What is the Closest Thing to Pepto-Bismol? A Guide to OTC and Natural Alternatives

October 9, 2025 •

4 min read

According to a 2020 estimate, millions of Americans use bismuth subsalicylate products annually to relieve digestive distress. If you can't find the well-known pink liquid, knowing what is the closest thing to Pepto-Bismol and other alternatives is crucial for treating your symptoms effectively.

Quick Summary

The most direct alternatives to the brand-name medication contain the same active ingredient, bismuth subsalicylate. Other options depend on specific symptoms, such as loperamide for diarrhea or famotidine for heartburn. Natural remedies like ginger and the BRAT diet can also provide relief.

Key Points

Closest Match: Generic store brands and Kaopectate, which contain the same active ingredient, bismuth subsalicylate, are the most direct replacements.
Targeted Diarrhea Relief: For fast, specific relief from diarrhea, loperamide (Imodium A-D) is a powerful alternative that works by slowing gut movement.
Heartburn & Indigestion: For acid-related symptoms, H2 blockers like famotidine (Pepcid AC) or antacids like Tums are more targeted and effective alternatives.
Natural Remedies: Simple remedies such as the BRAT diet, ginger, or peppermint tea can help soothe mild upset stomachs and nausea.
Avoid in Children: Do not give bismuth subsalicylate to children or teenagers recovering from viral illnesses due to the risk of Reye's syndrome; use caution with dosage for all medications.
Common Side Effects: The temporary and harmless darkening of the tongue or stool is a normal side effect of bismuth subsalicylate.
Drug Interactions: Bismuth subsalicylate can interact with other medications, including certain antibiotics and blood thinners, so it's important to check before use.

For anyone experiencing digestive issues, Pepto-Bismol is a well-known, multi-symptom relief option. Its active ingredient, bismuth subsalicylate, provides relief from diarrhea, nausea, heartburn, indigestion, and upset stomach by reducing inflammation and slowing fluid movement. However, if the name brand isn't available, or you need a different type of treatment, several alternatives are available. Choosing the right one depends on your specific symptoms and medical needs.

Direct Generic Alternatives: The Same Active Ingredient

The most straightforward substitute for Pepto-Bismol is a generic or store-brand version containing the exact same active ingredient: bismuth subsalicylate. These alternatives work in the same way and provide identical relief for a similar range of symptoms, including diarrhea, heartburn, and upset stomach.

Kaopectate: A popular brand that also uses bismuth subsalicylate as its active ingredient.
Store Brands: Most major pharmacies and grocery stores offer their own "Stomach Relief" or "Pink Bismuth" products, which are direct, often cheaper, equivalents to Pepto-Bismol.
Wonderbelly Multi-Symptom Relief: A newer, dye-free alternative that also uses bismuth subsalicylate and is marketed as a "clean medicine" option.

These products are available in liquid, chewable tablet, and caplet forms, just like the brand-name version, offering a comparable user experience.

Symptom-Specific Over-the-Counter Alternatives

If you are targeting a single symptom, other OTC medications may be more effective or better suited for your needs. Unlike Pepto-Bismol, which is a broad-spectrum treatment, these alternatives focus on a specific aspect of digestive distress.

For Diarrhea

Loperamide (Imodium A-D): This medication works differently than bismuth subsalicylate by slowing down the movement of fluids through the intestines. A 1990 study found that loperamide provided faster and more effective relief from acute nonspecific diarrhea than bismuth subsalicylate. It is important to note that loperamide is not recommended for children under 12.
Racecadotril: A newer alternative to loperamide for acute diarrhea, with some studies suggesting a superior safety and tolerability profile in children.

For Heartburn and Acid Indigestion

Famotidine (Pepcid AC): An H2 blocker that reduces the amount of acid produced by the stomach, making it more targeted for acid-related issues. It provides relief for heartburn and acid indigestion but does not treat diarrhea.
Calcium Carbonate (Tums): A classic antacid that neutralizes stomach acid on contact, offering very quick, but often short-lived, relief from heartburn and indigestion.
Proton Pump Inhibitors (PPIs) like Omeprazole (Prilosec OTC): These provide longer-lasting relief by blocking acid production, making them more suitable for chronic or persistent heartburn and GERD.

