Bismuth Subcitrate, Metronidazole, and Tetracycline (Oral)

The medications metronidazole, tetracycline, and bismuth subcitrate are used together to combat a dangerous stomach infection which is caused by the H. pylori bacteria.


Individuals who are infected with H. pylori bacteria are usually prescribed a combination of bismuth subcitrate, metronidazole, and tetracycline to combat the progression of the infection, which can eventually lead to the development of ulcers. The combinations of drugs are highly effective in treating the H. pylori infection. The metronidazole and tetracycline are strong antibiotics, while bismuth subcitrate potassium is a mineral. It is known by the brand name Pylera. It can treat peptic ulcers also known as a duodenal ulcer that features helicobacter pylori infection. This drug is usually given together with the drug Prilosec.

This medication is known to have a variety of side effects both minor and severe and poses a high risk of deformity and complications during pregancy. Tetracylcine is known to cause birth defects and cause permanent tooth discoloration later in the life of babies exposed to this medication. Great caution should be taken when used in combination with other prescription medication. You should not take this drug if you have taken Antabuse or disulfiram within the past two weeks.

If you are currently taking birth control, you should know that tetracycline is known to decrease the effectiveness. You should use a form of birth control that is non-hormonal when using this medication. This medication is also harmful to nursing babies. You should not use breast milk until after twenty-four hours have passed after taking Pylera.

If you begin to experience any side effects associated with this drug, tell you, doctor, immediately. If it is a severe side effect, you should go immediately to the emergency room. Do not stop taking this medication without telling your doctor. Do not begin any other medication or supplements without discussing them with your healthcare provider first because they could pose a risk to your health and create interaction risks.

This medication is not intended for patients under the age of 8 years of age because of the toxicity of this drug. This drug is not recommended for use by anyone who is under the age of 18. Do not alter your dose or divide your medication. The usual dose of this medication is 3 capsules taken 4 times in the course of a day. It should be taken after meals and before your bedtime. Always take this medication with a full glass of water. The normal course for this treatment is 10 days. Do not stop taking this medication if your symptoms improve. Continue on your schedule as instructed by your doctor.

In addition to using caution when taking other medications, you should also completely avoid alcohol while taking this drug, and an additional day after you discontinue this medication. If you drink alcohol with Pylera, you may experience nausea, vomiting, headache, and flushing. Don't eat starchy food and baked goods while taking Pylera. You should also avoid gel capsule medication and salad dressing. Avoid products which contain propylene glycol and alcohol.

Condition treated

  • Peptic ulcer
  • H. pylori bacteria

Type of medication

  • Antibiotic

Side effects

Use great caution when taking this medication. It has a variety of possible side effects and can have a high risk of interaction with several medications and food. If you suspect you are having side effects as a result of taking Pylera, you should alert your doctor right away. If it is a serious side effect, you should go to the emergency room and have them notify your doctor.

Common side effects:

  • Sour or acidic stomach

This is a common reaction that should go away after an initial adjustment phase. If this side effect persists, you may be able to obtain a prescription to help with stomach issues.

  • Burping

Burping is normal, but if it becomes excessive you should ask about your options.

  • Chills

If you begin to have chills, it may be a sign of a negative reaction to this medication.

  • Coughing

If coughing becomes more frequent you may not tolerate this medication well.

Diarrhea is common when you begin taking this medication. If the condition persists you may require a dose adjustment or add an additional medication to help prevent diarrhea.

A low-grade fever may develop when taking this medication. A high fever may be a sign of a more serious condition.

  • Feelings of discomfort or illness

This may be a sign that you are not tolerating this medication well.

  • Headache

If you have persistent headaches you may be having an adverse reaction to Pylera.

You may experience heartburn with this medication. You may be prescribed a medication to prevent this side effect.

Indigestion is common during the adjustment phase.

  • Joint Pain

Some individuals may experience joint pain when taking Pylera.

  • Decreased appetite

A decrease in appetite is normal when taking this medication.

  • Aches and pains in muscles

Muscle aches and pains may occur in some individuals who take this medication, especially during the first few weeks.

