-222-1222 Poison Control Center, their local poison control center or emergency room immediately.

Serious symptoms of poisoning may include: coma, seizures, confusion, dizziness, dehydration, nausea, vomiting, ringing in the ears, unusual bleeding or bruising.

What if I missed the dose of Kaopectate and Pepto-Bismol?

Patients should take the missed dose as soon as they remember. They should skip the missed dose if it is almost time for next scheduled dose. They should not take extra dose to make up the missed dose.

Can I drink alcohol while taking Kaopectate and Pepto-Bismol?

It is never a good idea to take alcohol during some medicine treatment. There is no direct interaction or real negative outcome related with combination of Kaopectate or Pepto Bismol with alcohol. Because alcohol can cause digestive-tract problems, worsening the diarrhea, dyspepsia or gastric ulcers, patients should not drink alcohol while having these problems and if taking Kaopectate or Pepto-Bismol.

Pepto-Bismol and Kaopectate for Dogs and Cats

Pepto-Bismol and Kaopectate is not considered to be safe for cats. These drugs should only be used by a veterinarian in cases when medical intervention is necessary.

However, dogs with diarrhea and stomach discomforts can be treated with Pepto-Bismol and Kaopectate.

If dog has problems with bleeding or blood thinners drugs such as NSAIDs are given to the dog, you should be very careful when giving Pepto-Bismol or Kaopectate to the dog. In such cases, it’s probably a good idea to ask veterinarian first before giving Pepto-Bismol or Kaopectate to your dog.

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