Comprehensive medication guide to Pylera including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$30–$100 copay on commercial plans that cover Pylera, which typically require prior authorization; many Medicare Part D and Medicaid plans do not cover it — check your formulary.
Estimated Cash Pricing
$300–$400 retail for the 10-day course (120 capsules); as low as $187–$200 with a GoodRx or SingleCare coupon at participating pharmacies.
Medfinder Findability Score
62/100
Summarize with AI
On this page
Pylera is a prescription oral capsule containing three active medications combined into one: bismuth subcitrate potassium (140 mg), metronidazole (125 mg), and tetracycline hydrochloride (125 mg). It is FDA-approved for the treatment of Helicobacter pylori (H. pylori) infection in adults with active duodenal ulcer disease or a history of duodenal ulcer within the past five years.
Pylera is always used together with omeprazole (a proton pump inhibitor) as part of what is called bismuth-based quadruple therapy (BQT). The standard regimen is 3 Pylera capsules four times daily after meals and at bedtime for 10 days, plus omeprazole 20 mg twice daily. This combination achieves H. pylori eradication rates of approximately 90–97% when taken correctly.
Pylera is manufactured by H2 Pharma and is classified in the drug class of H. pylori eradication agents. It is not a controlled substance. A generic version has received FDA approval, though its retail availability at pharmacies can be inconsistent.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Pylera attacks H. pylori bacteria through three simultaneous and distinct mechanisms, making it very difficult for the bacteria to develop resistance to the treatment. Bismuth subcitrate potassium disrupts H. pylori's outer cell membrane, inhibits the urease enzyme that the bacteria uses to survive in stomach acid, and enhances the antibacterial activity of the two antibiotic components.
Metronidazole enters H. pylori cells and, once activated by bacterial electron transport proteins, generates toxic free radicals that damage the bacteria's DNA — preventing replication and causing cell death. Tetracycline binds to the 30S subunit of the bacterial ribosome, blocking protein synthesis and preventing H. pylori from growing and dividing.
The fourth component, omeprazole, is prescribed alongside Pylera to reduce stomach acid. This improves the stability and bioavailability of the antibiotic components and directly promotes healing of any existing peptic ulcers. Together, these four drugs create a highly effective environment for eliminating H. pylori from the stomach lining.
140 mg / 125 mg / 125 mg per capsule — capsule
Bismuth subcitrate potassium 140 mg / metronidazole 125 mg / tetracycline HCl 125 mg. Take 3 capsules 4 times daily (after meals and at bedtime) with a full glass of water for 10 days, alongside omeprazole 20 mg twice daily.
Pylera is not currently on the FDA's official Drug Shortage Database, but many patients still struggle to find it at local pharmacies. The primary barriers are economic rather than manufacturing: Pylera's high retail price ($300–$400 per course) and limited insurance coverage result in low prescription volume, which means many pharmacies don't routinely keep it in stock.
Larger chain pharmacies (CVS, Walgreens, Walmart, Costco) and hospital-affiliated outpatient pharmacies are the most likely to carry Pylera. Smaller independent pharmacies frequently do not stock it. Pharmacies that don't have it on hand can typically special-order it within 24–48 hours from their drug distributor.
If you're struggling to locate Pylera near you, medfinder can help. Enter your medication, dosage, and location, and medfinder contacts pharmacies in your area to find which ones can fill your prescription. Results are texted directly to you — no hold music required.
Pylera is not a controlled substance, which means any licensed prescriber with prescribing authority can write a prescription for it — without DEA scheduling restrictions, special licensing, or mandatory in-person visits. Prescriptions can be sent electronically, faxed, or called in to the pharmacy.
Gastroenterologists (GI specialists)
Internal medicine physicians
Primary care physicians (PCPs) and family medicine doctors
Nurse practitioners (NPs) and physician assistants (PAs)
Telehealth providers can prescribe Pylera in most states without an in-person visit, since it is not a controlled substance. Patients typically need a confirmed positive H. pylori test result (urea breath test or stool antigen test) before a telehealth provider will prescribe Pylera. Some telehealth platforms can coordinate lab testing as part of the virtual visit workflow.
No. Pylera (bismuth subcitrate potassium/metronidazole/tetracycline) is not a controlled substance and is not scheduled by the DEA. It does not have abuse potential or carry DEA scheduling restrictions. Any licensed prescriber with prescribing authority — including primary care physicians, nurse practitioners, physician assistants, and telehealth providers — can prescribe Pylera without additional DEA registration requirements.
