Information about Therapies Used to Treat Peptic Ulcer Disease

Several medications and drug regimens are available for the treatment of peptic ulcers. Peptic ulcer disease may be treated with triple therapy, quadruple therapy or combination products.

Triple Therapy to Treat Peptic Ulcers

Triple therapy consists of two antibiotics and one proton pump inhibitor for 7-14 days. The duration of the regimen including AcipHex is 7 days; the duration of the other regimens is 10-14 days. Medications and usual dosages include

  1. Biaxin (clarithromycin)—One 500-mg tablet 2x/day
  2. amoxicillin—Two 500-mg capsules 2x/day or metronidazole—One 500-mg tablet 2x/day
  3. AcipHex (rabeprazole)—One 20-mg tablet 2x/day or
    • Nexium (esomeprazole)—One 40-mg capsule 1x/day or
    • Prevacid (lansoprazole)—One 30-mg capsule 2x/day or
    • Prilosec OTC (omeprazole)—One 20-mg tablet 2x/day or
    • Protonix (pantoprazole)—One 40-mg tablet 2x/day

Side effects of biaxin, amoxicillin, metronidazole include diarrhea, nausea, vomiting, stomach upset, changes in taste, and headache. Call your doctor immediately if you experience persistent diarrhea, abdominal pain or cramping, blood or mucus in your stool. Biaxin only may be taken with milk if stomach upset occurs. Amoxicillin only: Drink plenty of liquids. Metronidazole only: Avoid alcohol while taking and for at least one day after finishing the medication.

Side effects of proton pump inhibitors include headache, diarrhea, nausea, dizziness, and constipation. Call your doctor if you experience skin rash, weakness, sore tongue, numbness or tingling, chest pain, dark urine, severe stomach pain or fast or irregular heartbeat.

Quadruple Therapy to Treat Peptic Ulcers

Quadruple therapy consists of bismuth, two antibiotics, and one proton pump inhibitor or H2-blocker for 14 days. Medications and usual dosages include the following:

  1. Pepto-Bismol (bismuth subsalicylate)—Two 262-mg tablets 3-4x/day or 30 mL liquid 3-4x/day
  2. metronidazole—One 250-mg tablet 4x/day
  3. tetracycline—One 500-mg capsule 4x/day
  4. proton pump inhibitor (AcipHex, Nexium, Prevacid, Prilosec OTC, Protonix, Zegerid)—same dosage as in triple therapy
    • Axid (nizatidine)—One 150-mg capsule 2x/day or
    • Pepcid AC (famotidine)—One 20-mg tablet 2x/day or
    • Tagamet (cimetidine)—One 400-mg tablet 2x/day or
    • Zantac 150 (ranitidine)—One 150-mg tablet 2x/day

Bismuth may cause stools to become gray-black. Tetracycline makes skin more sensitive to sunlight; wear sunscreen.

Side effects of H2-blockers include headache, dizziness, diarrhea, and constipation. People with kidney disease need to take a lower dosage to prevent side effects such as confusion and dizziness. Call your doctor if you experience signs of liver problems: unusual tiredness, persistent nausea or vomiting, severe stomach or abdominal pain, dark urine, yellowing eyes or skin.

Combination Products to Treat Peptic Ulcers

These medications include Helidac (bismuth/metronidazole/tetracycline) and Prevpac (amoxicillin/Biaxin/Prevacid), each usually taken for 14 days. Usual administration of Helidac involves chewing two 262-mg bismuth tablets, then swallowing one 250-mg metronidazole tablet and one 500-mg tetracycline capsule with a glass of water 4x/day (at breakfast, lunch, dinner and bedtime).

Side effects include nausea, diarrhea and abdominal pain. Do not take if you have kidney or liver problems. Other side effects include gray-black stools, vomiting, stomach upset, changes in taste, headache and sun sensitivity.

Usual administration of Prevpac involves swallowing two 500-mg amoxicillin capsules, one 500-mg Biaxin tablet, and one 30-mg Prevacid capsule 2x/day before eating. Side effects include diarrhea, headache and changes in taste.

Publication Review By: H. Franklin Herlong, M.D.

Published: 30 Mar 2011

Last Modified: 20 Aug 2014