When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to bismuth, aspirin or other salicylates, metronidazole or similar medicines, or tetracycline. Do not use this medicine if you are pregnant or breastfeeding.

How to Use This Medicine:
Chewable Tablet, Tablet, Capsule

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• The medicine for each day is packaged on a blister card that contains 8 chewable tablets of bismuth subsalicylate, 4 tablets of metronidazole, and 4 capsules of tetracycline.
• Completely chew and swallow 2 bismuth tablets. Swallow the metronidazole tablet and the tetracycline capsule whole with a full glass (8 ounces) of water. This will help prevent irritation of the esophagus. Do not chew, crush, or break the metronidazole tablet or the tetracycline capsule.
• Take 1 dose (all 4 pills) 4 times a day, after meals and at bedtime.
• Take all of the medicine in your prescription to clear up your infection, even if you feel better after the first few doses.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose. Call your doctor if you missed more than 4 doses of this combination of medicines.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use this medicine if you have also used disulfiram within the last 2 weeks, or if you recently used or will soon use methoxyflurane.
• Some medicines and foods can affect how this medicine works. Tell your doctor if you are taking any of the following:
  
  • A blood thinner, such as warfarin
  • Antacids, vitamin supplements
  • Aspirin
  • Cimetidine
  • Diabetes medicine
  • Lithium
  • Penicillin
  • Phenobarbital, phenytoin
  • Probenecid, sulfinpyrazone
• Do not drink alcohol or other products that have propylene glycol while you are using this medicine and for 3 days after you stop.
• Do not take this medicine with milk or other dairy products.

Warnings While Using This Medicine:

• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• Tell your doctor if you have kidney disease, liver disease, nerve problems, or a history of blood disorders or seizures.
• This medicine may make you dizzy or have trouble seeing clearly. Do not drive or do anything that could be dangerous until you know how this medicine affects you.
• This medicine may make your skin more sensitive to sunlight. Wear sunscreen. Do not use sunlamps or tanning beds.
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• This medicine should not be given to children, especially if they have or are recovering from the chicken pox or flu. Children can develop a rare but serious condition called Reye syndrome if given this medicine.
• Birth control pills may not work well while you are using this combination of medicines. Use a different form of birth control to prevent pregnancy.
• Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• Call your doctor if your symptoms do not improve or if they get worse.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Changes in vision
• Decrease in how much or how often you urinate, difficult or painful urination
• Headache, stiff neck, dizziness, nausea, vomiting
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet
• Seizures or tremors
• Sudden and severe stomach pain, nausea, vomiting, fever, and lightheadedness
• Unusual bleeding, bruising, weakness
• Warmth or redness in your face, neck, arms, or upper chest

If you notice these less serious side effects, talk with your doctor:

• Black stools, dark tongue
• Diarrhea, stomach pain, mild nausea
• White patches in your mouth or on your tongue

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088