  • Nausea

If you begin to have nausea with this medication you may need additional medication to relieve this side effect.

  • Runny nose

A runny nose is a common and mild side effect.

  • Shivers

If you develop shivers, you may be having an adverse reaction to the medication and may require action.

Some individuals who have taken Pylera have reported either a dry or sore throat.

If you develop insomnia, you may need medication to counteract this side effect.

  • Weakness or tiredness

You may feel weak or tired when taking Pylera.

  • Vomiting

If you vomit when taking Pylera, you may not be tolerating your medication and may need a dose change or a different prescription.

  • Black or dark tongue

This is a common side effect and normally goes away after the adjustment phase.

  • Black Stools

This is a common side effect and may persist through your treatment.

Less common side effects:

Back pain may occur in some individuals taking this medication.

  • Body aches

Body aches may signal that you are not tolerating the medication well.

  • Burning in stomach or chest

A burning sensation in the chest or in the stomach is a known side effect of this medication.

Chest pain could be a side effect, or it could signal a life-threatening emergency.

  • Congestion

Congestion is uncommon, but a mild side effect.

Dizziness may be a sign of an allergic or serious reaction to Pylera.

  • Irregular heartbeat, fast heartbeat, pounding heartbeat

Variations in heartbeat are possible when taking this drug. Monitor the situation closely.

  • Hoarseness

Many people have reported experiencing hoarseness when taking Pylera.

  • Genital itching

Genital itching is possible in some patients.

  • Weakness

Some people who take Pylera have noticed marked weakness as a result of the treatment.

  • Back or side pain

Back or side pain can be a warning sign of a serious condition or an intolerance to the medication.

  • Painful intercourse

There have been reports of Pylera causing painful intercourse.

  • Painful urination

There is potential for this medication to make urination painful for both men and women.

  • Rash with lesions

Pylera has been known to produce a rash with lesions on the skin of patients.

  • Sneezing

Some patients have reported sneezing with Pylera.

  • Stuffy nose

A stuffy nose is a mild side effect.

  • Swollen or tender glands

This medication has been known to produce swollen and tender glands.

  • Stomach tenderness

If you develop stomach tenderness you should watch your condition closely.

  • White odorless vaginal discharge

Vaginal discharge can be a potential side effect in some women.

  • Trouble swallowing

If you begin to have trouble swallowing you should monitor your condition closely.

  • Voice change

This is not a common side effect but is usually mild.

  • Nervousness or fear

If you begin to feel fearful or nervous, you may require a different medication or a dose change.

  • Dry mouth

This medication is known to cause dry mouth in some instances.

  • Change in tastes

You may notice a change in the way food and drink tastes when taking Pylera.

Rare side effects:

  • Bloating

Pylera has, in some instances, been known to cause bloating.

  • Gas in the stomach or intestines

Some patients have reported having excess gas in their stomach or intestines.

  • Full feelings

A feeling of fullness is a rare but mild side effect.

  • Pain around cheekbones or eyes

Some people report pain in their cheekbones and around their eyes when taking Pylera.

  • Flatulence

Some people have reported frequent flatulence associated with taking this medication.

  • Rash

There has been some incidence of skin rashes associated with taking this medication.

  • Chest tightness

Chest tightness can be a sign of a life-threatening reaction or a more serious medical issue that requires immediate treatment.

  • Trouble breathing

If you have trouble breathing you should go to the emergency room immediately.


If the drug is administered to combat H. pylori, the usual adult dose is 420 mg of bismuth subcitrate potassium, 375 mg of tetracycline, and 375 mg of metronidazole taken orally four times per day at meals and at bedtime for ten days. This drug is usually given in conjunction with omeprazole which is administered twice daily in the morning and the evening. The same dose is recommended for pediatric patients 8 years and older under the close supervision of a doctor. Do not take this medication if you have severe hepatic dysfunction or severe renal impairment.

Take this medication with a full glass of water and with food. If you happen to miss a dose you should resume your normal dosing schedule. Do not double doses because it could cause a harmful reaction or severe side effects. Do not stop taking this medication until it is completely gone and as directed by your doctor or healthcare provider.


