Skip to main content

Pylera Disease Interactions

There are 10 disease interactions with Pylera (bismuth subcitrate potassium / metronidazole / tetracycline).

Major

Antibiotics (applies to Pylera) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious), Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

References

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):
  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
View all 30 references
Major

Nitroimidazoles (applies to Pylera) blood dyscrasias

Major Potential Hazard, Low plausibility. Applicable conditions: History - Blood Dyscrasias, Bone Marrow Depression/Low Blood Counts

The use of nitroimidazoles (e.g., metronidazole, tinidazole) has rarely been associated with hematologic adverse effects such as mild, transient leukopenia, thrombocytopenia, and bone marrow aplasia. The manufacturers recommend that therapy with nitroimidazoles be administered cautiously in patients with evidence of or a history of blood dyscrasias, and that total and differential leukocyte counts be performed before and after treatment with these drugs, particularly in patients receiving repeated courses of therapy.

References

  1. Smith JA "Neutropenia associated with metronidazole therapy." Can Med Assoc J 123 (1980): 202
  2. White CM, Price JJ, Hunt KM "Bone marrow aplasia associated with metronidazole." Br Med J 280 (1980): 647
  3. "Product Information. Flagyl (metronidazole)." Searle (2002):
  4. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc (2004):
View all 4 references
Major

Nitroimidazoles (applies to Pylera) neurologic toxicity

Major Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder, Peripheral Neuropathy

The use of nitroimidazoles (e.g., metronidazole, tinidazole) has been associated with the development of nervous system toxicity including convulsive seizures and dose-related peripheral neuropathy, the latter characterized primarily by numbness or paresthesia of an extremity. Persistent peripheral neuropathy has been reported in some patients treated for prolonged periods. Other neurologic adverse effects include vertigo, incoordination, ataxia, confusion, agitation, hallucinations, and depression. Therapy with nitroimidazoles should be administered cautiously in patients with or predisposed to seizures or other nervous system abnormalities. Nitroimidazole therapy should be discontinued promptly if neurologic disturbances occur.

References

  1. Kusumi RK, Plouffe JF, Wyatt RH, Fass RJ "Central nervous sytem toxicity associated with metronidazole therapy." Ann Intern Med 93 (1980): 59-60
  2. Schentag JJ, Ziemniak JA, Greco JM, Rainstein M, Buckley RJ "Mental confusion in a patient treated with metronidazole: a concentration-related effect." Pharmacotherapy 2 (1982): 384-7
  3. Alvarez RS, Richardson DA, Bent AE, Ostergard DR "Central nervous system toxicity related to prolonged metronidazole therapy." Am J Obstet Gynecol 145 (1983): 640-1
  4. Wienbren M, Perinpanayagam RM, Camba L, Lee CA "Convulsions and encephalopathy in a patient with leukaemia after treatment with metronidazole." J Clin Pathol 38 (1985): 1076
  5. Duffy LF, Daum F, Fisher SE, et al. "Peripheral neuropathy in Crohn's disease patients treated with metronidazole." Gastroenterology 88 (1985): 681-4
  6. Boyce EG, Cookson ET, Bond WS "Persistent metronidazole-induced peripheral neuropathy." DICP 24 (1990): 19-21
  7. Stahlberg D, Barany F, Einarsson K, Ursing B, Elmquist D, Persson A "Neurophysiologic studies of patients with Crohn's disease on long-term treatment with metronidazole." Scand J Gastroenterol 26 (1991): 219-24
  8. "Product Information. Flagyl (metronidazole)." Searle (2002):
  9. Learned-Coughlin S "Peripheral neuropathy induced by metronidazole." Ann Pharmacother 28 (1994): 536
  10. Lawford R, Sorrell TC "Amebic abscess of the spleen complicated by metronidazole-induced neurotoxicity: case report." Clin Infect Dis 19 (1994): 346-8
  11. Ahmed A, Laes DJ, Bressler EL "Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy." Neurology 45 (1995): 588-9
  12. Schreiber W, Spernal J "Metronidazole-induced psychotic disorder." Am J Psychiatry 154 (1997): 1170-1
  13. Beloosesky Y, Grosman B, Marmelstein V, Grinblat J "Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure." Am J Med Sci 319 (2000): 338-9
  14. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc (2004):
View all 14 references
Moderate

Metronidazole (applies to Pylera) dialysis

Moderate Potential Hazard, High plausibility. Applicable conditions: hemodialysis

