Bismuth Subsalicylate, Metronidazole, and Tetracycline (Oral)

Bismuth subsalicylate, metronidazole, and tetracycline, also known by the brand name Helidac, is used as an oral treatment for duodenal ulcers.

Overview

Bismuth subsalicylate, metronidazole, and tetracycline is a combination of medications used to treat duodenal ulcers, which are caused by H. pylori bacteria. It is often sold under the brand name Helidac. The bismuth subsalicylate is an anti-inflammatory and bactericidal substance which soothes the gastrointestinal system, helps to fight infection, and binds toxins produced by some bacterial infections. Metronidazole is an antibiotic and antiprotozoal medication, which disrupts the DNA of microbial cells without harming human cells or human-friendly bacteria. Tetracycline is an antibiotic which works by blocking the ability of your bacterial infection to make proteins, reducing the reproduction rate of H. pylori.

Conditions treated

  • Duodenal ulcer
  • H. pylori bacteria

Type of Medicine

  • Capsule
  • Chewable tablet
  • Tablet
  • Bactericidal
  • Antibiotic
  • Anti-inflammatory

Side Effects

Mild Side Effects

Like any drug or medication, bismuth subsalicylate, metronidazole, and tetracycline can have unwanted effects on the body in addition to the therapeutic effects for which it is prescribed. The following side effects are usually mild in nature and may be a result of your body getting used to the new medication. These will normally subside in time and may go away altogether over the course of treatment. Always let your prescribing or overseeing physician know if you are experiencing any side effects. Your doctor may be able to suggest ways to reduce the impact of these side effects on your system. If these side effects persist, do not respond to treatment, become worse, or become bothersome, let your doctor know as soon as possible.

Some mild side effects of bismuth subsalicylate, metronidazole, and tetracycline include a general feeling of illness or discomfort, some nervousness or trouble sleeping, and a loss of appetite. You may experience constipation or a feeling of itching or burning around the anus.

Serious Side Effects

Some unwanted side effects of bismuth subsalicylate, metronidazole, and tetracycline can be more serious health problems or can be symptoms of health conditions which are triggered by the use of bismuth subsalicylate, metronidazole, and tetracycline. If you experience any of these side effects, check with your with your prescribing or overseeing physician immediately. You may need more medical assistance or may need to change your dosage or stop taking bismuth subsalicylate, metronidazole, and tetracycline.

Serious side effects of bismuth subsalicylate, metronidazole, and tetracycline most often manifest as gastrointestinal distress. Symptoms in this category include nausea, diarrhea, pain in the abdominal or stomach area, and stools that are bloody, tarry, or black. Your tongue or mouth may feel irritated, and you may have some trouble with swallowing. You may experience vomiting, or see blood in your vomit. You may feel burning, tingling, or prickling sensations, have pain or swelling in your joints. Your skin may become very sensitive to sunlight, or you may see or feel a rash on your skin. You may experience a feeling of dizziness, lose consciousness or faint, or have convulsions or seizures. If you experience any of these symptoms, contact your doctor immediately for advice and direction regarding medical assistance and continuation or dosage of bismuth subsalicylate, metronidazole, and tetracycline.

Side Effects of Bismuth Subsalicylate

Any medication with bismuth subsalicylate as an ingredient can trigger the side effects of bismuth subsalicylate within the body. If you experience any of these side effects while taking bismuth subsalicylate, metronidazole, and tetracycline or medications with bismuth subsalicylate, contact your prescribing or overseeing physician immediately. You may experience a temporary but harmless grayish-blackening of the tongue or stool, which will not look the same as a bloody or tarry stool. Side effects of bismuth subsalicylate can include gastrointestinal effects such as stomach or abdominal pain that does not go away, severe stomach or abdominal pain, severe constipation or diarrhea, continuous or severe nausea, or vomiting that does not go away. You may experience some anxiety, confusion, or mental depression. You may have some difficulty in speaking or experience slurred speech, a continuing ringing or buzzing in the ears, or some loss of hearing. You may feel dizzy or lightheaded, or feel unusually drowsy. You may experience blurred vision or other vision problems. You may find yourself breathing unusually deep or unusually fast. You may experience increased sweating or increased thirst. You may experience trembling in the muscles, muscle spasms in the face, neck, and back, as well as weakness in the muscles. Some senior patients experience uncontrollable flapping movements of the hands or other uncontrolled body movements. You may experience severe headaches or headaches that do not go away. If you experience any of these symptoms or side effects, check with your doctor immediately.

Side Effects of Metronidazole

Any medication with metronidazole as an ingredient can trigger the side effects of metronidazole within the body. If you experience any of these side effects while taking bismuth subsalicylate, metronidazole, and tetracycline or medications with metronidazole, contact your prescribing or overseeing physician immediately.