For Gas and Bloating

Simethicone (Gas-X): This medication specifically targets gas bubbles in the digestive tract, offering relief from bloating and pressure.

Natural and Lifestyle Alternatives

In some cases, or for milder symptoms, natural remedies can be effective. These can also be used in conjunction with medications (after consulting a healthcare provider) and involve simple dietary and lifestyle adjustments.

The BRAT Diet: Consisting of bananas, rice, applesauce, and toast, this diet includes bland, easily digestible foods that can help bind stool and settle an upset stomach.
Ginger: Known for its anti-nausea properties, ginger can be consumed as a tea, candy, or chew to help soothe an upset stomach.
Peppermint Tea: This can help relax stomach muscles and ease cramping and bloating. However, it should be avoided by individuals with heartburn, as it can relax the lower esophageal sphincter and allow acid to reflux.
Hydration: Replenishing fluids and electrolytes is essential, especially with diarrhea or vomiting. Clear fluids like water, broth, or electrolyte solutions are best.

Comparison of Key Stomach Relief Options


Feature	Pepto-Bismol (Bismuth Subsalicylate)	Imodium A-D (Loperamide)	Pepcid AC (Famotidine)
Primary Function	Coats, protects, and reduces inflammation; treats multiple symptoms	Slows down intestinal movement to reduce stool frequency	Reduces stomach acid production to treat acid-related issues
Key Symptoms	Diarrhea, nausea, heartburn, indigestion, upset stomach	Diarrhea	Heartburn, acid indigestion, GERD
Onset of Action	Relatively quick for coating action, but may take longer for full effect	Starts working within an hour	Starts working within an hour
Considerations	Contains salicylate (aspirin-like compound); temporary dark tongue/stool common	Potential for constipation and drowsiness; not for prolonged use	Generally well-tolerated, but doesn't address diarrhea
Child Use	Generally not recommended for children under 12 due to Reye's syndrome risk	Can be used in children as young as 2 years old, with physician guidance	Can be used in younger children under medical guidance

Important Safety Considerations

When using any medication, safety should be the top priority. All alternatives carry potential side effects and contraindications. Bismuth subsalicylate products should be avoided in children and teenagers recovering from viral illnesses due to the risk of Reye's syndrome. Temporary and harmless side effects of bismuth subsalicylate include darkening of the tongue and stool. It can also interfere with certain medications, including tetracycline antibiotics and blood thinners. If symptoms persist for more than 48 hours or worsen, seek medical attention immediately. For more information on drug interactions, consult a trusted resource like Drugs.com.

Conclusion

When seeking a replacement, the closest thing to Pepto-Bismol is a generic product with the same active ingredient, bismuth subsalicylate, like store-brand stomach relief or Kaopectate. However, the best alternative ultimately depends on your specific symptoms. For targeted diarrhea relief, loperamide (Imodium) is a potent option. For acid indigestion or heartburn, famotidine (Pepcid AC) or antacids are better choices. Milder cases may be managed with natural remedies like ginger or the BRAT diet. Always consider your primary symptoms, potential drug interactions, and any underlying health conditions before choosing an alternative, and consult a healthcare professional if unsure.

Frequently Asked Questions

The active ingredient in Pepto-Bismol is bismuth subsalicylate, which is what provides its multi-symptom relief for diarrhea, nausea, heartburn, indigestion, and upset stomach.

Yes, generic brands containing the same active ingredient and dosage strength, like GoodSense or Major Stomach Relief, are considered just as effective as the brand-name version.

For pure diarrhea control, Imodium (loperamide) is often faster and more effective, as it works by directly slowing down intestinal movement. Pepto-Bismol offers a broader range of relief for other stomach issues as well.

Bismuth subsalicylate products should not be given to children under 12 due to the risk of Reye's syndrome, a serious illness that can occur in those recovering from viral illnesses.

For heartburn and acid indigestion, a different class of medication like an H2 blocker (e.g., famotidine/Pepcid AC) or an antacid (e.g., Tums) would be a more targeted choice.

The harmless black discoloration of the tongue or stool is a temporary side effect of bismuth subsalicylate. It occurs when the bismuth reacts with sulfur in the mouth and digestive tract.

Natural alternatives include consuming ginger, peppermint tea, following the BRAT diet (bananas, rice, applesauce, toast), and staying properly hydrated.