bismuth subcitrate / metronidazole / tetracycline
Pylera is a combination medication containing bismuth subcitrate (a mineral) and two antibiotics (metronidazole and tetracycline). It's used to treat duodenal ulcers in adults caused by Helicobacter pylori (H. pylori) infection. It's usually given together with a stomach acid-reducing medication like omeprazole (Prilosec), but it can interact with antacids. The medication comes as a capsule that's taken by mouth 4 times a day. Dark urine and stool, nausea, and headache are some potential side effects of Pylera. It's not recommended to drink alcohol during treatment and for at least 3 days after.
What is Pylera?
What is Pylera used for?
- Duodenal (gut) ulcer associated with Helicobacter pylori (H. pylori) infection
How Pylera works
Pylera is a combination medication that contains three different ingredients that work together to get rid of H. pylori bacteria in the stomach.
- Bismuth subcitrate is a mineral. It's thought to kill bacteria and interfere with the way bacteria attach to the walls of your gut.
- Metronidazole is a nitroimidazole antibiotic. It kills bacteria by damaging their genetic material.
- Tetracycline is a tetracycline antibiotic. It prevents bacteria from making certain important proteins for growth.
Drug facts
Side effects of Pylera
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dark stools (16%)
- Nausea (8%)
- Diarrhea (7%)
- Headache (5%)
- Abdominal pain (5%)
- Change in taste (4%)
- Indigestion (3%)
- Weakness (3%)
- Vaginal infection (3%)
- Dizziness (3%)
Less Common Side Effects
- Constipation
- Dry mouth
- Higher liver enzymes
- Changes in urine
- Rash
- Itchy skin
- Anxiety
- Higher appetite
- Weight gain
Pylera serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reaction or skin reaction: hives, rash, blisters, skin peeling, skin reddening, fever, swelling of the lips or tongue, trouble breathing
- Brain and nerve problems: seizures, numbness in the feet and hands, pain when moving the eye, headache, dizziness, vertigo, coordination problems, slurred speech, easily irritable, depression, weakness, trouble sleeping
- High pressure around the brain: headache, dizziness, blurred vision, vision changes, blind spots
- Infectious diarrhea (C. difficile-related diarrhea):: loose and watery stools, severe stomach pain or cramps, fever, nausea
The following Pylera side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Increased pressure around the brain—severe headache, blurry vision, change in vision, nausea, vomiting
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Seizures
- Severe diarrhea, fever
- Unusual vaginal discharge, itching, or odor
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Pylera
Pros
- Combines three medications in one capsule
- Taken for only 10 days
- Good choice for those who can't take other treatments for H. pylori
Cons
- Interacts with many medications
- Not the best option if you have severe kidney or liver problems
- Not safe during pregnancy
Pharmacist tips for Pylera
- Each Pylera capsule contains three different medications. You should take 3 capsules at a time, after meals and at bedtime, for a total of 4 daily doses. Additionally, omeprazole (Prilosec) should be taken with your morning and evening doses, also after a meal.
- Continue taking Pylera until you complete the 10-day treatment, even if you feel better sooner. Stopping too early can cause the infection to become harder to treat.
- Make sure you drink a full glass of water when taking Pylera, especially for the bedtime dose. This is so that the pills don't irritate your throat.
- If you accidentally miss a dose of Pylera, just continue with your normal schedule. Don't take a double dose to make up for it. If you miss more than 4 doses, reach out to your prescriber for advice.
- If you take antacids, multivitamins, or supplements containing calcium, iron, magnesium, or zinc, make sure to separate them from Pylera by at least a few hours. Otherwise, this medication might not work as well to treat your infection.
- Pylera interacts with many medications. Review a list of your current medications with your care team so they can make sure they're safe for you to take together.
- Drinking alcohol while taking Pylera can make you feel very sick and cause you to experience symptoms such as nausea, vomiting, headache, and stomach cramps. Don't drink alcohol while you're taking this medication and for at least 3 days after stopping it.
- Pylera can raise your risk for serious allergic reactions and skin reactions. If you develop any type of rash, stop the medication and contact your prescriber right away.
- Pylera can cause your tongue to turn dark and make your stool black, but this is harmless and should go away a few days after stopping the medication. But if you see blood in your stool, contact your prescriber right away, as it could be something serious.
- Pylera can make you more sensitive to the sun, raising your risk for getting a severe sunburn. To protect yourself, wear sunblock, limit sun exposure, and avoid using tanning salons.
- Use a back-up method of birth control since Pylera can make oral birth control pills work less well to prevent pregnancy.
- If you're breastfeeding, it's recommended to pump and throw away your breast milk while taking Pylera and for 2 days after treatment. In the meantime, talk to your prescriber about how to feed your baby during this time.
