Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Pylera

Descriptions

Bismuth subcitrate, metronidazole, and tetracycline combination is used together with omeprazole to treat a stomach infection caused by the H. pylori bacteria and duodenal ulcer. This bacteria can cause stomach ulcers if it is not treated. This medicine should not be used for any other infection.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Capsule

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Because of tetracycline's toxicity, use in children younger than 8 years of age is not recommended. Tetracycline may cause permanent discoloration of the teeth. Safety and efficacy have not been established in this age group.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of Pylera® in the elderly. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Acitretin
• Amprenavir
• Bepridil
• Cisapride
• Disulfiram
• Dronabinol
• Dronedarone
• Levoketoconazole
• Mesoridazine
• Methoxyflurane
• Pimozide
• Saquinavir
• Sparfloxacin
• Terfenadine
• Thioridazine
• Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acenocoumarol
• Adagrasib
• Alfuzosin
• Amiodarone
• Amitriptyline
• Amoxicillin
• Ampicillin
• Anagrelide
• Apomorphine
• Aripiprazole
• Aripiprazole Lauroxil
• Arsenic Trioxide
• Asenapine
• Astemizole
• Atazanavir
• Azithromycin
• Bacampicillin
• Bedaquiline
• Bexarotene
• Buprenorphine
• Bupropion
• Buserelin
• Busulfan
• Capecitabine
• Ceritinib
• Chloroquine
• Chlorpromazine
• Cholera Vaccine, Live
• Cimetidine
• Ciprofloxacin
• Citalopram
• Clarithromycin
• Clofazimine
• Clomipramine
• Clothiapine
• Cloxacillin
• Clozapine
• Crizotinib
• Cyclobenzaprine
• Dabrafenib
• Dasatinib
• Degarelix
• Delamanid
• Desipramine
• Deslorelin
• Desogestrel
• Deutetrabenazine
• Dexmedetomidine
• Dicloxacillin
• Dienogest
• Digoxin
• Disopyramide
• Dofetilide
• Dolasetron
• Domperidone
• Donepezil
• Doxepin
• Doxifluridine
• Droperidol
• Drospirenone
• Ebastine
• Efavirenz
• Encorafenib
• Entrectinib
• Eribulin
• Erythromycin
• Escitalopram
• Estradiol
• Ethinyl Estradiol
• Ethynodiol
• Etretinate
• Famotidine
• Felbamate
• Fexinidazole
• Fingolimod
• Flecainide
• Fluconazole
• Fluorouracil
• Fluoxetine
• Formoterol
• Foscarnet
• Fosphenytoin
• Galantamine
• Gatifloxacin
• Gemifloxacin
• Gestodene
• Glasdegib
• Gonadorelin
• Goserelin
• Granisetron
• Halofantrine
• Haloperidol
• Histrelin
• Hydroquinidine
• Hydroxychloroquine
• Hydroxyzine
• Ibutilide
• Iloperidone
• Imipramine
• Inotuzumab Ozogamicin
• Isotretinoin
• Itraconazole
• Ivabradine
• Ivosidenib
• Ketoconazole
• Lapatinib
• Leuprolide
• Levofloxacin
• Levonorgestrel
• Lithium
• Lofexidine
• Lumefantrine
• Macimorelin
• Magnesium Sulfate
• Mebendazole
• Mefloquine
• Mestranol
• Methadone
• Methicillin
• Methotrexate
• Methotrimeprazine
• Mifepristone
• Mizolastine
• Mobocertinib
• Moricizine
• Moxifloxacin
• Mycophenolate Mofetil
• Mycophenolic Acid
• Nafarelin
• Nafcillin
• Nelfinavir
• Nilotinib
• Nomegestrol
• Norethindrone
• Norfloxacin
• Norgestimate
• Norgestrel
• Octreotide
• Ofloxacin
• Olanzapine
• Ondansetron
• Osimertinib
• Oxacillin
• Oxaliplatin
• Ozanimod
• Pacritinib
• Paliperidone
• Palovarotene
• Panobinostat
• Papaverine Hydrochloride
• Paroxetine
• Pasireotide
• Pazopanib
• Penicillin G
• Penicillin G Benzathine
• Penicillin G Procaine
• Penicillin V
• Pentamidine
• Perphenazine
• Phenobarbital
• Phenprocoumon
• Phenytoin
• Pimavanserin
• Pipamperone
• Piperacillin
• Piperaquine
• Pitolisant
• Pivampicillin
• Ponesimod
• Porfimer
• Posaconazole
• Primidone
• Probucol
• Procainamide
• Prochlorperazine
• Promethazine
• Propafenone
• Protriptyline
• Quetiapine
• Quinidine
• Quinine
• Ranolazine
• Relugolix
• Ribociclib
• Risperidone
• Ritonavir
• Selpercatinib
• Sertindole
• Sertraline
• Sevoflurane
• Siponimod
• Sodium Phosphate
• Sodium Phosphate, Dibasic
• Sodium Phosphate, Monobasic
• Solifenacin
• Sorafenib
• Sotalol
• Sulpiride
• Sultamicillin
• Sultopride
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tegafur
• Telaprevir
• Telavancin
• Telithromycin
• Temocillin
• Tetrabenazine
• Tolterodine
• Toremifene
• Trazodone
• Tretinoin
• Trimipramine
• Triptorelin
• Vandetanib
• Vardenafil
• Vemurafenib
• Venlafaxine
• Vilanterol
• Vinflunine
• Voclosporin
• Voriconazole
• Vorinostat
• Warfarin
• Zotepine
• Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aluminum Carbonate, Basic
• Aluminum Hydroxide
• Aluminum Phosphate
• Aminolevulinic Acid
• Atovaquone
• Calcium
• Carbamazepine
• Cholestyramine
• Colestipol
• Cyclosporine
• Dihydroxyaluminum Aminoacetate
• Dihydroxyaluminum Sodium Carbonate
• Iron
• Magaldrate
• Magnesium Carbonate
• Magnesium Hydroxide
• Magnesium Oxide
• Magnesium Trisilicate
• Milk Thistle
• Quinine

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is not recommended. Your doctor may decide not to treat you with this medication, change some of the other medicines you take, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Dairy Food

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Blood problems, history of (eg, leukopenia) or
• Encephalopathy or
• Fungal infection (eg, candidiasis) or
• Peripheral neuropathy or
• Seizures, history of—Use with caution. May make these conditions worse.

