Pilera

PATIENT INFORMATION LEAFLET: USER INFORMATION

Warning! Keep the leaflet! Information on the immediate packaging in a foreign language.

Pylera

140 mg + 125 mg + 125 mg hard capsules, Bismuth potassium subcitrate+Metronidazole+Tetracycline hydrochloride

You should read the contents of the leaflet before taking the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• You should consult a doctor or pharmacist if you have any further doubts.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm them, even if their symptoms are the same as yours.
• If you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What is Pylera and what is it used for
• 2. Important information before taking Pylera
• 3. How to take Pylera
• 4. Possible side effects
• 5. How to store Pylera
• 6. Contents of the pack and other information

1. WHAT IS PYLERA AND WHAT IS IT USED FOR

Pylera contains 3 different active substances: bismuth potassium subcitrate, metronidazole, and tetracycline hydrochloride. Tetracycline and metronidazole belong to a group of medicines called antibiotics. Bismuth potassium subcitrate helps antibiotics treat the infection.
Pylera is used to treat adult patients infected with Helicobacter pylori (H. pylori)who have or have had stomach ulcers. H. pyloriis a bacterium present in the stomach lining.
Pylera should be taken with a medicine called omeprazole.Omeprazole is a medicine that works by reducing the amount of acid produced by the stomach. Pylera taken with a proton pump inhibitor (e.g., omeprazole) has a combined effect aimed at curing the infection and relieving the inflammation of the stomach lining.

2. IMPORTANT INFORMATION BEFORE TAKING PYLERA

When not to take Pylera

• if you are pregnant or breastfeeding.
• in patients under 12 years of age.
• if you have kidney problems.
• if you have liver problems.
• if you are allergic (hypersensitive) to bismuth potassium subcitrate, metronidazole, or other nitroimidazole derivatives, tetracycline, or any other ingredient of Pylera (listed in section 6).
• if you have Cockayne syndrome (see Warnings and precautions).

Warnings and precautions

Before taking Pylera, you should discuss it with your doctor or pharmacist.
Patients with Cockayne syndrome have reported cases of severe, irreversible liver damage/acute liver failure, including deaths, which occurred very soon after starting systemic metronidazole treatment.
You should immediately inform your doctor and stop taking metronidazole if you experience:

• Abdominal pain, loss of appetite, nausea, vomiting, fever, malaise, fatigue, jaundice, dark urine, dark stools, or itching.

Metronidazole, one of the ingredients of this medicine, may increase changes in the ECG recording, i.e., prolongation of the QT interval, leading to delayed conduction of electrical signals and heart rhythm disturbances (arrhythmias), when given with compounds that can cause similar changes in the ECG recording. Before taking Pylera, you should discuss it with your doctor, especially if you have previously had such changes in the ECG recording or heart rhythm disturbances (see "Pylera and other medicines").

When to be extra careful when taking Pylera

• if you are going to have an X-ray, as Pylera may affect the results of the X-ray.
• if you are going to have blood tests, as Pylera affects the results of some blood tests.
• if you have previously had intolerance to some sugars.

You should avoid exposure to the sun and use a sunbedwhile taking Pylera, as it may increase the effect of sunlight. If you get sunburned, you should see a doctor.

Children and adolescents

Pylera capsules should not be given to children under 12 years of age and are not recommended for children between 12 and 18 years of age.

Pylera and other medicines

You should tell your doctor or pharmacist about all medicines you are taking, have recently taken, or plan to take, including those obtained without a prescription.
In particular, you should inform your doctor if you are taking or have recently taken any of the following medicines:

• Lithium used to treat certain mental disorders;
• Medicines used to thin the blood or prevent blood clots (e.g., warfarin);
• Phenytoin and phenobarbital used in epilepsy;
• Methoxyflurane (an anesthetic);
• Other antibiotics, especially penicillins;
• Dietary supplements containing iron, zinc, sodium hydroxide;
• Taking Pylera with other medicines containing bismuth for a long time may affect the nervous system;
• Busulfan and fluorouracil used in chemotherapy;
• Cyclosporine used to suppress the immune system after a transplant;
• Disulfiram used in people with alcohol problems;
• Ranitidine used in indigestion and heartburn;
• Retinoids used to treat skin diseases;
• Atovaquone used to treat lung infections;
• Medicines known to cause changes in the ECG recording (prolongation of the QT interval) and for which increased blood levels are caused by metronidazole. These substances include:
• Amiodarone (used to treat heart rhythm disturbances);
• Ondansetron (used to treat nausea and vomiting);
• Methadone (used as replacement therapy in opioid dependence);
• Domperidone (used to treat nausea and vomiting)

You should not take antacids containing aluminum, calcium, or magnesium at the same time as Pylera.