Common questions about Pylera
The amount of time Pylera stays in your system can depend on things like how well your kidneys and liver are working, as well as other medications you might be taking. In general, it takes about 25 days for bismuth subcitrate, and 2 days for metronidazole and tetracycline, to leave your body. This is based on the half-life of each medication seen in studies.
How long side effects from Pylera last can be different for each person. In general, black or dark urine, tongue, and stool should get better within several days after stopping the medication. Other side effects, like nausea and headache, should also get better after you stop taking Pylera. Talk to your prescriber if you have any questions or concerns about side effects from this medication.
Coffee doesn't interact with Pylera. But it can cause your stomach to release more acid, which can affect your ulcer. Ask your prescriber how much coffee is a safe amount to drink while your ulcer is healing. Because Pylera interacts with dairy products, don't add milk or anything that contains calcium to your coffee if you're drinking it close to the time you take your dose.
Yes, you can take acetaminophen (Tylenol) together with Pylera. These two medications aren't known to interact. But acetaminophen (Tylenol) might not be the best choice for everyone. Check with your care team before starting any medications while you're taking Pylera.
Yes, it's okay to eat eggs while taking Pylera. But don't add milk or other dairy products to the eggs since dairy products can make Pylera work less well.
There isn't enough information to know how well probiotics work when taken together with Pylera, but some research suggests it might help. Similarly, it isn't clear when you should take your probiotic while taking antibiotics. But some healthcare professionals recommend taking them 1-2 hours after the antibiotics. Talk with your prescriber about whether you should take a probiotic as part of your treatment for H. pylori infection.
It's recommended to take Pylera after meals and at bedtime, with a full glass of water. Avoid eating or drinking dairy products (like milk or yogurt) at the same time as you take Pylera as this interaction can affect how the medication works.
Pylera doesn't commonly cause weight gain. It's usually only taken for a short period of time, and less than 1% of people during clinical studies reported weight gain as a side effect. If you have concerns about your weight, speak with your prescriber.
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Risks and warnings for Pylera
Pylera can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Possible risk of cancer
It’s not clear if taking Pylera can put you at risk for cancer. Studies show that rats who took metronidazole (an ingredient in Pylera) throughout their lifetime were at higher risk for tumors in different parts of the body, like the liver and lungs. Don't take this medication more often than what your prescriber has directed.
Harm to unborn baby
Tetracycline (one of the antibiotics in Pylera) can cause harm to unborn babies if taken during pregnancy, causing permanent changes to tooth color and affecting bone development. If you are or plan to become pregnant, talk to your care team to see what the best treatment is for you.
Tooth problems
- Risk factors: Taking Pylera for a long time | Last half of pregnancy | Children younger than 8 years old
The tetracycline component in Pylera can cause permanent tooth discoloration, turning them yellow, gray, or brown. The risk is higher in those who are pregnant, children under 8 years old, and those who take the medication long term. Speak with your prescriber if you're concerned about this side effect.
Severe skin rash
Pylera can cause serious skin reactions that can be life-threatening. These skin reactions can include Stevens-Johnson syndrome (SJS), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, and toxic epidermal necrolysis (TEN). Talk to your prescriber right away if you suddenly develop a fever, burning eyes, skin pain, red or purple skin rash with blistering and peeling.
Brain and nerve problems
Pylera rarely causes seizures, swelling of the brain, nerve pain, or meningitis. You can experience difficulty with walking straight, dizziness, blurry vision, numbness, an inability to speak, or uncontrolled movements of your body. These problems will usually go away within days to weeks of stopping Pylera. If you experience any of these side effects while taking this medication, contact your prescriber or go to the emergency room right away.
Black-colored tongue and stool
Pylera contains bismuth subcitrate, which can cause your stool to turn black and your tongue to darken. These side effects are harmless and typically go away a few days after stopping the medication. But if you notice black, tarry stools or blood in your stool, contact your prescriber right away.
Sensitivity to sunlight
- Risk factors: Being under the sun for a long period of time | Use of tanning salons
Pylera can make your skin more sensitive to sunlight and make you more likely to get a sunburn. While taking this medication, make sure to use sunblock and wear protective clothing. Avoid using tanning salons since artificial light can cause a similar skin rash. If you do develop skin redness or get a rash, stop taking the medication right away and let your prescriber know.
Pylera dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 140mg/125mg/125mg | 120 capsules | $197.02 | $1.64 |
Typical dosage for Pylera
The typical dose is 3 capsules by mouth four times a day (after meals and at bedtime) for 10 days.
Pylera should be taken with omeprazole (Prilosec). The typical omeprazole dose is 20 mg by mouth twice a day with Pylera after the morning and evening meal for 10 days.
How much does Pylera cost?
Pylera contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Pylera will not be safe for you to take.
- Taking Pylera with methoxyflurane
- Taking Pylera within 2 weeks of taking disulfiram
- Drinking alcohol while taking Pylera and for 3 days after stopping
- Cockayne syndrome
- Serious kidney problems
- Currently pregnancy
