Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination (patient information)

# IMPORTANT WARNING
Metronidazole can cause cancer in laboratory animals. However, it is very important to heal ulcers. Talk to your doctor about the risks and benefits of using this combination containing metronidazole in the treatment of your ulcers.

# Why this medication is prescribed
Bismuth subsalicylate, metronidazole, and tetracycline combination is used to treat duodenal ulcers. It fights infection by Helicobacter pylori bacteria, which often occurs with ulcers. Treating this infection keeps ulcers from coming back. It usually is used in combination with other ulcer medicines.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# How this medication should be used
Bismuth subsalicylate, metronidazole, and tetracycline combination comes as four pills: two pink, round, chewable tablets (bismuth subsalicylate), one white tablet (metronidazole), and one pale orange and white capsule (tetracycline). It usually is taken four times a day at meals and bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take this medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Chew and swallow the bismuth subsalicylate tablets. Swallow the metronidazole tablet and tetracycline capsule whole with a full glass of water (8 ounces). Avoid taking this medication with dairy products or milk. Take the bedtime dose with plenty of fluid to prevent irritation of your throat and stomach.
Continue to take this medication even if you feel well. Most people will take it for 14 days. Do not stop taking it without talking to your doctor.

# Special Precautions
Before taking bismuth subsalicylate, metronidazole, and tetracycline combination:
- tell your doctor and pharmacist if you are allergic to bismuth subsalicylate, metronidazole (Flagyl), aspirin or salicylates, tetracycline, or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially oral contraceptives and medications that contain aspirin, antibiotics, or anticoagulants ('blood thinners') such as warfarin (Coumadin), and vitamins.
- tell your doctor if you have or have ever had kidney, blood, liver, or Crohn's disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. This medication may make oral contraceptives less effective. Use a different form of birth control while taking it. If you become pregnant while taking this medication, call your doctor immediately. Tetracycline can cause birth defects and may harm nursing babies.
- remember not to drink alcoholic beverages while taking this medication and for at least 1 day after treatment is finished. Metronidazole causes severe vomiting and illness when taken before or after drinking alcohol.
- plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. This medication may make your skin sensitive to sunlight.

# What to do if you forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you miss more than four doses, call your doctor.

# Side Effects

## Minor Side Effects
Bismuth subsalicylate, metronidazole, and tetracycline combination may cause side effects. Darkening of the tongue and stool is temporary and harmless. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- blurred vision
- dizziness
- upset stomach
- diarrhea
- constipation
- loss of appetite
- stomach discomfort

## Severe Side Effects
If you have any of the following symptoms, stop taking this medication and call your doctor immediately:
- numbness in your hands or feet
- seizures
- confusion or agitation
- ringing in the ears
- bloody, black, or tarry stools
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Other information
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to this medication.
Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Helidac