← Search & browse all drugs
ALIMENTARY TRACT AND METABOLISM › DRUGS FOR ACID RELATED DISORDERS › DRUGS FOR PEPTIC ULCER AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) › Combinations for eradication of Helicobacter pylori
bismuth subcitrate, tetracycline and metronidazole
A02BD08
Forms & Strengths
- Combination capsule: bismuthe subcitrate potassium 140 mg, tetracycline hydrochloride 125 mg, metronidazole 125 mg
Adult Dosing
- 3 capsules four times daily (after meals and at bedtime) for 10 days, combined with a proton pump inhibitor twice daily
Pediatric Dosing
- Safety and efficacy not established in pediatric patients
Indications
- Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer recurrence
Mechanism of Action
- Bismuth provides local gastrointestinal mucosal protection and direct antimicrobial effects against H. pylori
- Tetracycline inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit
- Metronidazole is reduced intracellularly by anaerobic bacteria/protozoa to form reactive radicals that damage bacterial DNA
Contraindications
- Pregnancy and lactation
- Renal or hepatic impairment
- Hypersensitivity to bismuth, tetracyclines, metronidazole, or imidazole derivatives
- Pediatric patients under 8 years of age due to risk of permanent tooth discoloration
Adverse Reactions
- Darkening of stool and tongue
- Nausea, vomiting, and abdominal pain
- Diarrhea and pseudomembranous colitis
- Dizziness, headache, and peripheral neuropathy (metronidazole)
- Photosensitivity and candidiasis (tetracycline)
Drug Interactions
- Antacids containing aluminum, calcium, or magnesium decrease absorption of tetracycline
- Oral anticoagulants (warfarin): metronidazole may potentiate the hypoprothrombinemic effect
- Lithium: metronidazole may increase lithium serum concentrations and toxicity
- Alcohol: disulfiram-like reaction with metronidazole
- Methoxyflurane: fatal nephrotoxicity reported when combined with tetracycline
Curated Content: Needs Vetting Before Put to Clinical Use