Metronidazole and its metabolites are moderately removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. Somogyi A, Kong C, Sabto J, Gurr FW, Spicer WJ, McLean AJ "Disposition and removal of metronidazole in patients undergoing haemodialysis." Eur J Clin Pharmacol 25 (1983): 683-7
  2. Roux AF, Moirot E, Delhotal B, et al. "Metronidazole kinetics in patients with acute renal failure on dialysis: a cumulative study." Clin Pharmacol Ther 36 (1984): 363-8
  3. Kreeft JH, Ogilvie RI, Dufresne LR "Metronidazole kinetics in dialysis patients." Surgery 93 (1983): 149-53
  4. Lau AH, Chang CW, Sabatini S "Hemodialysis clearance of metronidazole and its metabolites." Antimicrob Agents Chemother 29 (1986): 235-8
  5. "Product Information. Flagyl (metronidazole)." Searle (2002):
View all 5 references
Moderate

Metronidazole (applies to Pylera) liver disease

Moderate Potential Hazard, High plausibility.

Metronidazole is extensively metabolized by the liver to both pharmacologically active and inactive compounds. The plasma clearance of metronidazole may be decreased and the half-life prolonged in patients with impaired hepatic function. Therapy with metronidazole should be administered cautiously at reduced dosages in patients with severe liver disease.

References

  1. Lau AH, Evans R, Chang CW, Seligsohn R "Pharmacokinetics of metronidazole in patients with alcoholic liver disease." Antimicrob Agents Chemother 31 (1987): 1662-4
  2. Jensen JC, Gugler R "Single- and multiple-dose metronidazole kinetics." Clin Pharmacol Ther 34 (1983): 481-7
  3. Farrell G, Baird-Lambert J, Cvejic M, Buchanan N "Disposition and metabolism of metronidazole in patients with liver failure." Hepatology 4 (1984): 772-6
  4. Loft S, Dossing M, Poulsen HE, et al. "Influence of dose and route of administration on disposition of metronidazole and its major metabolites." Eur J Clin Pharmacol 30 (1986): 467-73
  5. Loft S, Sonne J, Dossing M, Andreasen PB "Metronidazole pharmacokinetics in patients with hepatic encephalopathy." Scand J Gastroenterol 22 (1987): 117-23
  6. "Product Information. Flagyl (metronidazole)." Searle (2002):
View all 6 references
Moderate

Metronidazole (applies to Pylera) sodium

Moderate Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, Hypertension, Fluid Retention, Hypernatremia

Flagyl I.V. RTU (brand of metronidazole ready-to-use injection) contains 14 mEq of sodium per each 500 mg dose of metronidazole. The sodium content should be considered when this product is used in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

References

  1. "Product Information. Flagyl (metronidazole)." Searle (2002):
Moderate

Nitroimidazoles (applies to Pylera) alcoholism

Moderate Potential Hazard, Moderate plausibility.

Nitroimidazoles (e.g., metronidazole, tinidazole, fexinidazole, secnidazole) may inhibit alcohol dehydrogenase and occasionally precipitate a disulfiram-like reaction in patients who consume alcohol while being treated. Symptoms may include abdominal cramps, nausea, vomiting, headache, flushing, rash, weakness, diarrhea, abdominal pain, dizziness, sweating, and hypotension. Patients should be instructed to avoid alcohol-containing products during nitroimidazole therapy and for at least 48 hours (fexinidazole, secnidazole) to 72 hours (metronidazole, tinidazole) after the last dose. Therapy with nitroimidazoles should be administered cautiously in patients who might be prone to acute alcohol intake. An alternative therapy may be appropriate.

References

  1. "Product Information. Flagyl (metronidazole)." Searle (2002):
  2. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc (2004):
  3. "Product Information. Solosec (secnidazole)." Symbiomix Therapeutics (2017):
  4. "Product Information. Fexinidazole (fexinidazole)." sanofi-aventis (2021):
View all 4 references
Moderate

Tetracyclines (applies to Pylera) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

The use of tetracyclines has rarely been associated with hepatotoxicity. Histologic fatty changes of the liver, elevated liver enzymes, and jaundice have been reported, primarily in patients treated with large doses of intravenous tetracycline hydrochloride (no longer available in the U.S.) but also in patients receiving high oral doses of these drugs. Therapy with tetracyclines should be administered cautiously in patients with preexisting liver disease or biliary obstruction. Reduced dosages may be appropriate, particularly with minocycline and doxycycline, since the former is metabolized by the liver and the latter undergoes enterohepatic recycling. Liver function tests are recommended prior to and during therapy, and the concomitant use of other potentially hepatotoxic drugs should be avoided.

