Bismuth subcitrate, metronidazole, and tetracycline (Oral)
BIZ-muth sub-SIT-rate poe-TAS-ee-um, met-roe-NYE-da-zole, tet-ra-SYE-kleen hye-droe-KLOR-ide
Metronidazole has been shown to be carcinogenic in mice and rats. It is unknown whether metronidazole is associated with carcinogenicity in humans .
Medically reviewed on June 7, 2018
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antiulcer, Helicobacter Pylori
Chemical Class: Nitroimidazole
Uses For bismuth subcitrate, metronidazole, and tetracycline
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. Bismuth subcitrate, metronidazole, and tetracycline should not be used for any other infection.
Bismuth subcitrate, metronidazole, and tetracycline is available only with your doctor's prescription.
Before Using bismuth subcitrate, metronidazole, and tetracycline
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 bismuth subcitrate, metronidazole, and tetracycline, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to bismuth subcitrate, metronidazole, and tetracycline 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.
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.
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 bismuth subcitrate, metronidazole, and tetracycline.
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.
Interactions with Medicines
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 bismuth subcitrate, metronidazole, and tetracycline, 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 bismuth subcitrate, metronidazole, and tetracycline 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.
Using bismuth subcitrate, metronidazole, and tetracycline 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.
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Cholera Vaccine, Live
- Inotuzumab Ozogamicin
- Mycophenolate Mofetil
- Mycophenolic Acid
- Papaverine Hydrochloride
- Penicillin G
- Penicillin G Benzathine
- Penicillin G Procaine
- Penicillin V
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
Using bismuth subcitrate, metronidazole, and tetracycline 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
- Dihydroxyaluminum Aminoacetate
- Dihydroxyaluminum Sodium Carbonate
- Magnesium Carbonate
- Magnesium Hydroxide
- Magnesium Oxide
- Magnesium Trisilicate
- Milk Thistle
Interactions with Food/Tobacco/Alcohol
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 bismuth subcitrate, metronidazole, and tetracycline 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.
Using bismuth subcitrate, metronidazole, and tetracycline 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 bismuth subcitrate, metronidazole, and tetracycline, 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 bismuth subcitrate, metronidazole, and tetracycline. 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 (a rare brain and nerve disorder that causes loss of function over time)—Use with caution. Patients with this condition have an increased risk for having serious side effects (eg, liver failure).
- Kidney disease, severe or
- Liver disease, severe—Should not be used in patients with these conditions.
Proper Use of bismuth subcitrate, metronidazole, and tetracycline
Take bismuth subcitrate, metronidazole, and tetracycline 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 bismuth subcitrate, metronidazole, and tetracycline.
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 bismuth subcitrate, metronidazole, and tetracycline 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.
The dose of bismuth subcitrate, metronidazole, and tetracycline 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 bismuth subcitrate, metronidazole, and tetracycline. 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.
- For the treatment of H. pylori infection and duodenal ulcer (taken with omeprazole):
If you miss a dose of bismuth subcitrate, metronidazole, and tetracycline, 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 bismuth subcitrate, metronidazole, and tetracycline, check with your doctor right away.
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 While Using bismuth subcitrate, metronidazole, and tetracycline
It is very important that your doctor check your progress at regular visits for any problems or unwanted effects that may be caused by bismuth subcitrate, metronidazole, and tetracycline.
Do not use bismuth subcitrate, metronidazole, and tetracycline if you are also using methoxyflurane or have used disulfiram in the last 2 weeks. Do not drink alcohol while you are using bismuth subcitrate, metronidazole, and tetracycline and for at least 3 days after your last dose.
Using bismuth subcitrate, metronidazole, and tetracycline 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 bismuth subcitrate, metronidazole, and tetracycline, tell your doctor right away.
Birth control pills may not work properly if you take them while you are using bismuth subcitrate, metronidazole, and tetracycline. You should use a different or additional means of birth control (eg, condoms, diaphragm, or a contraceptive foam or jelly) while you are using bismuth subcitrate, metronidazole, and tetracycline. 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 bismuth subcitrate, metronidazole, and tetracycline. Ask your doctor about this if you have any concerns.
Do not drink milk or eat dairy products with bismuth subcitrate, metronidazole, and tetracycline.
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 can occur with bismuth subcitrate, metronidazole, and tetracycline. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using bismuth subcitrate, metronidazole, and tetracycline.
Before you have any medical tests or x-rays, tell the medical doctor in charge that you are using bismuth subcitrate, metronidazole, and tetracycline. The results of some tests may be affected by bismuth subcitrate, metronidazole, and tetracycline.
You should not drink alcoholic beverages or take other alcohol-containing preparations while you are using bismuth subcitrate, metronidazole, and tetracycline, 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.
Bismuth subcitrate, metronidazole, and tetracycline 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:
- general feeling of discomfort or illness
- joint pain
- loss of appetite
- muscle aches and pains
- runny nose
- sore or dry throat
- stomach discomfort, upset, or pain
- trouble sleeping
- unusual tiredness or weakness
- Back pain
- body aches or pain
- burning feeling in the chest or stomach
- chest pain
- fast, irregular, pounding, or racing heartbeat or pulse
- itching of the vagina or genital area
- lack or loss of strength
- lower back or side pain
- pain during sexual intercourse
- painful or difficult urination
- rash with flat lesions or small raised lesions on the skin
- stuffy nose
- tender, swollen glands in the neck
- tenderness in the stomach area
- thick, white vaginal discharge with no odor or with a mild odor
- trouble with swallowing
- voice changes
- Bloated feeling
- excess air or gas in the stomach or bowels
- feeling of fullness
- pain or tenderness around the eyes and cheekbones
- passing gas
- skin rash
- tightness of the chest
- trouble breathing
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:
- Black or dark tongue
- black stools
- Change in taste, or bad, unusual, or unpleasant aftertaste
- dry mouth
- 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.
See also: Side effects (in more detail)
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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- Drug class: H. pylori eradication agents
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Other brands: Pylera