Biltricide (praziquantel) is a broad-spectrum anthelmintic medication recognized as the gold standard treatment for parasitic infections caused by schistosomes (blood flukes) and liver flukes. As a World Health Organization Essential Medicine, it represents a critical tool in global parasitic disease control programs. Its mechanism of action induces rapid tegumental damage and paralysis in susceptible parasites, leading to their elimination from the host. Clinical studies and decades of therapeutic use have established Biltricide as a highly efficacious and generally well-tolerated treatment option when administered under appropriate medical supervision.

Features

• Active ingredient: Praziquantel 600 mg film-coated tablets
• Broad-spectrum activity against trematode (fluke) and cestode (tapeworm) species
• High oral bioavailability with fatty meal enhancement
• Rapid parasiticidal effect through calcium ion influx disruption
• WHO-listed essential medicine for parasitic infections
• Manufactured under strict pharmaceutical quality standards

Benefits

• Achieves parasitological cure rates exceeding 85% in most schistosome infections
• Single-day dosing regimen enhances patient compliance and treatment completion
• Rapid reduction in parasite burden decreases egg-induced tissue inflammation
• Prevents progression to chronic complications including hepatic fibrosis, portal hypertension, and bladder wall pathology
• Reduces community transmission when deployed in mass drug administration programs
• Well-established safety profile with extensive clinical experience across diverse populations

Common use

Biltricide is indicated for the treatment of schistosomiasis (bilharzia) caused by Schistosoma mansoni, S. haematobium, S. japonicum, S. mekongi, and S. intercalatum. It is also effective against clonorchiasis (Chinese liver fluke) and opisthorchiasis (Southeast Asian liver fluke) infections. Additionally, Biltricide demonstrates efficacy against intestinal tapeworms including Taenia saginata (beef tapeworm), T. solium (pork tapeworm), and Diphyllobothrium latum (fish tapeworm). Medical practitioners may also employ it off-label for certain other trematode infections based on parasitological confirmation and clinical judgment.

Dosage and direction

Dosage is weight-based and varies according to the specific parasitic infection being treated. For schistosomiasis, the standard dose is 40 mg/kg body weight administered as a single dose or in two divided doses on the same day. For liver fluke infections (clonorchiasis/opisthorchiasis), the recommended dosage is 25 mg/kg three times daily for one or two days. Tablets should be swallowed whole with liquid during meals, preferably containing some fat to enhance absorption. The tablets have a bitter taste and should not be chewed or crushed. Dosing intervals should be approximately 4-6 hours for divided dose regimens. Specific dosing should always follow healthcare provider instructions based on parasite identification and patient characteristics.

Precautions

Patients with ocular cysticercosis should not receive Biltricide due to risk of retinal damage from inflammatory response to dying parasites. Hepatic impairment may alter drug metabolism, requiring careful monitoring. Patients should be advised that dizziness or drowsiness may occur, potentially affecting ability to drive or operate machinery. The medication may cause abdominal discomfort, which typically resolves without intervention. Pregnancy category B: should only be used during pregnancy if clearly needed, though the WHO recommends treatment in endemic areas due to schistosomiasis risks outweighing theoretical drug risks. Nursing mothers should exercise caution as praziquantel is excreted in breast milk.

Contraindications

Hypersensitivity to praziquantel or any component of the formulation. First trimester pregnancy unless compelling clinical circumstances exist. Concurrent use with strong CYP450 inducers such as rifampin, which significantly reduces praziquantel bioavailability. Patients with known subarachnoid neurocysticercosis due to risk of inflammatory complications. History of seizures or underlying neurological disorders requiring careful risk-benefit assessment before administration.

Possible side effect

Most adverse reactions are mild and transient, typically resolving within 24-48 hours. Common effects include abdominal pain or discomfort (30-50%), nausea (15-30%), headache (15-25%), dizziness (15-20%), and malaise (10-20%). Less frequently reported include low-grade fever, urticaria, and mild eosinophilia. These symptoms often represent host inflammatory response to parasite death rather than direct drug toxicity. Severe reactions are rare but may include hypersensitivity reactions, exacerbation of neurological symptoms in cerebral cysticercosis, or marked elevation of liver enzymes in patients with pre-existing hepatic compromise.

Drug interaction

Rifampin and other strong CYP3A4 inducers significantly reduce praziquantel plasma concentrations—concomitant use is contraindicated. Antiepileptic drugs including carbamazepine, phenytoin, and phenobarbital may decrease praziquantel efficacy through enzyme induction. Chloroquine may reduce bioavailability when administered concurrently. Dexamethasone may lower praziquantel levels in cerebrospinal fluid, potentially reducing efficacy for neurocysticercosis. Cimetidine may increase praziquantel concentrations through CYP inhibition. Grapefruit juice may increase bioavailability through inhibition of intestinal CYP3A4 and P-glycoprotein.

Missed dose

If a dose is missed within the same treatment day, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. For divided dose regimens spanning multiple days, maintain the regular dosing schedule and do not double the next dose to make up for a missed one. Given the typical short treatment duration (1-2 days), missed doses should be discussed with a healthcare provider to determine if additional dosing is required. Extended delay in dosing may compromise treatment efficacy, particularly for tapeworm infections where incomplete parasite clearance may occur.

Overdose

Cases of overdose are rare due to the drug’s wide therapeutic index. Reported symptoms at very high doses include gastrointestinal disturbances, dizziness, sweating, and in extreme cases, impaired coordination or transient hepatic enzyme elevation. Management is supportive and symptomatic. Gastric lavage may be considered if presentation is early after ingestion. No specific antidote exists. Medical supervision is recommended for significant overdoses, particularly in children or individuals with compromised hepatic function. Hemodialysis is not effective for elimination due to high protein binding and extensive metabolism.

Storage

Store at controlled room temperature (15-30°C or 59-86°F) in the original container. Protect from moisture and light. Keep tightly closed and out of reach of children. Do not use beyond the expiration date printed on packaging. Tablets should not be removed from blister packaging until immediately before administration to maintain stability. Avoid storage in bathrooms or other areas with high humidity. Do not freeze the medication.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Biltricide is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Proper diagnosis of parasitic infection through appropriate laboratory testing is essential before initiation of therapy. Dosage and treatment duration must be individualized based on parasite species, infection severity, patient weight, and clinical status. Patients should disclose full medical history and current medications to their healthcare provider before beginning treatment.

Reviews

Clinical studies consistently demonstrate Biltricide’s high efficacy across various parasitic infections. A meta-analysis of 35 trials showed cure rates of 94.7% for S. haematobium and 91.3% for S. mansoni infections. Gastroenterologists report excellent outcomes in liver fluke infections with complete parasite clearance in over 90% of appropriately treated cases. Public health organizations note its critical role in reducing schistosomiasis morbidity in endemic regions. The well-characterized safety profile and single-day dosing make it particularly valuable for mass administration programs. Some clinicians note the bitter taste can challenge pediatric administration, though whole tablet swallowing with food generally mitigates this issue. The drug’s reliability and predictable pharmacokinetics have maintained its position as first-line therapy for trematode infections for decades.