Because Pylera is not a controlled substance, there are no quantity limits, no mandatory waiting periods, and no restrictions on early refills beyond standard pharmacy practices. Prescriptions can be called in, faxed, or sent electronically, and telehealth providers can prescribe it without an in-person visit in most states.
Most Pylera side effects are mild and temporary, resolving after the 10-day treatment course is completed:
Black or dark stools (from bismuth — harmless and temporary)
Dark or black tongue (from bismuth — harmless and temporary)
Metallic or bitter taste (from metronidazole)
Nausea and vomiting
Diarrhea
Headache
Abdominal pain and loss of appetite
Photosensitivity (sun sensitivity from tetracycline)
Severe or bloody diarrhea (possible C. difficile colitis)
Peripheral neuropathy (numbness, tingling, or pain in hands/feet)
Neurological symptoms (seizures, confusion, dizziness, loss of coordination)
Aseptic meningitis (stiff neck, severe headache, fever, light sensitivity)
Severe allergic reactions (hives, swelling, difficulty breathing)
Severe skin reactions (blistering, peeling — Stevens-Johnson syndrome)
Know what you need? Skip the search.
Traditional Bismuth Quadruple Therapy (separate generics)
The same three active ingredients as Pylera (bismuth subsalicylate, metronidazole, tetracycline) prescribed as separate generic medications plus a PPI. Clinically equivalent to Pylera at much lower cost; standard course is 14 days rather than 10.
Talicia (rifabutin/omeprazole/amoxicillin)
FDA-approved combination capsule for H. pylori using different antibiotics. Effective for metronidazole-resistant strains and treatment failures. Requires amoxicillin tolerance (not for penicillin-allergic patients). Very expensive (>$1,000 without insurance).
Voquezna Triple Pak (vonoprazan/clarithromycin/amoxicillin)
Newer vonoprazan (PCAB)-based regimen FDA-approved 2022. Stronger acid suppression than PPIs. Best when clarithromycin susceptibility is confirmed or likely.
Voquezna Dual Pak (vonoprazan/amoxicillin)
Vonoprazan plus amoxicillin for patients where single-antibiotic coverage is appropriate. FDA-approved 2022. Not suitable for penicillin-allergic patients.
Prefer Pylera? We can find it.
Alcohol / propylene glycol
majorCauses severe disulfiram-like reaction with metronidazole: flushing, vomiting, rapid heart rate. Avoid ALL alcohol during treatment and for 3+ days after.
Disulfiram (Antabuse)
majorConcurrent use can cause acute psychosis and confusion. Do not use within 2 weeks of disulfiram.
Warfarin (Coumadin)
majorMetronidazole inhibits CYP2C9, increasing warfarin levels and bleeding risk. Monitor INR closely during and after treatment.
Busulfan
majorMetronidazole increases busulfan plasma concentrations, raising toxicity risk. Avoid concurrent use if possible.
Methoxyflurane (Penthrox)
majorTetracycline + methoxyflurane combination associated with fatal renal toxicity. Contraindicated.
Oral contraceptives
moderateTetracycline may reduce hormonal contraceptive effectiveness. Use additional non-hormonal contraception during treatment.
Lithium
moderateMetronidazole can increase lithium levels, risking toxicity. Monitor lithium levels during treatment.
Antacids (Al/Ca/Mg)
moderateChelate tetracycline and reduce its absorption significantly. Separate doses by at least 2 hours.
Dairy products and calcium-fortified foods
moderateCalcium reduces tetracycline absorption. Avoid within 1-2 hours of any Pylera dose.
Iron and zinc supplements
minorChelate tetracycline and reduce absorption. Separate by 2-3 hours.
Pylera is one of the most effective treatments available for Helicobacter pylori infection, with eradication rates of 90–97% when taken correctly as part of bismuth quadruple therapy. The 2024 American College of Gastroenterology guidelines designate optimized bismuth quadruple therapy as the preferred first-line empiric treatment for H. pylori in the United States — replacing older clarithromycin-based regimens that have been undermined by rising antibiotic resistance.
The main challenges with Pylera are cost and pharmacy availability. At $300–$400 retail per course, it is out of reach for many patients without insurance coverage. Using a GoodRx or SingleCare coupon can reduce the price to approximately $187–$200. Alternatively, the same active ingredients can be prescribed as separate, much cheaper generic medications with the same clinical efficacy.
If you've been prescribed Pylera and can't find it at your local pharmacy, medfinder contacts pharmacies in your area to check which ones have it in stock, texting you results directly. Don't let pharmacy availability or cost barriers prevent you from completing your H. pylori treatment — effective options exist for every situation.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini