Biltricide: Effective Treatment for Schistosomiasis and Fluke Infections
| Product dosage: 600mg | |||
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Synonyms | |||
Biltricide (praziquantel) is a leading anthelmintic medication prescribed for the treatment of schistosomiasis and infections caused by liver, lung, and intestinal flukes. As the drug of choice endorsed by the World Health Organization, it offers a critical solution in global health initiatives aimed at parasitic disease control. Its mechanism of action induces rapid paralysis and tegumental damage in susceptible parasites, facilitating their elimination from the host. This product card provides a comprehensive overview for healthcare professionals to ensure informed, safe, and effective clinical use.
Features
- Active ingredient: Praziquantel 600 mg per tablet
- Formulation: Film-coated oral tablet
- Pharmacologic class: Anthelmintic
- Mechanism: Increases cell membrane permeability to calcium, causing tetanic contraction and paralysis of helminth musculature
- Bioavailability: Enhanced significantly by a high-fat meal
- Metabolism: Hepatic, via CYP450 system; extensive first-pass effect
- Excretion: Primarily renal (80%) as metabolites; 20% fecal excretion
- Half-life: Approximately 0.8–1.5 hours (adults); metabolites 4–5 hours
- Prescription status: Prescription-only medication in most jurisdictions
Benefits
- Achieves high cure rates in schistosomiasis, often exceeding 85% with a single day of treatment in many cases.
- Broad-spectrum activity against all Schistosoma species pathogenic to humans (S. haematobium, S. mansoni, S. japonicum, S. mekongi, S. intercalatum).
- Effective against clonorchiasis, opisthorchiasis, and paragonimiasis, addressing a significant burden of food-borne trematodiases.
- Well-tolerated profile with a low incidence of serious adverse events when administered correctly.
- Simple, weight-based dosing regimen facilitates administration in both clinical and mass drug administration (MDA) settings.
- Contributes to the reduction of morbidity, including hepatic fibrosis, bladder pathology, and portal hypertension associated with chronic infections.
Common use
Biltricide is indicated for the treatment of infections caused by trematodes (flukes) and cestodes (tapeworms, though less commonly than for flukes). Its primary use is against schistosomiasis (bilharzia), a disease affecting hundreds of millions in tropical and subtropical regions, transmitted through contact with freshwater contaminated with cercariae released by specific snail intermediates. It is also a first-line treatment for clonorchiasis (Chinese liver fluke) and opisthorchiasis (Southeast Asian liver fluke), acquired from consuming raw or undercooked freshwater fish, and for paragonimiasis (lung fluke), from consuming raw crustaceans. Its use is central to public health control and elimination programs.
Dosage and direction
Dosing is weight-based and varies by infecting species. Tablets should be swallowed whole with liquid during a meal to enhance absorption.
- Schistosomiasis (all species): 40 mg/kg/day in two divided doses (approximately 6–8 hours apart) for one day.
- Clonorchiasis/Opisthorchiasis: 25 mg/kg three times daily (TID) for one day (total dose 75 mg/kg).
- Paragonimiasis: 25 mg/kg three times daily (TID) for two days (total dose 150 mg/kg).
- Intestinal flukes (e.g., Fasciolopsis buski): 15 mg/kg as a single dose.
A practical dosing chart is often used: for a 60 kg adult with schistosomiasis, the total dose is 2400 mg (40 mg/kg × 60 kg), administered as two 1200 mg doses (e.g., four 600 mg tablets per dose). Doses should not be chewed due to the bitter taste, which can cause gagging or vomiting.
Precautions
- Administer with caution in patients with a history of cardiac arrhythmias or severe underlying heart disease.
- Use cautiously in patients with hepatic impairment, as the drug is extensively metabolized by the liver; however, no specific dose adjustment is well-established.
- May cause dizziness or drowsiness; advise patients not to drive or operate machinery until they know how the medication affects them.
- In patients with ocular cysticercosis, destruction of the parasite within the eye may cause irreparable damage; specialist consultation is mandatory before treatment.
- Pregnancy: Category B. Use only if clearly needed. Data from mass drug administration programs have not shown a significant increase in adverse fetal outcomes.
- Lactation: Praziquantel is excreted in breast milk at low concentrations. The WHO recommends that lactating women be treated, including those with infants over 6 months old. For mothers of infants under 6 months, the benefit of treatment typically outweighs the theoretical risk.
Contraindications
- Hypersensitivity to praziquantel or any component of the formulation.
