Co-magaldrox is a combination of aluminium hydroxide and magnesium hydroxide and is classed as a antacid. It works by neutralising the excess acid in the stomach for the treatment of indigestion and heartburn (dyspepsia). The most common side effects of dicycloverine as stated in the BNF app are constipation, dilation of pupils with loss of accomomadtion, dry mouth, photophobia, reduced bronchial secretions, skin dryness, skin flushing, urinary retention and urination urgency. The most common side effects of macrogol according to the BNF app are abdominal distention, abdominal pain, flatulence and nausea. The most common side effects of metoclopramide as written in BNF are extrapyramidal effects – these include spasm and muscle contractions, motor restlessness and slowness in movement and jerky movements. Galactorrhoea (milky nipple discharge), gynaecomastia (enlargement of breasts in males), hyperprolactinaemia high levels of the hormone prolactin in the blood which causes irregular menstrual periods and menstrual changes. The triple drug therapy regime is used to treat Helicobacter Pylori Infection. It is usually taken for one week to treat the lower part of the stomach. The infection causes inflammation of the gastric mucosa which leads to a gastric ulcer. Clarithromycin and metronidazole are antibiotics and are used to kill the bacteria in the stomach and to prevent growth of bacteria while the omeprazole is a proton pump inhibitor which will reduce the amount of acid in the stomach. According to the BNF the most common side effects for clarithromycin are abdominal discomfort, diarrhoea, nauseas and vomiting. For metronidazole it states that there are no common side effects. The side effects of omeprazole according to the BNF are abdominal pain, constipation, diarrhoea, flatulence, GI disturbances, headache, nausea and vomiting. The information that i would give to the patient would be that this is an effective treatment of Helicobater Pylori if followed strictly. General gastric ulcers can be treated with PPI’s. During the one week treatment and for 48 hours after the treatment is finished alcohol must be avoided as this can cause severe side effects of sickenss, diarrheoa, nausea and stomach pain. If the metronidazole is not taken then the treatment will not be effective. To abstain from alcohol for 1 week and 2 days will be beneficial to the patient as the treatment has a good chance of working otherwise the symptoms of the ulcer will just worsen with the use of alcohol. The patients wife is probably just taking one PPI for her condition as it is probably a gastic ulcer and the symptoms can be controlled easily with a PPI. I would advise against taking ibuprofen as this can irritate the stomach as do aspirin so would recommend sticking to paracetamol during the treatment. Nsaids such as ibuprofen and aspirin could cause peptic ulcers in the stomach. Irritable bowel syndrome is a disorder of the intestines which causes spasms in the colon. It can leave the patient with stomach pains and cramps, diaarhoea, constipation, stomach bloating and trapped wind. Macrogol is an osmotic laxative and will help relieve constipation by increasing the amount of water in bowel so that passing of stools is easier. It also helps to reduce the effects of dehydration and the loss of electrolytes. Atropine is an antispasmodic- antimuscarinic, it works by blocking receptors which naturally cause the contraction of the smooth muscle in the stomach which is the cause of stomach cramps and spasms. Blocking the receptor means that the smooth muscle will be relaxed and contracts less so decreasing the frequency of cramps. According to the BNF the side effects of macrogol are abdominal distention, stomach pain, flatulence and nausea. The usual dose of macrogol would be two sachets made up with 100ml of water and drank straight after making up preferably in the morning. In the BNF it states that the side effects of Atropine is constipation, dry mouth, flushing, dry skin and urinary urgency. It only comes in 600mcg tablets so a dose of 1.2mg would be TWO tablets taken at night. I would advise that the atropine causes constipation and that macrogol was prescribed to help to counteract this effect. But if stools become too loose or signs of diarrheoa or vomting occur then to speak to their GP.