Pylera
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
What are the side effects of Pylera?
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%)
Other Side Effects
- Constipation
- Dry mouth
- Higher liver enzymes
- Changes in urine
- Rash
- Itchy skin
- Anxiety
- Higher appetite
- Weight gain
Serious Side Effects
- 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
Source: DailyMed
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.
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.
Frequently asked questions about Pylera
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What are the 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 forms
Typical dosing 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
Taking Pylera with methoxyflurane
Taking Pylera within 2 weeks of taking disulfiram
Drinking alcohol while taking Pylera and for 3 days after stopping
Serious kidney problems
Currently pregnancy
What are alternatives to Pylera?
Duodenal (gut) ulcer associated with Helicobacter pylori (H. pylori) infection
Helicobacter pylori (H. pylori) stomach infection in adults
Helicobacter pylori (H. pylori) stomach infection in adults
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References
Best studies we foundAgwuh, K. N., et al. (2006). Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. Journal of Antimicrobial Chemotherapy.
Alkim, H., et al. (2017). Role of bismuth in the eradication of Helicobacter pylori. American Journal of Therapeutics.
H2-Pharma, LLC. (2024). Pylera- bismuth subcitrate potassium, metronidazole, and tetracycline hydrochloride capsule [package insert]. DailyMed.
Ji, J., et al. (2020). Using probiotics as supplementation for Helicobacter pylori antibiotic therapy. International Journal of Molecular Sciences.
Kaur, H., et al. (2024). Aseptic meningitis. StatPearls.
MedlinePlus. (2016). Cockayne syndrome.
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