Dosing & Uses
Dosage Forms & Strengths
tablet
- 600mg
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious
Significant - Monitor Closely
Minor
Contraindicated (14)
- apalutamide
apalutamide will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- carbamazepine
carbamazepine will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- dexamethasone
dexamethasone decreases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP450 inducers significantly decrease praziquantel blood levels.
- enzalutamide
enzalutamide decreases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP450 inducers significantly decrease praziquantel blood levels.
- etravirine
etravirine will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Discontinue etravirine 2 weeks before starting praziquantel. May restart etravirine 1 day after last praziquantel dose.
- fosphenytoin
fosphenytoin will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- mitotane
mitotane will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- oxcarbazepine
oxcarbazepine decreases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP450 inducers significantly decrease praziquantel blood levels.
- phenobarbital
phenobarbital will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- phenytoin
phenytoin will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- primidone
primidone will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- rifampin
rifampin will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- St John's Wort
St John's Wort will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
Serious (30)
- amobarbital
amobarbital will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- armodafinil
armodafinil will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- belzutifan
belzutifan will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- bexarotene
bexarotene will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- bosentan
bosentan will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- butabarbital
butabarbital will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- butalbital
butalbital will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cenobamate
cenobamate will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP450 inducers significantly decrease praziquantel blood levels.
- dabrafenib
dabrafenib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- duvelisib
duvelisib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- efavirenz
efavirenz will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- elagolix
elagolix will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- encorafenib
encorafenib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP450 inducers significantly decrease praziquantel blood levels.
- fexinidazole
fexinidazole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- idelalisib
idelalisib will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- ivosidenib
ivosidenib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lorlatinib
lorlatinib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mavacamten
mavacamten will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mitapivat
mitapivat will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- modafinil
modafinil will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nafcillin
nafcillin will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- olutasidenib
olutasidenib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pentobarbital
pentobarbital will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pexidartinib
pexidartinib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- repotrectinib
repotrectinib will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rifabutin
rifabutin will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rifapentine
rifapentine will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- telotristat ethyl
telotristat ethyl will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tucatinib
tucatinib will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
Monitor Closely (29)
- atazanavir
atazanavir will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ceritinib
ceritinib will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cimetidine
cimetidine increases levels of praziquantel by decreasing metabolism. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- conivaptan
conivaptan will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
- crofelemer
crofelemer increases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- darunavir
darunavir will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- fedratinib
fedratinib will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- grapefruit
grapefruit will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- iloperidone
iloperidone increases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
- istradefylline
istradefylline will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lenacapavir
lenacapavir will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lopinavir
lopinavir will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mifepristone
mifepristone will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nelfinavir
nelfinavir will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nevirapine
nevirapine will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- posaconazole
posaconazole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ritonavir
ritonavir will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- stiripentol
stiripentol, praziquantel. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- tazemetostat
tazemetostat will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- voriconazole
voriconazole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
Minor (10)
- acetazolamide
acetazolamide will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- albendazole
praziquantel increases levels of albendazole by unspecified interaction mechanism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- chloroquine
chloroquine decreases levels of praziquantel by unspecified interaction mechanism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- danazol
danazol will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- drospirenone
drospirenone will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate increases levels of praziquantel by unspecified interaction mechanism. Minor/Significance Unknown.
- larotrectinib
larotrectinib will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ribociclib
ribociclib will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
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
Warnings
Contraindications
Hypersensitivity
Intraocular cysticercosis
Concomitant use with strong CYP450 inducers
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; may lead to potentially life-threatening events, for example, respiratory failure, encephalopathy, papilledema, and/or cerebral vasculitis
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
-
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
-
Moderate CYP450 Inducers
- Avoid concomitant administration with moderate CYP450 inducers, such as efavirenz, due to risk of clinically significant decrease in praziquantel plasma concentrations which may lead to reduced therapeutic effect of this drug
- In patients receiving a clinically significant CYP450 inducer drug who need immediate treatment for schistosomiasis, consider, where possible, alternative agents for schistosomiasis
- If praziquantel is necessary immediately, increase monitoring for reduced anthelmintic efficacy associated with praziquantel
- In patients receiving a clinically significant CYP450 inducer drug whose treatment could be delayed, discontinue the CYP450 inducer drug at least 2 weeks to 4 weeks before administration and, where possible, consider starting alternative medications that are not CYP450 inducers
- The CYP450 inducer drug can be restarted one day after completion of treatment, if needed
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.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)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Biltricide oral - | 600 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
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