Bismuth subcitrate/metronidazole/tetracycline

The drug combination bismuth subcitrate/metronidazole/tetracycline (trade name Pylera) is used for the treatment of peptic ulcer with an infection by the bacterium Helicobacter pylori.[1]

Bismuth subcitrate/metronidazole/tetracycline
Combination of
Bismuth subcitrateBismuth salt
MetronidazoleAntibiotic
TetracyclineAntibiotic
Clinical data
Trade namesPylera
AHFS/Drugs.compylera
Pregnancy
category
  • US: D (Evidence of risk)
    ATC code
    Legal status
    Legal status
    Identifiers
    ChemSpider
    • none

    Medical uses

    This combination is used together with omeprazole as a 'quadruple therapy' for the eradication of H. pylori and for preventing peptic ulcers that are caused by this bacterium.[2]

    Contraindications

    The drug must not be taken by pregnant women, because tetracycline is known to cause tooth and bone defects in unborn children. It is also contraindicated in breastfeeding women, children up to 12 years of age, and by patients with impaired liver or renal (kidney) function, because no studies in such persons have been conducted. Tetracycline is also likely to be harmful in liver patients.[2]

    Adverse effects

    Common side effects include diarrhoea, nausea and dysgeusia (distortion of the sense of taste), especially a metallic taste. These effects are known from the drug's components as well as from other antibiotics. A very rare but dangerous reaction is Stevens–Johnson syndrome, a life-threatening condition affecting the skin, which has also been described under metronidazole and tetracycline as separate drugs.[2]

    Interactions
    Further information: Bismuth subcitrate § Interactions, and Metronidazole § Drug interactions

    Metronidazole in combination with alcohol causes severe reactions such as vomiting and flushes in many patients. Tetracycline resorption is reduced by dairy products, antacids and other products containing calcium, magnesium, aluminium as well as iron.[2]

    Mechanism of action
    Further information: Bismuth subcitrate § Mechanism of action, Metronidazole § Mechanism of action, and Tetracycline § Mechanism of action

    Chemical properties

    Bismuth subcitrate potassium is a salt of bismuth (Bi3+), potassium (K+) and citrate (C6H5O73−), containing about 25.6% (mass percent) bismuth, which is the active moiety, and 22.9% potassium. Tetracycline is contained as the hydrochloride, and metronidazole as the pure substance.[2]

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    References
    1. Drugs.com FDA Professional Drug Information for Pylera.
    2. Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. 2017. Pylera 140 mg/125 mg/125 mg-Hartkapseln.
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