You may experience gastrointestinal distress such as nausea or an upset stomach, abdominal cramps or stomach pain, vomiting, and diarrhea or constipation. You may experience headaches, mood changes, a metallic taste in the mouth or changes in taste, unsteadiness, dizziness, seizures, or contract brain disease. You may experience a dry mouth, mouth sores, dark-colored urine, or painful urination or pain associated with urination. You may experience numbness or tingling of the hands or feet or pricking sensations that may become permanent. You may experience weight loss or loss of appetite. All of these symptoms should be reported to your physician immediately.

Side Effects of Tetracycline

Any medication with tetracycline as an ingredient can trigger the side effects of tetracycline within the body. Some of these side effects are a result of your body adjusting to the medication and do not usually require medical attention. These symptoms will normally subside or go away over the course of treatment. If these side effects do not subside, become stronger, or become bothersome, let your prescribing or overseeing doctor know. Your doctor can suggest ways to relieve many of these side effects. Less serious side effects of tetracycline include gastrointestinal symptoms such as diarrhea and cramps or burning of the stomach. You may experience a sore mouth or tongue, or some itching in the rectal area. You may experience minor dizziness, unsteadiness, or a lightheaded feeling. You may also experience a discoloration or darkening of the tongue.

Some side effects of tetracycline may be more serious or may be symptoms of more serious medical conditions. If you experience any of these side effects while taking bismuth subsalicylate, metronidazole, and tetracycline or medications with tetracycline, contact your prescribing or overseeing physician immediately. You may experience headaches, a loss of appetite, nausea and vomiting, changes in your vision, yellowing skin, unusual weakness or a feeling of tiredness, an unusual sensitivity to sunlight, abdominal pain or stomach pain, increased thirst, or a greatly increased frequency of urine or amount of urine when you urinate. If you experience any of these side effects, contact your doctor immediately as medical assistance may be required.

Dosage

The dosage and administration directions of bismuth subsalicylate, metronidazole, and tetracycline are standards provided by the manufacturer. Your doctor's directions regarding ingestion of bismuth subsalicylate, metronidazole, and tetracycline may differ depending on your medical condition and needs. When taking bismuth subsalicylate, metronidazole, and tetracycline, always refer to your doctor's directions.

Bismuth subsalicylate, metronidazole, and tetracycline comes in a package with three different medicals, which are to be taken together at the same time. A standard recommended dosage includes 525 mg of bismuth subsalicylate in the form of two 262.4 mg chewable tablets, a single 250 mg tablet of metronidazole, and a single 500 mg capsule of tetracycline hydrochloride. This medication should be taken four times daily for 14 days. One dose should be taken at mealtime three times per day, and once before bedtime. The chewable tablets should be chewed and swallowed, while the other tablet and capsule are to be taken whole with at least 8 ounces of water. It is necessary to take this medication with sufficient water in order to reduce irritation or ulcer of the esophagus.

If you miss a dose of bismuth subsalicylate, metronidazole, and tetracycline, simply take the next dose and continue to take each prescribed dose until the medication is gone. If more than 4 doses are missed, contact your prescribing physician for instructions.

Major Drug Interactions

Bismuth subsalicylate, metronidazole, and tetracycline can cause unwanted interactions with some other substances you may ingest. Keep a complete list of any drugs, treatments, medications, or supplements you regularly take, whether they have been prescribed to you or are available over the counter. Your doctor or pharmacist will be able to identify problematic drug interactions with bismuth subsalicylate, metronidazole, and tetracycline.

Methoxyflurane

Methoxyflurane or medications including methoxyflurane can cause fatal renal toxicity or a build-up of toxins in the liver that can result in liver failure to the point of death.

Methoxyflurane

Disulfiram can result in psychotic reactions in alcoholic patients. bismuth subsalicylate, metronidazole, and tetracycline and disulfiram should not be taken within two weeks of each other to avoid this interaction.

Alcohol and Propylene Glycol

Alcoholic beverages, or medications or other products including propylene glycol, can cause serious interactions with bismuth subsalicylate, metronidazole, and tetracycline if consumed within 3 days before or after a dose of bismuth subsalicylate, metronidazole, and tetracycline. Symptoms of this interaction can include headaches, flushing, abdominal cramps, nausea, and vomiting.

Birth Control

Ingredients in bismuth subsalicylate, metronidazole, and tetracycline can make oral contraceptives less effective in the body. People using oral birth control should use an additional form of contraceptive during sex while taking bismuth subsalicylate, metronidazole, and tetracycline. Patients have reported breakthrough bleeding while taking bismuth subsalicylate, metronidazole, and tetracycline. Patients who become pregnant while under a course of treatment of bismuth subsalicylate, metronidazole, and tetracycline should notify their prescribing physician immediately.

