praziquantel (Rx)

Brand and Other Names:Biltricide
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 600mg
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Schistosomiasis

Indicated for treatment for schistosomiasis caused by all species of Schistosoma

20 mg/kg PO TID for 1 day (at intervals of 4-6 hr) 

Clonorchiasis, Opisthorchiasis

Indicated for clonorchiasis and opisthorchiasis caused by liver flukes (Clonorchis sinensis, Opisthorchis viverrini)

25 mg/kg PO TID for 1 day (at intervals of 4-6 hr) 

Cysticercosis (Off-label)

50-100 mg/kg/day PO divided q8hr for 14 days 

Tapeworms (Off-label)

5-10 mg/kg as single dose or 25 mg/kg if caused by Hymenolepis nana 

Dosage Forms & Strengths

tablet

  • 600mg
more...

Schistosomiasis

Indicated for treatment for schistosomiasis caused by all species of Schistosoma

<1 year: Safety and efficacy not established

≥1 year: 20 mg/kg PO TID for 1 day (at intervals of 4-6 hr) 

Clonorchiasis, Opisthorchiasis

Indicated for clonorchiasis and opisthorchiasis caused by liver flukes (Clonorchis sinensis, Opisthorchis viverrini)

<1 year: Safety and efficacy not established

≥1 year: 25 mg/kg PO TID for 1 day (at intervals of 4-6 hr) 

Cysticercosis (Off-label)

≥1 year: 50-100 mg/kg/day PO divided TID for 30 days 

Tapeworms (Off-label)

≥1 year: 5-10 mg/kg as single dose or 25 mg/kg if caused by Hymenolepis nana 

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Interactions

Interaction Checker

and praziquantel

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Appetite loss

            Dizziness

            Drowsiness

            Headache

            Malaise

            CSF reaction syndrome in patients treated for neurocysticercosis

            Abdominal pain

            Nausea

            Vomiting

            Diaphoresis

            <1%

            Diarrhea

            Fever

            Itching

            Rash

            Urticaria

            Postmarketing Reports

            Eosinophilia

            Pruritus, rash Abdominal pain, anorexia, bloody diarrhea, vomiting

            Allergic reaction (generalized hypersensitivity, including polyserositis)

            Arrhythmia (including bradycardia, ectopic rhythms, ventricular fibrillation, AV blocks)

            Fatigue, somnolence, asthenia, vertigo

            Convulsions

            Myalgia

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            Warnings

            Contraindications

            Hypersensitivity

            Intraocular cysticercosis

            Strong CYP450 inducers

            • Coadministration with strong CYP450 inducers (eg, rifampin) is contraindicated since therapeutically effective blood levels of praziquantel may not be achieved
            • In patients receiving rifampin who need immediate treatment for schistosomiasis, alternative agents for schistosomiasis should be considered
            • If treatment with praziquantel is necessary, rifampin should be discontinued 4 weeks before praziquantel administration
            • Treatment with rifampin can be restarted 1 day after completion of praziquantel treatment

            Cautions

            Clinical deterioration may occur when treating schistosomiasis (eg, paradoxical reactions, serum sickness Jarisch-Herxheimer like reactions [sudden inflammatory immune response suspected to be caused by the release of schistosomal antigens]); reactions predominantly occur in patients treated during the acute phase of schistosomiasis

            Can exacerbate CNS pathology due to schistosomiasis, paragonimiasis, or Taenia solium cysticercosis; consider whether to treat with praziquantel in patients with epilepsy or other CNS diseases; hospitalize patient for duration of treatment if infection found to be associated with cerebral cysticercosis

            Evidence suggests treatment with praziquantel in the acute phase of infection may not prevent progression from asymptomatic infection to acute schistosomiasis, or from asymptomatic infection/acute schistosomiasis into chronic phase

            Bradycardia, ectopic rhythms, ventricular fibrillation, and AV blocks observed; monitor patients with cardiac arrhythmias during treatment

            Reduced hepatic metabolism of praziquantel results in higher and sustained plasma concentrations of unmetabolized drug in patients with liver impairment; monitor for adverse reactions when administering the recommended dose to patients with hepatosplenic schistosomiasis who have moderate or severe liver impairment (Child-Pugh Class B or C)

            Drug interaction overview

            • Concomitant administration of strong CYP450 inducers (eg, rifampin) is contraindicated since therapeutically effective levels of praziquantel may not be achieved
            • For patients receiving rifampin who need immediate treatment for schistosomiasis, consider alternant agents for schistosomiasis; however, if treatment with praziquantel is necessary, discontinue rifampin 4 weeks before administration praziquantel; may restart rifampin 1 day after completing praziquantel treatment
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            Pregnancy & Lactation

            Pregnancy

            Published studies have not identified association with use during pregnancy and major birth defects, miscarriage or adverse maternal or fetal outcomes

            Animal data

            • In animal reproduction studies conducted in pregnant rats and rabbits no adverse developmental outcomes were observed with oral administration of drug during organogenesis at approximately 0.65 times (rats) or 1.3 times (rabbits) the highest recommended human daily dose of 75 mg/kg/day, based on body surface area

            Lactation

            Limited data from published literature reports presence of drug in human milk at low concentrations; there is no information on effects of drug in breastfed infant or effects on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Increases cell membrane permeability to calcium in schistosomes causing the worm to dislodge following the paralysis of worm musculature

            Pharmacokinetics

            Absorption: ~80% (oral)

            Peak Plasma Time: 1-3 hr

            Distribution: CSF concentration is 14-20% of plasma concentration

            Protein Bound: ~80%

            Metabolism: Extensive first-pass effect

            Half-life 0.8-1.5 hr (parent drug); 4.5 hr (metabolites)

            Excretion: Urine (99% as metabolites)

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            Administration

            Oral Administration

            Swallow tablets with water during meals

            Do not chew or keep tablets in the mouth; bitter taste may cause gagging or vomiting

            Doses less than or greater than 600 mg

            • 600-mg tablets have 3 scores which can be split into 4 segments at the scores
            • When broken, each of the 4 segments contains 150 mg so that the dosage can be adjusted to the patient’s bodyweight
            • Segments are broken off by pressing the score (notch) with thumbnails
            • If one-quarter of a tablet is required, this is best achieved by breaking the segment from the outer end

            Unable to swallow tablet

            • Tablets may be crushed or disintegrated and mixed with semi-solid food or liquid
            • Use crushed or disintegrated tablets within 1 hr of mixing
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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.