• Cockayne Syndrome (genetic disorder) or
• Kidney disease, severe or
• Liver disease, severe—Should not be used in patients with these conditions.

Proper Use

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Your doctor will also prescribe another medicine called omeprazole that must be taken with this medicine.

Swallow the capsules whole and with a full glass (8 ounces) of water. Do not crush, break, or chew the capsules.

Drink extra fluids to help prevent irritation or ulcers in the esophagus (the tube between the throat and stomach).

Keep using this medicine for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (capsules):
  • For the treatment of H. pylori infection and duodenal ulcer (taken with omeprazole):
    • Adults—3 capsules 4 times a day, after meals and at bedtime, for 10 days.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss more than 4 doses of this medicine, check with your doctor right away.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is very important that your doctor check your progress at regular visits for any problems or unwanted effects that may be caused by this medicine.

Do not use this medicine if you are also using methoxyflurane or have used disulfiram in the last 2 weeks. Do not drink alcohol while you are using this medicine and for at least 3 days after your last dose.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.

Birth control pills may not work properly if you take them while you are using this medicine. You should use a different or additional means of birth control (eg, condoms, diaphragm, or a contraceptive foam or jelly) while you are using this medicine. If you have any questions about this, check with your doctor.

Bismuth subcitrate may cause your tongue to become a darker color or even black. It may also make your stools (bowel movements) black. This is only temporary and will not hurt you. Your tongue and stools will go back to normal when you stop using this medicine. Ask your doctor about this if you have any concerns.

Do not drink milk or eat dairy products with this medicine.

Check with your doctor right away if you start to have a stiff neck, drowsiness, fever, severe headache, nausea, vomiting, painful eye movements, or eye sensitivity to light. These could be symptoms of a serious condition called aseptic meningitis syndrome (AMS).

Check with your doctor right away if you are having burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Tetracycline may make your skin more sensitive to sunlight. Exposure to sunlight, even for brief periods of time, may cause a rash, itching, redness, or other discoloration of the skin, or a severe sunburn. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) can occur with this medicine. Check with your doctor right away if you have black, tarry stools, blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, fever, itching, painful or difficult urination, red irritated eyes, red skin lesions, severe acne or skin rash, sore throat, sores or ulcers or white spots in the mouth or on the lips, swollen glands, or unusual tiredness or weakness while you are using this medicine.

Before you have any medical tests or x-rays, tell the medical doctor in charge that you are using this medicine. The results of some tests may be affected by this medicine.

You should not drink alcoholic beverages or take other alcohol-containing preparations while you are using this medicine, and for at least 1 day after stopping it.

If your symptoms do not improve within a few days or if they become worse, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

1. Belching
2. chills
3. cough
4. darkened urine
5. diarrhea
6. fever
7. general feeling of discomfort or illness
8. headache
9. heartburn
10. indigestion
11. joint pain
12. loss of appetite
13. muscle aches and pains
14. nausea
15. pains in the stomach, side, or abdomen, possibly radiating to the back
16. runny nose
17. shivering
18. sore or dry throat
19. stomach discomfort, upset, or pain
20. sweating
21. trouble sleeping
22. unusual tiredness or weakness
23. vomiting
24. yellow eyes or skin

Less common

1. Back pain
2. black, tarry stools
3. body aches or pain
4. burning feeling in the chest or stomach
5. burning while urinating
6. chest pain
7. dizziness
8. fast, irregular, pounding, or racing heartbeat or pulse
9. frequent urination
10. hoarseness
11. increased volume of pale, dilute urine
12. itching of the vagina or genital area
13. lack or loss of strength
14. lower back or side pain
15. pain during sexual intercourse
16. painful or difficult urination
17. pale skin
18. rash with flat lesions or small raised lesions on the skin
19. sneezing
20. stuffy nose
21. tender, swollen glands in the neck
22. tenderness in the stomach area
23. thick, white vaginal discharge with no odor or with a mild odor
24. trouble with swallowing
25. unusual bleeding or bruising
26. voice changes

Rare

1. Bloated feeling
2. excess air or gas in the stomach or bowels
3. feeling of fullness
4. pain or tenderness around the eyes and cheekbones
5. passing gas
6. skin rash
7. tightness of the chest
8. trouble breathing

Incidence not known

1. Blistering, peeling, loosening of the skin
2. blurred or decreased vision
3. burning, numbness, tingling, or painful sensations
4. clumsiness
5. itching
6. pressure in the stomach
7. red irritated eyes
8. red skin lesions, often with a purple center
9. sores, ulcers, or white spots in the mouth or on the lips
10. swelling of the stomach area
11. unsteadiness or awkwardness
12. weakness in the arms, hands, legs, or feet
13. white patches in the mouth or throat or on the tongue

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

1. Black or dark tongue
2. black stools

Less common

1. Change in taste, or bad, unusual, or unpleasant aftertaste
2. dry mouth
3. fear or nervousness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: March 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/bismuth-subcitrate-metronidazole-and-tetracycline-oral-route/proper-use/DRG-20070959