Anticoagulants

Warfarin and other oral coumarin anticoagulants may be less effective in their clotting action while taking bismuth subsalicylate, metronidazole, and tetracycline. Plasma prothrombin activity may be depressed, so anticoagulation tests should be closely monitored. Salicylates can increase the risk of bleeding along with anticoagulants, so patients taking aspirin should be monitored closely for any signs of bleeding.

Lithium

Bismuth subsalicylate, metronidazole, and tetracycline can cause elevation of serum lithium concentrations, which can lead to lithium toxicity. Serum lithium and serum creatinine concentrations should be closely monitored while taking bismuth subsalicylate, metronidazole, and tetracycline to detect the potential of lithium toxicity before symptoms occur.

Diabetes Medication

Patients taking medication for diabetes should take bismuth subsalicylate, metronidazole, and tetracycline with caution, as this can result in an enhanced hypoglycemic effect.

Penicillin

Bismuth subsalicylate, metronidazole, and tetracycline can interfere with the ability of penicillin to kill bacteria in the body. Penicillin should not be taken during a treatment of bismuth subsalicylate, metronidazole, and tetracycline.

X-rays

Bismuth subsalicylate, metronidazole, and tetracycline absorbs X-rays and may interfere with X-rays taken of the gastrointestinal tract.

Warnings

Heart Attack

Some patients have had heart attacks, myocardial infarction, or cardiac arrest while taking bismuth subsalicylate, metronidazole, and tetracycline. Symptoms of a heart attack include chest discomfort that may manifest as a feeling of pain, fullness, or squeezing sensation in the chest, sudden shortness of breath, gastrointestinal symptoms such as nausea, belching, burping, vomiting, or indigestion, pain in the arm, jaw, head, or teeth, upper back pain, unusual perspiration, sweating, and a general feeling of malaise. If you experience some or all of these symptoms in a short period of time while taking bismuth subsalicylate, metronidazole, and tetracycline, seek emergency medical help immediately.

Regular Checkups

Patients taking bismuth subsalicylate, metronidazole, and tetracycline should schedule regular check-ups with their prescribing or overseeing physician to ensure that the medication is working as prescribed. If the symptoms you are being treated for do not subside with treatment, or if they get worse during the course of treatment, tell your doctor as soon as possible.

Diarrhea

Taking bismuth subsalicylate, metronidazole, and tetracycline can cause diarrhea in some patients. This side effect can be a symptom of a more serious health problem or appear along with other side effects that may need to be reported to your doctor. If you experience diarrhea while taking bismuth subsalicylate, metronidazole, and tetracycline, do not use over-the-counter products or remedies to treat this condition. Contact your doctor if your diarrhea is severe, if your stool is watery, or if your diarrhea lasts for more than two days.

Photosensitivity

Patients taking bismuth subsalicylate, metronidazole, and tetracycline can experience temporary photosensitivity or a strong sensitivity of the skin to sunlight. To reduce the effects of photosensitivity, patients taking bismuth subsalicylate, metronidazole, and tetracycline should avoid the sun as much as possible. If you are not able to keep out of sunlight, be sure to wear sunscreen and use protective clothing or apparatus such as sunshades. While using bismuth subsalicylate, metronidazole, and tetracycline, do not use tanning beds, tanning booths, or sun lamps.

Interaction With Ingredients

Some ingredients can impair the absorption of tetracycline into the body if taken at the same time as bismuth subsalicylate, metronidazole, and tetracycline, and should not be ingested within two hours of your dose of bismuth subsalicylate, metronidazole, and tetracycline. These ingredients include products with calcium, aluminum, magnesium, zinc, iron, or sodium bicarbonate. Antacids including these any of these products, other medications including these as ingredients, and any milk or dairy products should not be ingested two hours before or after your dose of bismuth subsalicylate, metronidazole, and tetracycline.

Discoloration of the Stool and Tongue

Some of the ingredients in bismuth subsalicylate, metronidazole, and tetracycline can cause a harmless and temporary discoloration of the stool or tongue. Your tongue may turn grayish or dark, and your stool may become a dark grey or grayish black without any other difference in texture. This will clear up when you stop taking the medication.

This is not to be confused with melena, which is a type of darkened stool that is a symptom of internal bleeding in the esophagus, stomach, or small intestine. Stools with melena are normally a tarry consistency. Melena is often accompanied by acute pain in the stomach or abdomen, diarrhea, and vomiting.

Patients experiencing a normal discoloration of the stool may also experience internal bleeding and melena. If you begin to experience gastrointestinal distress along with a dark stool, check with your doctor immediately to rule out bleeding or other serious side effects.

