WARNING

Taking bismuth, metronidazole, and tetracycline together, often referred to as “triple therapy,” is a common treatment for Helicobacter pylori infection, which can cause stomach ulcers and other gastrointestinal issues. However, there are several risks associated with this treatment:

• Side Effects: Each medication can cause its own set of side effects. Bismuth can lead to blackening of the tongue and stools, metronidazole may cause nausea, metallic taste in the mouth, and tetracycline can increase sensitivity to sunlight and cause gastrointestinal upset.
• Drug Interactions: Combining these medications can increase the risk of drug interactions, potentially leading to adverse effects or reducing the effectiveness of one or more of the drugs.
• Antibiotic Resistance: Overuse or misuse of antibiotics like metronidazole and tetracycline can contribute to the development of antibiotic-resistant bacteria, making infections harder to treat in the future.
• Allergic Reactions: Some individuals may be allergic to one or more of these medications, leading to allergic reactions ranging from mild to severe.
• Gastrointestinal Upset: The combination of these medications can cause significant gastrointestinal upset, including nausea, vomiting, diarrhea, and abdominal pain.
• Secondary Infections: Broad-spectrum antibiotics like tetracycline can disrupt the balance of bacteria in the gut, potentially leading to secondary infections such as Clostridium difficile colitis.

It’s essential for patients to discuss these risks with their healthcare provider before starting triple therapy, and to closely monitor for any adverse effects during treatment.

Why is this medication prescribed?

Bismuth, metronidazole, and tetracycline are typically prescribed together for the treatment of Helicobacter pylori (H. pylori) infection, which is a common bacterial infection of the stomach and upper gastrointestinal tract. H. pylori infection can lead to various digestive issues such as gastritis, peptic ulcers, and even stomach cancer if left untreated.

How should this medicine be used?

Bismuth, metronidazole, and tetracycline (Helidac) comes as two chewable bismuth tablets, one metronidazole tablet, and one tetracycline capsule to take together by mouth. Bismuth, metronidazole, and tetracycline (Pylera) are available as oral capsules. For ten days (Pylera) or fourteen days (Helidac), it is often taken four times a day, with meals and before bed. Pay close attention to the directions on the label of your prescription and ask your pharmacist or doctor to explain anything you do not understand. Follow the directions on this medication exactly. Take it as directed by your doctor; do not take less or more of it.

Chew the bismuth tablet and consume it if you are also taking metronidazole, tetracycline, and bismuth (Helidac). In a full glass (8 ounces, or 240 milliliters), swallow the metronidazole tablet and the tetracycline capsule whole. Suck the entire capsules with a full glass of water (8 ounces [240 milliliters]) if you are taking bismuth, metronidazole, and tetracycline (Pylera). To avoid irritating your stomach and throat, it’s crucial to take the dose before bed with lots of fluids.

Take tetracycline, metronidazole, and bismuth at least one hour before or two hours after consuming calcium-containing foods or beverages, such as dairy products and juices and foods with added calcium.

Take this medication as prescribed even if you feel better. Don’t stop taking it without first consulting your physician. Antibiotic-resistant bacteria may develop in your infection and treatment may not be fully achieved if you stop using this medicine too soon or miss doses.

Request a copy of the product’s manufacturer’s instructions from your physician or pharmacist.

Other uses for this medicine

• Bismuth: It’s also used in over-the-counter products for treating diarrhea and upset stomach. Additionally, bismuth subsalicylate can help alleviate symptoms of indigestion and heartburn.
• Metronidazole: In addition to its use in treating bacterial infections like H. pylori, metronidazole is also used to treat certain parasitic infections and anaerobic bacterial infections.
• Tetracycline: Besides its role in treating bacterial infections, tetracycline is sometimes used to treat acne and other skin conditions caused by bacteria.

What special precautions should I follow?

