What is the alternative to Pepto-Bismol in Europe?

October 8, 2025 •

4 min read

In many European countries, the active ingredient in Pepto-Bismol, bismuth subsalicylate, is heavily restricted or not available over-the-counter due to regulatory concerns about its potential toxicity with prolonged use. This means that travelers asking, “What is the alternative to Pepto-Bismol in Europe?” will need to rely on a different, symptom-specific approach for stomach ailments.

Quick Summary

Travelers seeking stomach relief in Europe will find that Pepto-Bismol is not widely available due to ingredient regulations. European pharmacies offer various symptom-specific alternatives, such as antacids for heartburn, loperamide for diarrhea, and antiemetics for nausea, providing targeted relief for digestive discomfort.

Key Points

Restricted Ingredient: Pepto-Bismol's active ingredient, bismuth subsalicylate, is banned or heavily restricted in many European countries due to regulatory concerns.
Symptom-Specific Alternatives: In Europe, digestive issues are treated with specific medications for heartburn, diarrhea, or nausea, rather than a single all-in-one product.
Heartburn and Indigestion Remedies: Common alternatives include antacids like Gaviscon, Rennie (calcium carbonate), or Maalox, and PPIs such as Omeprazole.
Diarrhea Relief: Loperamide (Imodium) is the standard OTC anti-diarrheal, and Oral Rehydration Salts (ORS) are critical for preventing dehydration.
Nausea and Upset Stomach Options: Domperidone (Motilium) for nausea and various effervescent salts or herbal remedies for upset stomach are available, sometimes requiring a prescription.
Consult a Pharmacist: In European pharmacies, medications are often behind the counter; a local pharmacist can provide expert guidance on the right remedy.

Why Pepto-Bismol is Restricted in Europe

Pepto-Bismol's primary active ingredient is bismuth subsalicylate, a compound that functions as an antacid, anti-inflammatory, and antimicrobial agent. While it is a staple in the United States for treating a range of digestive issues, including nausea, heartburn, indigestion, upset stomach, and diarrhea, European regulations are more cautious. The concern stems from the potential for bismuth to be absorbed by the body, with high levels linked to neurotoxicity in rare cases. As a result, the product is either banned or restricted to prescription-only status in many European nations, forcing visitors to seek different remedies for their gastrointestinal woes.

Bismuth Subsalicylate vs. European Regulations

The difference in availability highlights a contrasting approach to over-the-counter (OTC) medication. In Europe, the focus is often on treating specific symptoms with targeted medications rather than a single 'cure-all' product. This means that a traveler who would reach for Pepto-Bismol at home for a combination of symptoms must instead identify their primary discomfort and choose a corresponding European remedy. A local pharmacist is an invaluable resource in this situation, as they are highly trained and can recommend the most suitable product.

Symptom-Specific European Alternatives

Instead of one single alternative, European pharmacies offer a range of medicines designed for specific conditions. Here is a breakdown of common symptoms and the available alternatives:

For Heartburn and Indigestion

Antacids: These are widely available and include brands like Gaviscon, Rennie (containing calcium carbonate), and Maalox. They work by neutralizing stomach acid. Gaviscon, for instance, forms a protective layer on top of stomach contents to prevent reflux.
Proton Pump Inhibitors (PPIs): For more persistent heartburn, OTC PPIs like Omeprazole (Nexium Control, Emazole) reduce the amount of acid the stomach produces.
Effervescent Powders: Products like Italy's Brioschi or Citrosodina use sodium bicarbonate and other ingredients to settle an upset stomach, offering a similar effervescent effect to Alka-Seltzer.

For Diarrhea

Loperamide: Known commonly as Imodium, this medication is the primary European alternative for controlling diarrhea and is generally more effective and faster-acting than bismuth subsalicylate for cramping. It works by slowing down intestinal motility. Loperamide is available over-the-counter in most countries for adults and children over 12.
Oral Rehydration Therapy (ORS): The most critical treatment for diarrhea, especially traveler's diarrhea, is preventing dehydration. ORS products like Dioralyte or generic rehydration salts are available in pharmacies and help restore lost fluids and electrolytes.
Probiotics: In some cases, pharmacists may recommend probiotics (Codex in Italy) to help restore a healthy gut flora imbalance caused by infection.

For Nausea and Upset Stomach

Domperidone: Products containing domperidone, such as Motilium, are used for treating nausea and vomiting in some countries, but often require a prescription.
Other Antiemetics: Other antiemetics like dimenhydrinate (Vomex) are also available over the counter in certain European nations.
Herbal Remedies: Plant-based medicines like Iberogast (available in Germany) and capsules containing peppermint and caraway oil (Gastropan) are sometimes used to regulate digestion and relieve symptoms like bloating and cramps.