Pylera with food, drink, or alcohol

Pylera should be taken with a full glass of water (250 ml), aftermeals and before bedtime (best after a snack).
You should not eat or drink dairy products(e.g., milk or yogurt) or drinks with added calciumat the same time as taking Pylera and during treatment with Pylera, as this may affect the action of the medicine.
You should not drink alcoholwhile taking Pylera and for 24 hours after finishing treatment.
Drinking alcohol during treatment may cause unpleasant side effects, such as nausea, vomiting, abdominal pain (abdominal cramps), hot flashes, and headache.
You should tell your doctor or pharmacist about all medicines you are taking, have recently taken, or plan to take, including those obtained without a prescription.

Pregnancy and breastfeeding

You should not take Pylera if you are pregnant, may be pregnant, or think you may be pregnant.
If you become pregnant during treatment, you should contact your doctor.
You should not breastfeed while taking Pylera, as small amounts of Pylera ingredients may pass into breast milk.

Driving and using machines

You should not drive or operate machinery if you experience dizziness, drowsiness, seizures, or temporary blurred or double vision.

Pylera contains lactose and potassium

Pylera contains lactose, which is a type of sugar. If you have previously been diagnosed with intolerance to some sugars, you should contact your doctor before taking Pylera.
Pylera contains 96 mg of potassium in one dose (3 capsules, each containing 32 mg of potassium), which should be taken into account in patients with reduced kidney function and in patients controlling potassium levels in their diet.

3. HOW TO TAKE PYLERA

This medicine should always be taken as directed by your doctor. Pylera should be taken with a medicine called a proton pump inhibitor (e.g., omeprazole). If you are unsure, you should consult your doctor or pharmacist again.

Adults and the elderly

You should not open the capsules but swallow them whole.
You should take 3 Pylera capsules after breakfast, 3 capsules after lunch, 3 capsules after dinner, and 3 capsules before bedtime (best after a snack), for a total of 12 capsules per day.
You should swallow the capsules whole, sitting upright, with a full glass of water (250 ml), to avoid irritating the throat. Do not lie down immediately after taking Pylera. It is essential to complete the full treatment cycle (10 days) and take all 120 capsules.
You should take one omeprazole tablet (capsule) 20 mg with Pylera doses taken after breakfast and dinner (for a total of 2 omeprazole tablets (capsules) per day).
Daily dosing schedule for Pylera

Taking more Pylera than prescribed

If you take more Pylera than prescribed, you should contact your doctor or go to the emergency room of the nearest hospital. You should bring the medicine bottle and any remaining capsules, so the doctor knows what medicine was taken.

Missing a dose of Pylera

If you miss a dose, you should take it as soon as you remember. However, if it is almost time for the next dose, you should skip the missed dose. Do not take a double dose to make up for the missed dose. If you miss more than 4 consecutive doses of Pylera (1 day), you should contact your doctor.

Stopping Pylera treatment

It is essential to complete the full treatment cycle, even if you feel better after a few days. If you stop treatment too early, the infection may not be fully cured, and symptoms may return or worsen. Resistance to tetracycline or (and) metronidazole (antibiotics) may also develop.
If you have any further doubts about taking this medicine, you should consult your doctor or pharmacist.

4. POSSIBLE SIDE EFFECTS

Like all medicines, Pylera can cause side effects, although not everybody gets them.

If you experience any of the following, you should stop taking Pylera and contact your doctor or go to the emergency room of the nearest hospital:

• Swelling of the face, lips, tongue, or throat, which may cause difficulty swallowing or breathing;
• Itching, hives, or rash.

These may be symptoms of an allergic reaction.

• Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), drug reaction with eosinophilia and systemic symptoms (DRESS)) (See below under "Unknown" side effects).

A severe but very rare side effect is brain disease (encephalopathy). Symptoms are varied, but you may have a fever, stiff neck, headache, see or hear things that do not exist. You may also have difficulty moving your arms or legs, speaking, or feeling confused. If you experience such symptoms, you should immediately tell your doctor.

Other possible side effects

Very common(may affect more than 1 in 10 people):

• Changes in stool consistency and color, including blackening of the stool;
• Diarrhea;
• Nausea;
• Unusual or metallic taste in the mouth.

Common(may affect up to 1 in 10 people):

• Abdominal pain;
• Constipation;
• Dry mouth;
• Vomiting;
• Gas/flatulence;
• Headache;
• Feeling weak;
• Feeling tired and lacking energy;
• General malaise;
• Vaginal infections - symptoms including itching and irritation in the genital area, burning or yellow/white discharge from the vagina;
• Blood tests may show increased liver enzyme activity (aminotransferases);
• Dark urine;
• Loss of or decreased appetite;
• Dizziness;
• Feeling drowsy;
• Skin problems, such as redness (rash).

