What You Need to Know About the Three-Medicine Treatment for Stomach Ulcers

Has your doctor told you that your stomach ulcers are caused by a germ called H. pylori? Doctors often prescribe a special combination of three different medicines to clear this bacteria from your gut.

Because this treatment combines three powerful drugs, you need to follow your doctor's instructions very carefully. Let us walk through everything you need to know about taking this medicine safely and effectively.

What is this medicine?

Simply put, this combination medicine brings together bismuth subsalicylate, metronidazole, and tetracycline. Doctors prescribe it to treat ulcers in your stomach or the upper part of your small intestine. Most of these ulcers happen because of an H. pylori bacterial infection.

The main goal of this medicine combination is to destroy that bacteria or stop it from multiplying. Bismuth subsalicylate acts as a protectant and mild antibacterial agent, tetracycline is an antibiotic, and metronidazole is another powerful antibiotic. You might receive this treatment under the brand name Helidac or as a generic combination pack.

Sometimes, doctors may prescribe this medicine for other conditions not listed here. If you have questions about why you are taking it, ask your doctor or pharmacist right away.

Things to tell your doctor before taking this medicine.

Before you start taking this medicine, you must tell your doctor if you have any health conditions. Sharing your complete medical history keeps you safe during treatment.

Be sure to let your doctor know if you have any of the following:

• A rare genetic blood disorder called Cockayne syndrome.
• A history of blood disorders, such as sickle cell anemia, plain anemia, or leukemia.
• A habit of drinking alcohol regularly.
• An active viral infection, such as chickenpox, cold sores, or herpes.
• An irregular heartbeat or other heart rhythm problems.
• Kidney disease or liver disease.
• Low blood cell counts.
• Recent vaccines or plans to get vaccinated soon.
• A history of seizures.
• Numbness, tingling, or any other nerve disorders in your hands or feet.
• An allergy to bismuth subsalicylate, metronidazole, tetracycline, other drugs, foods, dyes, or preservatives.
• Pregnancy or plans to become pregnant soon.
• Breastfeeding or plans to breastfeed your baby.

Giving your doctor this information ensures that this medicine is safe for you to use.

How to use this medicine properly.

You should take this medicine with a full glass of water. Follow the directions on your prescription label exactly, and try to take your doses at the same times every day.

Never stop taking this medicine early without talking to your doctor first. Even if your stomach feels much better, you must finish the entire course to completely clear the infection.

Also, if you take products containing aluminum, calcium, iron, magnesium, or zinc—such as antacids or certain vitamins—do not take them at the exact same time as this medicine. Take your antacids or mineral supplements a few hours before or after your dose. Ask your pharmacist if you are unsure about the timing.

Important Note: This medicine combination is not approved for children. Never give this treatment to children.

What if you take too much? If you think you have taken too much of this medicine, go to your nearest emergency room right away or call your local poison control center.

One more thing: This medicine was prescribed just for you. Never share it with anyone else, even if they have the exact same symptoms you do.

What to do if you miss a dose.

If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose entirely.

Simply take your next dose at the normal time. Never take two doses at the same time to make up for a missed one.

Other medicines that can interact with this combination.

Managing drug interactions is very important. Certain medicines can cause serious problems when taken with this three-drug ulcer treatment.

Medicines you must never take with this treatment.

If you take any of the following medicines, you should not take this bismuth, metronidazole, and tetracycline combination:

• Acitretin.
• Alcohol or any product containing alcohol (including some cough syrups and mouthwashes).
• Cisapride.
• Disulfiram.
• Dronedarone.
• Ketorolac.
• Pimozide.
• Probenecid.
• Thioridazine.

Other products that can cause interactions.

The following items can also interact with your medicine:

• Antacids, vitamins, or any product containing aluminum, calcium, iron, magnesium, or zinc.
• Busulfan.
• Blood thinners, such as warfarin.
• Cimetidine.
• Estrogen or progestin hormones, such as birth control pills.
• Lithium.
• Other medicines that affect heart rhythm.
• Phenobarbital.
• Phenytoin.

This list does not include every possible interaction. Tell your doctor about all prescription drugs, over-the-counter medicines, herbal products, vitamins, and dietary supplements you use. Also mention if you smoke, drink alcohol, or use street drugs.

Things to watch out for while taking this medicine.

• If your symptoms do not improve or if they get worse, contact your doctor right away.
• Do not take over-the-counter medicine for diarrhea without asking your doctor. If diarrhea lasts for more than two days, or if it is severe and watery, call your doctor right away.
• Your skin may become more sensitive to sunlight while taking this medicine. You can burn or get red much faster than usual. Stay out of strong sunlight when possible, wear protective clothing outdoors, and use a broad-spectrum sunscreen. Avoid sunlamps and tanning beds completely during this time.
• If you use hormonal birth control (such as birth control pills containing estrogen or progestin), this medicine can make them less effective. Use a backup birth control method, such as condoms or a diaphragm. This taking this medicine and for a short time after. Talk to your doctor for specific guidance.
• Many liquid products or medicines can contain hidden alcohol. Check with your doctor or pharmacist to ensure your products are alcohol-free. Taking metronidazole with alcohol can trigger a very unpleasant reaction. Symptoms can include flushing, headache, nausea, vomiting, sweating, thirst, and dizziness. This reaction can last from 30 minutes to several hours. Avoid alcohol completely while taking this medicine.

Possible side effects of this medicine.

Like all medicines, this combination can cause side effects, though not everyone experiences them.

Side effects to report to your doctor quickly.

Contact your doctor or seek medical care as soon as possible if you notice any of these serious signs:

• Allergic reactions: skin rash, itching, hives, or swelling of your face, lips, tongue, or throat.
• Dizziness, trouble keeping your balance while walking, confusion, or trouble speaking.
• Severe headache, blurred vision, nausea, or vomiting (signs of increased pressure around the brain).
• Pain, numbness, or tingling in your hands or feet, muscle weakness, trouble walking, or loss of balance.
• Skin rash combined with fever and swollen lymph nodes.
• Severe redness, blistering, peeling, or sores inside your mouth.
• Seizures.
• Severe, watery diarrhea and fever.
• Unusual vaginal discharge, itching, or bad odor in women.

Side effects that are usually mild but need attention if they continue.

These effects are generally not dangerous, but let your doctor know if they bother you or do not go away:

• Dark or black-colored stools (caused by the bismuth. This is normal and harmless).
• Teeth changing color.
• A dark or black tongue.
• Mild diarrhea.
• A metallic or bitter taste in your mouth.
• Mild nausea.
• Increased sensitivity to sunlight.

This list does not cover every possible side effect. If you notice any other unusual symptoms, speak with your doctor.

How to store your medicine.

• Keep this medicine out of the reach of children and pets.
• Store at room temperature between 20°C and 25°C (68°F and 77°F).
• Do not use medicine after its expiration date. Safely discard any expired or leftover pills.

How to safely dispose of unused medicine:

• If available, use a community medicine take-back program. Ask your local pharmacy or police department where to find one.
• If no take-back program is nearby, check your prescription packaging to see if the medicine should go in the trash.
• To throw medicines in the household trash safely, remove them from their original containers. Mix them with an unappealing substance like cat litter, dirt, or used coffee grounds. Place the mixture inside a sealed bag or container, and put it in your normal household trash.

The most important thing to remember.

This guide is only a summary. If you have more questions about this medicine, talk to your doctor, pharmacist, or doctor.