Patients should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.

Patients who are candidates for taking bismuth subsalicylate should inform their physician of any history of unusual or allergic reaction to any salicylates, including aspirin. Patients taking either bismuth subsalicylate or loperamide should report all other allergies, including those to foods, preservatives or dyes, to their physician.

Use of bismuth subsalicylate may cause increased bleeding in patients who use anticoagulants (medications that help prevent the blood from clotting). Patients who take oral antidiabetic medications may find that bismuth subsalicylate causes blood sugar levels to fall too low. Patients who take any pain medicines or anti-inflammatory medicines that contain salicylates may experience increased incidences of side effects associated with those drugs. Bismuth subsalicylate may also hamper the effectiveness of antibiotics such as tetracyclines.

Medicines that may interact poorly with bismuth subsalicylate include the gout medications probenecid and sulfinpyrazone. Other drugs that may interact poorly with bismuth subsalicylate include the following analgesic, anti-inflammatory, anti-arthritic or antipyretic medications:

• Diclofenac
• Diflunisal
• Fenoprofen
• Flurbiprofen
• Ibuprofen
• Indomethacin
• Ketoprofen
• Naproxen
• Piroxicam
• Sulindac
• Suprofen

Patients who use loperamide may be at risk for severe constipation if they are also taking narcotic pain medicine. In addition, loperamide can worsen diarrhea caused by taking certain antibiotics such as erythromycins and tetracyclines.