References

  1. Burette A, Finet C, Prigogine T, De Roy G, Deltenre M "Acute hepatic injury associated with minocycline." Arch Intern Med 144 (1984): 1491-2
  2. Min DI, Burke PA, Lewis D, Jenkins RL "Acute hepatic failure associated with oral minocycline: a case report." Pharmacotherapy 12 (1992): 68-71
  3. Nelis HJ, De Leenheer AP "Metabolism of minocycline in humans." Drug Metab Dispos 10 (1982): 142-6
  4. Brogden RN, Speight TM, Avery GS "Minocycline: a review of its antibacterial and pharmacokinetic properties and therapeutic use." Drugs 9 (1975): 251-91
  5. "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Minocin (minocycline)." Lederle Laboratories (2002):
  7. "Product Information. Achromycin (tetracycline)." Lederle Laboratories (2001):
  8. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories (2001):
  9. Malcolm A, Heap TR, Eckstein RP, Lunzer MR "Minocycline-induced liver injury." Am J Gastroenterol 91 (1996): 1641-3
  10. Golstein PE, Deviere J, Cremer M "Acute hepatitis and drug-related lupus induced by minocycline treatment." Am J Gastroenterol 92 (1997): 143-6
  11. "Product Information. Terramycin (oxytetracycline)." Pfizer U.S. Pharmaceuticals (2001):
View all 11 references
Moderate

Tetracyclines (applies to Pylera) renal dysfunction

Moderate Potential Hazard, High plausibility.

Tetracyclines (except doxycycline) are eliminated by the kidney to various extent. Patients with renal impairment may be at greater risk for tetracycline-associated hepatic and/or renal toxicity (increased BUN with consequent azotemia, hyperphosphatemia, and acidosis) due to decreased drug clearance. Therapy with tetracyclines should be administered cautiously at reduced dosages in patients with renal impairment. Clinical monitoring of renal and liver function is recommended, and serum tetracycline levels may be necessary during prolonged therapy.