Birth Control

Medications with tetracycline as an ingredient can make many forms of hormonal birth control less effective. If you are using birth control pills for any reason while you are taking bismuth subsalicylate, metronidazole, and tetracycline, talk to your doctor about an additional method of birth control, or for any needed adjustments in medication dosage or use.

Dizziness

bismuth subsalicylate, metronidazole, and tetracycline may cause drowsiness, dizziness, or fainting spells in some patients. When you begin to take bismuth subsalicylate, metronidazole, and tetracycline, do not use heavy machinery, drive, or perform actions that require mental alertness until you know how this medication affects you. Standing up or sitting up quickly can increase the likeliness and severity of dizziness or fainting, especially in senior citizens.

Alcohol

Alcohol can reduce the effectiveness of bismuth subsalicylate, metronidazole, and tetracycline and reduce the likeliness of effective recovery. Do not consume alcohol while taking bismuth subsalicylate, metronidazole, and tetracycline, or for one day after stopping your treatment of bismuth subsalicylate, metronidazole, and tetracycline.

Overdose Symptoms

An overdose of bismuth subsalicylate, metronidazole, and tetracycline can have serious health consequences. Get emergency help if you experience any symptoms of a bismuth subsalicylate, metronidazole, and tetracycline overdose. Symptoms include confusion, unusual tiredness, clumsiness, disorientation or feelings of unsteadiness, a continuing buzzing or ringing in the ears, a fast or rapid heartbeat, quick or deep breathing, vomiting, high temperature or fever, and pain, numbness, or tingling in the extremities such as arms, hands, legs, or feet. If you experience these symptoms of a bismuth subsalicylate, metronidazole, and tetracycline overdose, seek emergency medical help immediately.

Storage

Bismuth subsalicylate, metronidazole, and tetracycline is normally supplied in a carton which contains 14 blister cards, one for each prescribed day of the treatment. Each blister card contains 8 pink chewable tablets of bismuth subsalicylate, 4 round white tablets of metronidazole, and 4 black and yellow capsules of tetracycline. Store bismuth subsalicylate, metronidazole, and tetracycline at room temperature, at 68°-77°F (20°-25°C).

Summary

Bismuth subsalicylate, metronidazole, and tetracycline is a combination of medications used to treat duodenal ulcers caused by H. pylori bacteria. It is often sold under the brand name Helidac. It is taken four times a day at meals and bedtime for 14 days, with each dose consisting of a chewable tablet of bismuth subsalicylate, a tablet of metronidazole, and a capsule of tetracycline. The bismuth salicylate acts as an anti-bacterial and anti-inflammatory, while the metronidazole and tetracycline act as antibiotics.

Bismuth subsalicylate, metronidazole, and tetracycline has some mild side effects, which usually subside over time. Mild side effects of bismuth subsalicylate, metronidazole, and tetracycline include a general feeling of illness or discomfort, nervousness or insomnia, loss of appetite, constipation, and anal itching or burning. Your stools may become discolored and dark grey, but if this happens without accompanying gastrointestinal distress or changes in consistency, it's a temporary discoloration and will go away after your last dose of bismuth subsalicylate, metronidazole, and tetracycline.

More serious side effects of bismuth subsalicylate, metronidazole, and tetracycline include gastrointestinal distress such as nausea, diarrhea, stomach pain, and tarry or bloody stools, as well as vomiting or vomit with blood. This can be a result of internal bleeding and needs immediate medical attention. You might also feel skin irritation, such as tingling or burning of the skin, a rash, pain or swelling in the joints, or sudden sensitivity to sunlight. You may also become dizzy, drowsy, or lightheaded. You may experience unusual thirst and urination that is painful or very frequent. You may also experience weight loss due to your loss of appetite. If you experience any of these side effects, contact your doctor immediately, as you may need medical attention, or you may need to stop taking bismuth subsalicylate, metronidazole, and tetracycline or another medication.

Bismuth subsalicylate, metronidazole, and tetracycline can interact with other medications in ways that can affect the effectiveness of your other medications, or ways that can be hazardous to your health. You should not drink alcoholic beverages within 3 days of taking bismuth subsalicylate, metronidazole, and tetracycline. You should not take bismuth subsalicylate, metronidazole, and tetracycline while taking disulfiram, products including propylene glycol, or penicillin. You should use caution while taking bismuth subsalicylate, metronidazole, and tetracycline with methoxyflurane, lithium, diabetes medication, and anticoagulants such as warfarin or aspirin. Patients taking birth control should use an additional form of birth control or talk to their doctor. Bismuth subsalicylate, metronidazole, and tetracycline can also interfere with X-rays of the gastrointestinal tract.

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Last Reviewed:
December 25, 2017
Last Updated:
April 05, 2018
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