European Alternatives Comparison Table


Symptom	Primary European Alternative	Active Ingredient	How It Works	Key Benefit	Restrictions	Availability
Heartburn	Gaviscon, Rennie, Maalox	Alginic Acid, Calcium Carbonate, Magnesium Carbonate, etc.	Neutralizes stomach acid and/or forms protective barrier.	Fast, targeted relief for reflux.	Generally none.	OTC
Indigestion	Effervescent Salts, Omeprazole	Sodium Bicarbonate, Omeprazole	Settles stomach and reduces acid production.	Comprehensive relief for persistent issues.	Omeprazole may take longer to work.	OTC
Diarrhea	Loperamide (Imodium)	Loperamide	Slows intestinal muscle contractions.	Quickly reduces the frequency of bowel movements.	Not for children under 12 or with bloody stool or fever.	OTC
Diarrhea (Hydration)	Oral Rehydration Salts (ORS)	Glucose, Sodium, Potassium	Replaces lost fluids and electrolytes.	Prevents dehydration, a key complication.	None.	OTC
Nausea	Domperidone (Motilium)	Domperidone	Blocks receptors in the brain's 'vomiting center.'	Specifically targets and reduces nausea.	May require a prescription or be restricted.	OTC (sometimes)

Navigating a European Pharmacy for Digestive Relief

For American tourists, a European pharmacy experience can be quite different. Medications are often kept behind the counter, and you must speak with a pharmacist to obtain them. This system ensures you get the right medication for your specific needs, but it requires being prepared to describe your symptoms clearly.

Tips for Travelers:

Be Specific: Instead of asking for a Pepto-Bismol equivalent, describe your symptoms: “I have heartburn” (bruciore di stomaco in Italian) or “I have diarrhea” (la diarrea in Spanish).
Trust the Pharmacist: European pharmacists are highly knowledgeable and a trusted source of advice. They can guide you to a suitable and safe treatment. They are used to dealing with tourists and can usually communicate in English.
Carry a Basic Kit: Many travelers bring a small supply of common OTC medications from home, including antacids or anti-diarrheals, for emergencies. However, it is essential to remember that European regulations are different, and what works at home might be more tightly controlled or unavailable abroad.
Stay Hydrated: For diarrhea, the most important treatment is oral rehydration therapy to replace lost fluids and electrolytes. This is a universal treatment and crucial for recovery.

Conclusion: A Symptom-Based Approach is Key

For anyone asking “what is the alternative to Pepto-Bismol in Europe?”, the answer lies not in a single replacement product but in a symptom-specific strategy. Since the bismuth subsalicylate in Pepto-Bismol is restricted, European pharmacies provide a robust range of alternatives, including targeted antacids like Gaviscon for heartburn, loperamide (Imodium) for diarrhea, and specific remedies for nausea. By understanding the specific symptoms and consulting a local pharmacist, travelers can find safe and effective relief for common digestive issues while abroad. This symptom-based approach ensures that the treatment is tailored to the problem, leading to a faster and more effective recovery. For mild cases, focusing on hydration and a bland diet, like the BRAT diet, is often the first and most recommended step.

This information is for general guidance and not a substitute for professional medical advice. Always consult a healthcare professional, especially if symptoms are severe or persistent.

Frequently Asked Questions

Pepto-Bismol's active ingredient, bismuth subsalicylate, is often banned or regulated differently in Europe. This is due to regulatory concerns over its potential neurotoxic effects at high doses and the European preference for symptom-specific treatments.

For heartburn and indigestion, common alternatives include antacids like Gaviscon, Rennie, or Maalox. For more persistent acid issues, products containing Omeprazole are often available over-the-counter.

The most widely used alternative for diarrhea in Europe is loperamide (brand name Imodium), which is effective at controlling symptoms. Oral rehydration salts are also crucial for staying hydrated.

No, there is generally no single medication available in Europe that acts as an all-in-one solution like Pepto-Bismol. Treatment is typically tailored to the specific symptom you are experiencing.

Yes, some medications for nausea, like domperidone (Motilium), may be available, though they sometimes require a prescription or consultation. Other remedies like effervescent salts can also help with stomach upset.

Yes, it is common in many European countries for over-the-counter medications to be stored behind the counter. You will need to speak with a pharmacist directly to purchase them.

While homemade oral rehydration solutions can be used in an emergency, it is safer to use commercially prepared oral rehydration salts (ORS) like Dioralyte, as they have precise proportions of salts and sugars. For severe dehydration or persistent symptoms, seek medical advice.