- Concomitant use with strong CYP inducers like rifampin, which can drastically reduce praziquantel plasma levels, rendering the treatment ineffective.
- Treatment during the first trimester of pregnancy is generally avoided unless the potential benefit justifies the potential risk to the fetus.
- Ocular cysticercosis, due to the risk of retinal damage from inflammatory reactions to dying parasites.
Possible side effect
Most adverse reactions are mild to moderate, transient, and directly related to the parasitic infection and subsequent antigen release from dying worms rather than the drug itself. They often begin within a few hours of dosing and subside within 24-48 hours.
- Very common (>10%): Abdominal pain or cramps, nausea, vomiting, headache, dizziness, malaise, fever, pruritus, urticaria.
- Common (1-10%): Diarrhea, sweating, drowsiness, elevated liver enzymes (transaminases).
- Uncommon (0.1-1%): Arthralgia, myalgia, cardiac arrhythmias (e.g., extrasystoles).
- Rare (<0.1%): Seizures (particularly in patients with neurocysticercosis being treated for the condition), hypotension, syncope, bloody diarrhea.
Drug interaction
- Rifampin and other strong CYP450 inducers (e.g., carbamazepine, phenytoin, phenobarbital, St. John’s Wort): Significantly decrease praziquantel plasma concentrations, potentially leading to therapeutic failure. Concomitant use is contraindicated. A washout period of at least 4 weeks after stopping the inducer is recommended before administering praziquantel.
- Chloroquine: May decrease praziquantel levels; avoid concomitant administration.
- Cimetidine: May increase praziquantel bioavailability by inhibiting its metabolism. The clinical significance is uncertain.
- Dexamethasone: In patients being treated for neurocysticercosis, high-dose dexamethasone (used to manage cerebral edema) may lower praziquantel plasma levels. Monitoring is advised.
- Azole antifungals (e.g., ketoconazole): Potential to increase praziquantel concentrations, though data is limited.
Missed dose
In the context of its typical single-day or two-day regimen, managing a missed dose is time-sensitive. If a dose is missed within the treatment day, it should be taken as soon as possible. However, if it is close to the time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. The total daily dose should not be doubled. For longer regimens (e.g., in neurocysticercosis treatment under specialist care), follow the specific instructions provided by the prescribing physician.
Overdose
Experience with overdose is limited. Symptoms may be an exaggeration of known side effects, including severe gastrointestinal distress (nausea, vomiting, abdominal pain), dizziness, sedation, and possibly convulsions. There is no specific antidote. Management is supportive and symptomatic, including gastric lavage if presented early. Monitor vital signs and provide appropriate care for any neurological or cardiac symptoms. Hemodialysis is not expected to be effective due to high protein binding and extensive metabolism.
Storage
- Store at room temperature, between 15°C and 30°C (59°F and 86°F).
- Protect from light and moisture.
- Keep in the original blister pack or container until the moment of use.
- Keep out of reach of children and pets.
Disclaimer
This information is intended for educational purposes and for use by qualified healthcare professionals only. It is a summary and does not encompass all existing data, possible uses, directions, precautions, warnings, interactions, or adverse effects. This is not medical advice. The prescriber must use professional judgment in diagnosing and treating patients, consulting full prescribing information and relevant clinical guidelines before administering any drug. Dosage and suitability are the sole responsibility of the healthcare provider.
Reviews
“Biltricide remains the cornerstone of schistosomiasis control programs worldwide. Its efficacy, single-day dosing, and generally favorable safety profile make it indispensable in both clinical practice and public health.” – Head of Tropical Medicine, University Teaching Hospital.
“In our MDA campaigns, praziquantel’s impact on reducing community parasite load and associated morbidity has been demonstrably positive. The side effects are manageable and a small price to pay for the long-term health benefits.” – Director, National Neglected Disease Program.
“As a gastroenterologist, I’ve seen the reversal of hepatosplenic pathology in chronic schistosomiasis patients after treatment with praziquantel. It’s a truly transformative drug for those suffering from this debilitating disease.” – Consulting Gastroenterologist.
“While the drug is highly effective, the bitter taste can be a challenge for pediatric adherence in crushed form. We always emphasize swallowing the tablet whole with food.” – Pediatric Infectious Disease Specialist.
“The interaction with rifampin is a critical piece of knowledge, especially in co-endemic areas for TB and schistosomiasis. Ensuring a treatment gap is essential for cure.” – Clinical Pharmacologist.