Uncommon(may affect up to 1 in 100 people):

• Allergic reaction to the medicine (symptoms include swelling of the face, lips, tongue, or throat, which may cause difficulty swallowing or breathing; itching, hives, or rash;
• Feeling bloated;
• Hiccups or belching;
• Open sores in the mouth/oral ulcers;
• Changes in tongue color (dark tongue);
• Tongue swelling;
• Chest pain, feeling uncomfortable in the chest;
• Fungal infection (candidiasis), which may include the mouth (symptoms are white patches in the mouth) or genitals (symptoms are intense itching, burning, irritation);
• Numbness;
• Tingling;
• Tremors;
• Feeling anxious, depressed, or having difficulty sleeping;
• Memory problems;
• Skin problems, such as itching or burning (hives);
• Blurred vision;
• Dizziness.

Unknown(frequency cannot be estimated from the available data)

• Severe disease with blisters on the skin, mouth, eyes, and genitals (Stevens-Johnson syndrome);
• Severe disease with blisters on the skin (toxic epidermal necrolysis (Lyell's syndrome));
• Flu-like symptoms, rash on the face spreading to the whole body with high temperature, elevated liver enzyme levels in blood tests, increased levels of a certain type of white blood cell (eosinophilia), and swollen lymph nodes (DRESS);

Blisters (bubbles on the skin) and skin peeling;

• Aseptic meningitis: a syndrome of symptoms including fever, nausea, vomiting, headache, stiff neck, and extreme sensitivity to light. This may be caused by inflammation of the membranes covering the brain and spinal cord (meningitis);
• Nerve damage, which may cause numbness, tingling, pain, or weakness in the arms or legs (peripheral neuropathy);
• Colitis (pseudomembranous colitis).

Reporting side effects

If you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety Monitoring of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181 C, 02-222 Warsaw, tel.: +48 22 49 21 301, fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl
By reporting side effects, you can help provide more information on the safety of this medicine.

5. HOW TO STORE PYLERA

The medicine should be stored out of sight and reach of children.
Do not use this medicine after the expiry date stated on the carton and bottle after EXP.
The expiry date refers to the last day of the month.
There are no special storage instructions for the medicine. Store in the original packaging to protect from light and moisture.
Medicines should not be disposed of via wastewater or household waste. You should ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. CONTENTS OF THE PACK AND OTHER INFORMATION

What Pylera contains

The active substances of Pylera are bismuth potassium subcitrate, metronidazole, and tetracycline hydrochloride.
Each capsule contains 140 mg of bismuth potassium subcitrate (equivalent to 40 mg of bismuth oxide), 125 mg of metronidazole, and 125 mg of tetracycline hydrochloride.
Other ingredients are: magnesium stearate (E 572), lactose monohydrate, talc (E 553b); and for the capsule shell: titanium dioxide (E 171), gelatin, and printing ink containing shellac, propylene glycol, and iron oxide red (E 172).
Pylera contains lactose and potassium. See section 2.

What Pylera looks like and contents of the pack

Pylera is a white, non-transparent, elongated capsule with the logo Aptalis Pharma printed on the capsule body and the print "BMT" in red on the capsule cap. The capsules contain a white powder and an additional small, non-transparent capsule containing a yellow powder.
Pylera capsules are available in a HDPE bottle with a child-resistant closure, a desiccant (silica gel), and a polyester fiber, in a cardboard box.
The bottle contains 120 capsules.
To protect from moisture, the bottle contains a desiccant (silica gel) and a polyester fiber. Do not swallow the desiccant or polyester fiber.
For more detailed information, you should contact the marketing authorization holder or the parallel importer.

Marketing authorization holder in Spain, the country of export:

LABORATOIRES JUVISE PHARMACEUTICALS
149 Boulevard Bataille de Stalingrad, 69100 Villeurbanne, France

Manufacturer:

SKYEPHARMA PRODUCTION SAS, Zone Industrielle Chesnes Ouest,
55 rue du Montmurier, 38070 Saint Quentin Fallavier, France
Allergan Pharmaceuticals International Limited
Clonshaugh Business & Technology Park, Dublin 17, D17 E400
Ireland

Parallel importer:

Aga Kommerz spol. s r.o.
Frydecka 2006, 737 01 Czeski Cieszyn, Czech Republic

Repackaged by:

Medezin Sp. z o.o., ul. Zbąszyńska 3, 91-342 Łódź
CEFEA Sp. z o.o. Sp. komandytowa
ul. Działkowa 56
02-234 Warszawa
Wytwórnia Euceryny Laboratorium Farmaceutyczne COEL S.J. E.Z.M. KONSTANTY
ul. Wł. Żeleńskiego 45
31-353 Kraków
Spanish marketing authorization number, country of export: 686167.7

Parallel import authorization number: 291/24

This medicinal product is authorized in the Member States of the European Economic Area under the following names:

Belgium: Tryplera Austria, Czech Republic, France, Spain, Germany, Poland, Portugal, Slovakia, Italy: Pylera

Date of leaflet approval: 18.07.2024

[Information about the trademark]