Special precautions to follow when using bismuth, metronidazole, and tetracycline include:

• Allergies and Sensitivities: Inform your healthcare provider about any allergies or sensitivities you have to medications, especially if you have experienced reactions to bismuth, metronidazole, tetracycline, or other antibiotics in the past.
• Pregnancy and Breastfeeding: Consult with your healthcare provider if you are pregnant or breastfeeding before taking these medications, as they may have potential risks to the fetus or infant.
• Drug Interactions: Inform your healthcare provider about all other medications, supplements, and herbal remedies you are taking, as these can interact with bismuth, metronidazole, and tetracycline, potentially affecting their effectiveness or increasing the risk of side effects.
• Avoid Alcohol: Metronidazole should not be taken with alcohol or products containing alcohol, as it can cause a severe reaction leading to symptoms such as nausea, vomiting, headache, and rapid heartbeat.
• Complete the Course: Finish the full course of treatment prescribed by your healthcare provider, even if you start feeling better before completing the medication. Stopping antibiotics prematurely can contribute to antibiotic resistance and treatment failure.
• Side Effects: Be aware of potential side effects associated with these medications, such as gastrointestinal upset, allergic reactions, and interactions with other medications. Contact your healthcare provider if you experience any concerning symptoms while taking these medications.

Always follow your healthcare provider’s instructions and recommendations regarding the use of bismuth, metronidazole, and tetracycline, and do not hesitate to seek medical advice if you have any questions or concerns.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with bismuth, metronidazole, or tetracycline. However, it’s generally recommended to take tetracycline on an empty stomach, as food can interfere with its absorption. For metronidazole, taking it with food may help reduce gastrointestinal upset.

What should I do if I forget a dose?

If you miss a dose of bismuth, metronidazole, or tetracycline, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Bismuth, metronidazole, and tetracycline are often combined to form a treatment regimen for certain gastrointestinal conditions, particularly Helicobacter pylori infection, which is associated with peptic ulcers. Here are some potential side effects of each medication:

• Weakness
• Diarrhea
• Constipation
• Dark urine
• Loss of appetite
• Stomach pain
• Heartburn
• Metallic taste in the mouth
• Dry or sore mouth

If you have any of the following symptoms, stop taking this medication and call your doctor immediately:

• Numbness, pain, burning, or tingling in your hands or feet
• Headache
• Blurred vision
• Seizures
• Dizziness
• Difficulty speaking
• Problems with coordination
• Confusion or agitation
• Ringing in the ears
• Vaginal itching and/or discharge
• Fever, cough, sore throat, chills, or other signs of infection
• Bloody or tarry stools
• Nausea
• Vomiting
• Hives
• Rash
• Itching

It’s important to note that not everyone will experience these side effects, and some individuals may tolerate these medications well. However, if any side effects occur and persist or worsen, it’s essential to consult a healthcare professional. Additionally, certain medications may interact with these drugs, so it’s important to inform your healthcare provider about any other medications or supplements you are taking.

What should I know about storage and disposal of this medication?

Storage and disposal:

• Storage: Store these medications at room temperature away from moisture and heat. Follow any specific storage instructions provided on the medication packaging or by your pharmacist.
• Disposal: Dispose of unused or expired medications properly according to local regulations. Do not flush them down the toilet or pour them down the drain unless instructed to do so. Instead, take them to a medication take-back program or follow specific disposal instructions provided by your healthcare provider or pharmacist.

In case of emergency/overdose

• In Case of Emergency: If you suspect an overdose or experience severe side effects from bismuth, metronidazole, or tetracycline, seek immediate medical attention or contact your local poison control center.
• Overdose Symptoms: Symptoms of overdose may include severe nausea, vomiting, diarrhea, dizziness, confusion, seizures, and difficulty breathing. Prompt medical attention is essential in the event of an overdose.

What other information should I know?

• Follow Instructions: Always take these medications exactly as prescribed by your healthcare provider. Do not alter the dosage or frequency of use without consulting your healthcare provider first.
• Complete the Course: Finish the full course of treatment, even if you start feeling better before completing the medication. Stopping antibiotics prematurely can contribute to antibiotic resistance and treatment failure.
• Avoid Alcohol: Avoid consuming alcohol while taking metronidazole, as it can cause a severe reaction leading to symptoms such as nausea, vomiting, headache, and rapid heartbeat.
• Inform Healthcare Providers: Inform all healthcare providers involved in your care about all medications, supplements, and herbal remedies you are taking, including bismuth, metronidazole, and tetracycline.
• Monitor for Side Effects: Be vigilant for any side effects while taking these medications. If you experience any concerning symptoms, contact your healthcare provider for guidance.
• Regular Follow-up: Attend any follow-up appointments scheduled by your healthcare provider to monitor your response to treatment and address any concerns or questions you may have.

By following these guidelines and staying informed about the proper use, storage, disposal, and potential risks associated with bismuth, metronidazole, and tetracycline, you can help ensure safe and effective treatment. If you have any further questions or concerns, don’t hesitate to consult your healthcare provider or pharmacist for guidance.