Praziquantel

Indications

Praziquantel is used for: Schistosomiasis, Clonorchiasis, Opisthorchiasis

Adult Dose

Oral 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)

Child Dose

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)

Renal Dose

Administration

Should be taken with food. Swallow whole, do not chew/crush.

Contra Indications

Ocular cysticercosis. Concomitant admin of strong CYP inducers (e.g. rifampicin). Lactation.

Precautions

Patient w/ cardiac abnormalities, cerebral cysticercosis, history of epilepsy and/or other signs of potential CNS involvement (e.g. subcutaneous nodules suggestive of cysticercosis). Moderate to severe hepatic impairment. Pregnancy. Patient Counselling This drug may cause dizziness or drowsiness, if affected, do not drive or operate machinery during or 24 hr after treatment. Monitoring Parameters Monitor LFTs; patients w/ cardiac irregularities during therapy; monitor for seizures; culture urine or faeces for ova prior to treatment.

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

Interactions

Headache, drowsiness, dizziness, malaise, abdominal discomfort, anorexia, nausea, vomiting, diarrhoea, urticaria, rash, fever, asthenia, malaise, fatigue, myalgia. Rarely, seizures, eosinophilia, pruritus, raised liver enzyme values.

Adverse Effects

Side effects of Praziquantel : 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

Mechanism of Action

Praziquantel is a pyrazinoisoquinoline anthelmintic agent w/ a broad spectrum of activity against trematodes (flukes) and cestodes (tapeworms). It increases the cell permeability to Ca in schistosomes, causing strong contractions and paralysis of worm musculature leading to detachment of suckers from the blood vessel walls and to dislodgement.