bismuth subsalicylate, metronidazole, and tetracycline

Generic Name: bismuth subsalicylate, metronidazole, and tetracycline (bizz MUTH sub sah LIH sah late, me troe NI da zole, and tet ra SYE kleen)Brand Names: Helidac

What is bismuth subsalicylate, metronidazole, and tetracycline?

Bismuth subsalicylate is a mild antibiotic.

Likewise, metronidazole and tetracycline are also antibiotics. They fight bacteria in your body.

Together, bismuth subsalicylate, metronidazole, and tetracycline are used to treat Helicobacter pylori, a bacterial infection involved in causing stomach ulcers.

Bismuth subsalicylate, metronidazole, and tetracycline may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about bismuth subsalicylate, metronidazole, and tetracycline?Take all of the bismuth subsalicylate, metronidazole, and tetracycline that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated. Bismuth subsalicylate, metronidazole, and tetracycline is not approved for use by children. Children younger than 8 years of age should not use tetracycline because of its unfavorable effects on tooth and bone formation. Avoid taking dairy products, multivitamins, iron supplements, antacids, and laxatives within 2 hours of taking tetracycline. These products decrease the effectiveness of tetracycline. Tetracycline may decrease the effectiveness of birth control pills. Use a second method of birth control while taking this medication to be sure you are protected from pregnancy. Avoid prolonged exposure to sunlight. Tetracycline may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Do not drink alcohol or take alcohol-containing products while taking this medication and for 1 day after stopping therapy, unless approved by your doctor. Alcohol and metronidazole may cause nausea, vomiting, abdominal cramps, headache, and flushing.What should I discuss with my healthcare provider before taking bismuth subsalicylate, metronidazole, and tetracycline?

Before taking this medication, tell your doctor if you have

• kidney disease;

• liver disease;

• epilepsy or another seizure disorder; or

• an allergy to aspirin.

You may not be able to take bismuth subsalicylate, metronidazole, and tetracycline or you may require a lower dose or special monitoring if you have any of the conditions listed above.

Bismuth subsalicylate, metronidazole, and tetracycline is in the FDA pregnancy category D. This means that it is known to harm an unborn baby. Tetracycline may affect bone and tooth development. Do not take this medication without first talking to your doctor if you are pregnant. Tetracycline and metronidazole pass into breast milk. Tetracycline may affect bone and tooth development in a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. Children younger than 8 years of age should not receive tetracycline. It can cause permanent tooth discoloration, and it can affect growth.

How should I take bismuth subsalicylate, metronidazole, and tetracycline?

Take bismuth subsalicylate, metronidazole, and tetracycline exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Chew and swallow the bismuth subsalicylate tablets.

Swallow (don't chew) one each of the metronidazole and tetracycline pills.

To prevent heartburn and damage to the esophagus, be sure to take each dose (especially the bedtime dose) with a full glass of water (8 ounces).

Take all 4 pills four times daily with meals and at bedtime.

Do not take dairy products, iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours of taking tetracycline. These products reduce the effectiveness of tetracycline. Take all of the bismuth subsalicylate, metronidazole, and tetracycline that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated. Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

Skip the missed dose and take your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor. If more than 4 doses in a row have been missed, contact your doctor.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a bismuth subsalicylate, metronidazole, and tetracycline overdose include nausea, vomiting, diarrhea, slow breathing, ringing in the ears, fever, a fast heartbeat, confusion, numbness or tingling, and seizures.

What should I avoid while taking bismuth subsalicylate, metronidazole, and tetracycline?Avoid taking dairy products, multivitamins, iron supplements, antacids, and laxatives within 2 hours of taking tetracycline. These products decrease the effectiveness of tetracycline. Avoid prolonged exposure to sunlight. Tetracycline may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Do not drink alcohol or take alcohol-containing products while taking this medication and for 1 day after stopping therapy, unless approved by your doctor. Alcohol and metronidazole may cause nausea, vomiting, abdominal cramps, headache, and flushing.

Bismuth subsalicylate, metronidazole, and tetracycline side effects

If you experience any of the following serious side effects, stop taking bismuth subsalicylate, metronidazole, and tetracycline and seek emergency medical attention:

• an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

• a severe headache;

• vision changes;

• confusion;

• liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue);

• blood problems (fever, fatigue, easy bruising or bleeding);

• severe diarrhea; or

• seizures.

If you experience any of the following less serious side effects, continue to take your medication and talk your doctor.

• nausea, vomiting, or diarrhea;

• metallic taste in mouth;

• sensitivity to the sun;

• dark "furry"; tongue, black tongue, or swollen tongue;

• vaginal yeast infection;

• numbness or tingling;

• dizziness or decreased co-ordination;

• decreased appetite; or

• dark stools.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Bismuth subsalicylate, metronidazole, and tetracycline Dosing Information

Usual Adult Dose for Helicobacter pylori Infection:

524.8 mg bismuth subsalicylate (chewable), metronidazole 250 mg, and tetracycline 500 mg orally four times daily for 14 days with meals and at bedtime. This therapy should be accompanied by a histamine-2 antagonist approved for the treatment of acute duodenal ulcer. The metronidazole tablet and the tetracycline capsule should be swallowed whole with a full glass of water (8 ounces).

What other drugs will affect bismuth subsalicylate, metronidazole, and tetracycline?

Do not take the following drugs within 2 hours of taking bismuth subsalicylate, metronidazole, and tetracycline because they will decrease the effectiveness of tetracycline:

• cholestyramine (Questran) or colestipol (Colestid);

• antacids containing aluminum or magnesium such as Tums and Rolaids;

• minerals such as iron, zinc, calcium, and magnesium, which are found in dairy products (milk, cheese, etc.) and over-the-counter vitamin and mineral supplements.

Before taking bismuth subsalicylate, metronidazole, and tetracycline tell your doctor if you are taking any of the following medicines

• anticoagulants such as warfarin (Coumadin). This medicine may have an increased effect when taken with bismuth subsalicylate, metronidazole, and tetracycline, and bleeding could result.

• penicillin and cephalosporin antibiotics. These may have a decreased effect and an infection could worsen.

• birth control pills. Their effectiveness may be decreased, resulting in pregnancy.

• disulfiram (Antabuse). A two week period should elapse between therapy with disulfiram and metronidazole.

• cimetidine (Tagamet, Tagamet HB). This medication may increase the effects of metronidazole leading to side effects.

• lithium (Lithobid, Eskalith, others). Metronidazole may increase the effects of lithium leading to side effects.

• phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton). These medications may make metronidazole ineffective.

• diabetes medicines, aspirin, probenecid (Benemid), and sulfinpyrazone. These medicines may be affected by bismuth subsalicylate.

Drugs other than those listed here may also interact with bismuth subsalicylate, metronidazole, and tetracycline. Talk to your doctor before taking any prescription or over-the-counter medicine.

Where can I get more information?

• Your pharmacist has additional information about bismuth subsalicylate, metronidazole, and tetracycline written for health professionals that you may read.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.08. Revision Date: 4/12/2009 4:42:33 PM.