References

  1. Lee P, Crutch ER, Morrison RB, et al. "Doxycycline: studies in normal subjects and patients with renal failure." N Z Med J 75 (1972): 355-8
  2. Letteri JM, Miraflor F, Tablante V, Siddiqi S "Doxycycline (vibramycin) in chronic renal failure." Nephron 11 (1973): 318-24
  3. Whelton A, von Wittenau MS, Twomey TM, et al. "Doxycycline pharmacokinetics in the absence of renal function." Kidney Int 5 (1974): 365-71
  4. Mahon WA, Johnson GE, Endrenyi L, et al. "The elimination of tritiated doxycycline in normal subjects and in patients with severely impaired renal function." Scand J Infect Dis 9 (1976): 24-31
  5. Heaney D, Eknoyan G "Minocycline and doxycycline kinetics in chronic renal failure." Clin Pharmacol Ther 24 (1978): 233-9
  6. Houin G, Brunner F, Nebout T, et al. "The effects of chronic renal insufficiency on the pharmacokinetics of doxycycline in man." Br J Clin Pharmacol 16 (1983): 245-52
  7. Shils ME "Renal disease and the metabolic effects of tetracycline." Ann Intern Med 58 (1963): 389-408
  8. George CR, Evans RA "Tetracycline toxicity in renal failure." Med J Aust 06/12/71 (1971): 1271-3
  9. Whelton A "Tetracyclines in renal insufficiency: resolution of a therapeutic dilemma." Bull N Y Acad Med 54 (1978): 223-36
  10. Reddy J "Tetracycline antibiotics should be avoided in patients with renal disease." N Z Med J 94 (1981): 396
  11. Carney S, Butcher RA, Dawborn JK, Pattison G "Minocycline excretion and distribution in relation to renal function in man." Clin Exp Pharmacol Physiol 1 (1974): 299-308
  12. Welling PG, Shaw WR, Uman SJ, Tse FL, Craig WA "Pharmacokinetics of minocycline in renal failure." Antimicrob Agents Chemother 8 (1975): 532-7
  13. Saivin S, Houin G "Clinical pharmacokinetics of doxycycline and minocycline." Clin Pharmacokinet 15 (1988): 355-66
  14. Sklenar I, Spring P, Dettli L "One-dose and multiple-dose kinetics of minocycline in patients with renal disease." Agents Actions 7 (1977): 369-77
  15. Jonas M, Cunha BA "Minocycline." Ther Drug Monit 4 (1982): 137-45
  16. Macdonald H, Kelly RG, Allen ES, et al. "Pharmacokinetic studies on minocycline in man." Clin Pharmacol Ther 14 (1973): 852-61
  17. Brogden RN, Speight TM, Avery GS "Minocycline: a review of its antibacterial and pharmacokinetic properties and therapeutic use." Drugs 9 (1975): 251-91
  18. "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals (2002):
  19. "Product Information. Minocin (minocycline)." Lederle Laboratories (2002):
  20. "Product Information. Achromycin (tetracycline)." Lederle Laboratories (2001):
  21. Braden GL, Geheb MA, Shook A, Singer I, Cox M "Demeclocycline-induced natriuresis and renal insufficiency: in vivo and in vitro studies." Am J Kidney Dis 5 (1985): 270-7
  22. Roth H, Becker KL, Shalhoub RJ, Katz S "Nephrotoxicity of demethylchlortetracycline hydrochloride. A prospective study." Arch Intern Med 120 (1967): 433-5
  23. Miller PD, Linas SL, Schrier RW "Plasma demeclocycline levels and nephrotoxicity. Correlation in hyponatremic cirrhotic patients." JAMA 243 (1980): 2513-5
  24. Kirkpatrick R "Demeclocycline and renal insufficiency." JAMA 239 (1978): 616
  25. Oster JR, Epstein M "Demeclocycline-induced renal failure." Lancet 1 (1977): 52
  26. Carrilho F, Bosch J, Arroyo V, Mas A, Viver J, Rodes J "Renal failure associated with demeclocycline in cirrhosis." Ann Intern Med 87 (1977): 195-7
  27. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories (2001):
  28. "Product Information. Terramycin (oxytetracycline)." Pfizer U.S. Pharmaceuticals (2001):
View all 28 references
Moderate

Tetracyclines (oral) (applies to Pylera) esophageal irritation

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Esophageal Obstruction

The use of oral tetracycline capsules and tablets has been associated with esophageal irritation and ulceration in patients who ingested the drug without sufficient fluid shortly before bedtime. Therapy with solid formulations of tetracyclines should preferably be avoided in patients with esophageal obstruction, compression or dyskinesia. If the drugs are used, patients should be advised not to take the medication just before retiring and to drink fluids liberally.

References

  1. Aarons B, Bruns BJ "Oesophageal ulceration associated with ingestion of doxycycline." N Z Med J 91 (1980): 27
  2. Geschwind A "Oesophagitis and oesophageal ulceration following ingestion of doxycycline tablets." Med J Aust 140 (1984): 223
  3. Amendola MA, Spera TD "Doxycycline-induced esophagitis." JAMA 253 (1985): 1009-11
  4. Khera DC, Herschman BR, Sosa F "Tetracycline-induced esophageal ulcers." Postgrad Med J 68 (1980): 113-5
  5. Channer KS, Hollanders D "Tetracycline-induced oesophageal ulceration." Br Med J 282 (1981): 1359-60
  6. "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals (2002):
  7. "Product Information. Minocin (minocycline)." Lederle Laboratories (2002):
  8. "Product Information. Achromycin (tetracycline)." Lederle Laboratories (2001):
  9. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories (2001):
  10. Foster JA, Sylvia LM "Doxycyline-induced esophageal ulceration." Ann Pharmacother 28 (1994): 1185-7
  11. Nordt SP "Tetracycline-induced oral mucosal ulceration." Ann Pharmacother 30 (1996): 547-8
  12. "Product Information. Terramycin (oxytetracycline)." Pfizer U.S. Pharmaceuticals (2001):
View all 12 references

Pylera drug interactions

There are 497 drug interactions with Pylera (bismuth subcitrate potassium / metronidazole / tetracycline).

Pylera alcohol/food interactions

There are 3 alcohol/food interactions with Pylera (bismuth subcitrate potassium / metronidazole / tetracycline).


Report options

Share by QR Code
QR code containing a link to this page

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.