Biltricide (praziquantel) is a broad-spectrum anthelmintic medication recognized as the gold standard treatment for schistosomiasis and various trematode infections. As the World Health Organization’s essential medicine for parasitic worm eradication, this potent antiparasitic agent demonstrates remarkable efficacy against all human schistosome species. Its mechanism of action causes rapid tegumental damage to parasites, leading to calcium influx and subsequent muscular paralysis. Clinical studies consistently show cure rates exceeding 85% with single-dose regimens, making it the cornerstone of global parasitic disease control programs.

Features

• Contains praziquantel as the active pharmaceutical ingredient (600 mg tablets)
• Broad-spectrum activity against Schistosoma haematobium, S. mansoni, S. japonicum, S. mekongi, and S. intercalatum
• Effective against liver flukes (Clonorchis sinensis, Opisthorchis viverrini) and intestinal flukes
• Standardized tablet formulation with precise scoring for accurate dosing
• Heat-stable composition suitable for tropical climates
• WHO-prequalified manufacturing ensuring international quality standards

Benefits

• Achieves high parasitological cure rates with single-day treatment in most cases
• Rapid reduction in egg output within 24-48 hours post-administration
• Significant decrease in transmission potential within endemic communities
• Prevents chronic complications including hepatic fibrosis, bladder cancer, and portal hypertension
• Well-tolerated profile with predominantly mild and transient adverse effects
• Cost-effective intervention for mass drug administration programs

Common use

Biltricide is primarily indicated for the treatment of schistosomiasis (bilharzia) caused by infection with blood flukes of the genus Schistosoma. It is equally effective against infections caused by liver flukes (Clonorchis sinensis and Opisthorchis viverrini) and intestinal flukes (Fasciolopsis buski). The medication is deployed both in clinical settings for individual patient management and in public health initiatives for community-wide parasite control in endemic regions. Healthcare providers may also prescribe it for off-label use against certain cestode infections, though clinical evidence for these applications varies.

Dosage and direction

Dosage is weight-based and varies according to the specific parasitic infection. For schistosomiasis, the standard regimen is 40 mg/kg body weight administered as a single dose or divided into two doses taken 4-6 hours apart. For liver fluke infections, the recommended dosage is 25 mg/kg three times daily for one or two days. Tablets should be swallowed whole with water during meals to minimize gastrointestinal discomfort. Crushing or chewing tablets is not recommended due to the bitter taste that may cause gagging or vomiting. Dosing should be supervised by healthcare professionals in mass administration settings.

Precautions

Patients with a history of seizure disorders require careful monitoring as praziquantel may lower the seizure threshold. Those with ocular cysticercosis should initiate treatment in hospital settings due to the risk of retinal damage from inflammatory reactions to dying parasites. Hepatic impairment necessitates dosage adjustment as praziquantel undergoes extensive first-pass metabolism. Pregnancy category B: use during pregnancy only if clearly needed, though WHO recommends treatment for infected pregnant women in endemic areas. Lactating women should suspend breastfeeding for 72 hours post-treatment as the drug concentrates in breast milk.

Contraindications

Absolute contraindications include hypersensitivity to praziquantel or any tablet components. The medication is contraindicated in patients with known subarachnoid neurocysticercosis due to the risk of life-threatening inflammatory responses. Concurrent administration with strong CYP450 inducers such as rifampin is prohibited due to significant reduction in praziquantel bioavailability. Patients with severe hepatic dysfunction (Child-Pugh class C) should not receive standard dosing without specialist supervision.

Possible side effects

Most adverse reactions are mild to moderate and reflect the pharmacological action against parasites rather than direct drug toxicity. Common side effects include abdominal discomfort or cramps (45%), nausea (32%), headache (28%), dizziness (25%), and malaise (20%). These typically emerge within 3-4 hours post-dose and resolve spontaneously within 12-24 hours. Less frequently reported effects include low-grade fever (15%), urticarial rash (8%), and elevated liver enzymes (5%). Severe reactions such as seizures or cardiac arrhythmias occur in less than 0.1% of patients, usually those with pre-existing conditions.

Drug interaction

Praziquantel metabolism involves cytochrome P450 3A4, creating several clinically significant interactions. Strong CYP3A4 inducers including rifampicin, carbamazepine, phenytoin, and St. John’s wort reduce praziquantel plasma concentrations by up to 80%, necessitating alternative antiparasitic agents. Conversely, CYP3A4 inhibitors like ketoconazole, itraconazole, and ritonavir may increase systemic exposure. Chloroquine co-administration decreases praziquantel bioavailability by approximately 50%. Dexamethasone may alter praziquantel pharmacokinetics through both enzymatic induction and reduced gastrointestinal motility.

Missed dose

In multi-dose regimens, take the missed dose as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to compensate for a missed administration. For single-dose protocols typically used in schistosomiasis treatment, a missed dose should be taken as soon as possible within 24 hours of the scheduled time. If beyond this window, consult healthcare providers for guidance. In mass drug administration programs, directly observed therapy minimizes missed dose occurrences.

Overdose

Cases of deliberate or accidental overdose are rare due to the drug’s high therapeutic index. Reported symptoms include gastrointestinal distress, dizziness, sweating, and sedation. Massive overdose may precipitate convulsions, impaired coordination, or coma. There is no specific antidote; management involves symptomatic and supportive care. Gastric lavage may be considered if presentation occurs within one hour of ingestion. Activated charcoal administration should follow standard poisoning protocols. Hemodialysis is not effective due to high protein binding and extensive tissue distribution.

Storage

Store tablets below 30°C (86°F) in their original packaging protected from light and moisture. Keep the container tightly closed to prevent tablet degradation. Do not remove desiccant packets from the packaging. Avoid storage in bathrooms or other areas with high humidity. Properly dispose of expired medication through pharmaceutical take-back programs. Under appropriate conditions, the product maintains stability for 36 months from the manufacturing date.

Disclaimer

This information provides a comprehensive overview of Biltricide (praziquantel) but does not replace professional medical advice, diagnosis, or treatment. Always consult qualified healthcare providers regarding any medical condition or treatment decisions. Dosage and administration should be determined by trained medical professionals based on individual patient characteristics and local parasitic epidemiology. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.

Reviews

Clinical studies across endemic regions demonstrate consistent efficacy and safety profiles. A meta-analysis of 42 trials (n=15,000) showed overall cure rates of 87.3% for S. haematobium, 83.4% for S. mansoni, and 94.7% for S. japonicum. Field reports from mass administration programs in sub-Saharan Africa confirm excellent community tolerance with treatment completion rates exceeding 95%. Parasitologists emphasize its critical role in reducing schistosomiasis-associated morbidity, particularly reversing hepatosplenic pathology in children. The drug’s inclusion in WHO’s preventive chemotherapy protocols has accelerated progress toward elimination targets in multiple countries.