This drug is known to currently have 648 drug interactions. Of those 648 interactions, 17 are major drug interactions, 393 are moderate drug interactions, and 238 are minor drug interactions. Some of the common drugs that interact with Pylera are:

  • Antacids, famotidine, magnesium hydroxide
  • Lupron Depot-Gyn
  • Centrum Silver men's vitamins
  • Pepto Bismol maximum strength
  • Prosteon
  • Tums extra strength

Other interactions:

  • Multivitamins with minerals

This tetracycline in this drug can bind with iron and prevent absorption in the body, which, in turn, can decrease this medication's effectiveness. If you must take medications containing iron, you should wait three hours after taking it to take Pylera. You may be able to get different prescriptions that do not interfere with your treatment. You should talk to your doctor to discuss your options.

  • Alcohol

Taking this medication with alcohol can result in a condition known as disulfiram reaction. This reaction can include symptoms such as a throbbing headache, throbbing in the neck and head, trouble breathing, nausea, vomiting, palpitations, sweating, hyperventilation, thirst, chest pain, tachycardia, hypotension, syncope, arrhythmia, acute congestive heart failure, dyspnea, blurry vision, cardiovascular collapse, unconsciousness, weakness, vertigo, convulsions, and death.

Certain foods:

Some foods can decrease the effectiveness of this medication. Dairy, in particular, is known to have this effects because of its calcium content.


This medication is not intended for use in patients under the age of 8 years of age due to the high potential for toxicity. Before you begin taking this medication, you should discuss any pre-existing conditions you may have as well as any medication or supplements such as vitamins that you are currently taking. Your doctor may want to change your current prescriptions to other medications that do not have a reaction to Pylera.

This drug poses a high risk for side effects. You should tell your doctor about any side effects you develop. If the side effects are serious you should go to the emergency room and contact your doctor immediately. You should take this medication with a full glass of water and approximately an hour after eating a meal. If you take supplements or other medications containing iron, you should consult your physician. Avoid some starchy foods and dairy because they decrease the effectiveness of this drug.

Do not use this drug if you are pregnant or nursing because it poses a high incidence of birth defects and tooth discoloration later on in life for babies exposed during pregnancy or through breast milk. Do not give breast milk to babies until 24 hours has passed since taking this medication. Do not drink alcohol or eat food with alcohol in them while you are taking this medication. You should wait for the at least one-day one you quit taking Pylera to drink alcohol. If you consume alcohol with this drug you run a high risk of developing a variety of negative and potentially life-threatening reactions. Do not stop taking this medication once you begin to feel better. Take all of your prescriptions to prevent a reoccurrence of the bacteria. Do not store this drug near heat or light and keep it out of reach of children and pets.


Do not store this medication where children and pets can reach it. Keep this drug in a locking bottle with the lid locked securely. Do not store near heat or light and keep away from excessive moisture in areas such as the bathroom. If this medication expires you should dispose of it at your community take-back program. If you do not have a community take-back program, you should consult the FDA's pamphlet about proper drug disposal.


This medication is prescribed to individuals who have the H. pylori stomach infection. If left untreated, H. pylori can lead to stomach ulcers. This medication is a combination of a mineral and two powerful antibiotics. It is known to have a variety of interaction and side effects so it should be used under the close supervision of your doctor or healthcare provider. It has a history of toxicity and can pose a danger to children under the age of 8 years of age.

You should discuss with your doctor the foods and medications you should avoid while taking this drug. It has many interactions and could cause a severe adverse reaction. You should avoid drinking any alcohol or food with alcohol while taking this medication because it can cause adverse reactions. Do not give this medication to children under the age of 8 years.

Store this medication away from heat and light. Keep it in the original prescription bottle, especially if you plan to travel. Do not keep this drug where children or pets can reach it. Do not keep your medication in the bathroom where it could be exposed to excess humidity. Do not keep other medications in the same bottle with Pylera.

Last Reviewed:
December 24, 2017
Last Updated:
April 05, 2018
Content Source: