Ultra-Levura (Saccharomyces boulardii) in Spain: Uses and Safety

Ultra-Levura is a Spanish pharmacy medicine that contains Saccharomyces boulardii, a live yeast used as a probiotic. It eases sudden (acute) diarrhoea and helps prevent and treat diarrhoea caused by antibiotics. It does not replace drinking fluids, and you should see a doctor if there is fever, blood, or it lasts more than two days. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280).

What is Ultra-Levura used for?

The Spanish product information lists two uses:

• easing the symptoms of acute diarrhoea with no specific cause;
• preventing and easing diarrhoea caused by antibiotics.

It eases symptoms. It does not treat the cause. The most important thing is still to replace water and salts, above all in young children and older adults.

What exactly is Ultra-Levura?

It is a live yeast, Saccharomyces boulardii strain CNCM I-745. Many probiotics are sold as food supplements, but Ultra-Levura is licensed as a medicine by the Spanish medicines agency (AEMPS). Its product information and leaflet are on CIMA. It comes as hard capsules and as sachets of powder to mix with water. The capsules contain lactose.

Do you need a prescription for Ultra-Levura?

You can buy it at a Spanish pharmacy (farmacia) without a prescription. Still, ask the pharmacist if it suits you, above all if you take other medicines, are pregnant, or it is for a child. Ask for "Ultra-Levura" or "un probiótico para la diarrea".

How do you take Ultra-Levura?

The dose and how long to take it are set by the leaflet or your doctor. Ask your pharmacist. Because it contains live cells, keep these points in mind:

• Do not mix it with very hot food or drinks (over 50 °C), ice cream or alcohol.
• If you are taking an antibiotic, the leaflet explains how to combine them. Check with the pharmacist.
• Do not open capsules or sachets near patients with a central line, and wash your hands after.

Can children take it?

The 250 mg capsules are for adults and children over 12. The sachets can be used from age 2. Under 2, use it only after a doctor's advice. In a child with diarrhoea, the first job is oral rehydration and watching for signs of dehydration.

Who should not take Ultra-Levura?

• People allergic to yeasts or to any of its ingredients.
• People with a central venous line (catheter).
• People who are very ill or in hospital, or whose immune system is very weak.
• Anyone taking antifungal medicines by mouth or by drip, as they kill the yeast.

The product information reports very rare cases of the yeast getting into the blood (fungaemia) and sepsis, mainly in people with a central line, people who are very ill, or people with a weak immune system.

Can I take it when pregnant or breastfeeding?

There is not enough data. The product information says it is not absorbed, but the benefit and risk should be weighed first. Ask your doctor or pharmacist.

Does it help travellers' diarrhoea?

Travellers' diarrhoea is usually acute diarrhoea with no specific cause, so it can be used to ease the symptoms. The key is to drink oral rehydration salts and watch for fever or blood in the stools. Read more about travellers' diarrhoea and loperamide (Imodium) in Spain.

In English: what is the equivalent?

The same yeast strain is sold in the US under the brand Florastor, mostly as a supplement. In the UK, Saccharomyces boulardii is sold as a food supplement under several brands. In Spain it is a licensed pharmacy medicine called Ultra-Levura. Look for Saccharomyces boulardii on the box to match products.

What are the side effects?

They are uncommon. Wind (gas) has been reported, and constipation, though how often is not known. Very rarely, allergic reactions with itching, hives or swelling can happen, and fungaemia in people at risk.

When to see a doctor

The leaflet says to see a doctor if:

• The diarrhoea gets worse or is not better after 2 days.
• You have a fever or are vomiting.
• There is blood in your stools.
• You feel very thirsty or your tongue is dry, which are signs of dehydration.
• Severe diarrhoea starts during or after a course of antibiotics.

When to call 112

• Signs of severe dehydration: not passing urine, bad dizziness, confusion or great drowsiness.
• Swelling of the face, lips or tongue, or trouble breathing.
• High fever and feeling very unwell in someone with a central line or a weak immune system.

Frequently asked questions about Ultra-Levura

Getting a medical assessment

If you are in Spain and have diarrhoea, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read how long a stomach bug is contagious and antibiotic rules in Spain. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.