Biltricide: Targeted Treatment for Schistosomiasis Infection
| Product dosage: 600mg | |||
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Synonyms | |||
Biltricide (praziquantel) is an anthelmintic medication specifically formulated for the treatment of schistosomiasis and certain trematode infections. As the therapeutic cornerstone for these parasitic diseases, it offers a critical intervention in global health, particularly in endemic regions. Its mechanism of action induces rapid paralysis and tegumental damage in susceptible parasites, leading to their elimination from the host. Clinical use is supported by decades of research and WHO endorsement, making it an essential agent in both treatment and mass drug administration programs.
Features
- Active ingredient: Praziquantel 600 mg per tablet
- Formulation: Film-coated oral tablet
- Mechanism: Increases cell membrane permeability to calcium in susceptible parasites
- Broad-spectrum activity against all major Schistosoma species
- Rapid absorption, with peak plasma concentrations occurring 1-3 hours post-administration
- Extensive first-pass metabolism, primarily via cytochrome P450 system
- Administration: Taken as a single or divided dose, typically with food to enhance bioavailability
Benefits
- Achieves high cure rates, often exceeding 85% for most schistosome species with appropriate dosing
- Provides rapid symptomatic relief from fever, abdominal pain, and hematuria associated with active infection
- Helps prevent long-term complications of chronic schistosomiasis, including hepatic fibrosis, portal hypertension, and bladder wall pathology
- Contributes to reducing community transmission in endemic areas when used in control programs
- Well-established safety profile with extensive clinical use in both children and adults
- Single-day dosing regimen supports adherence and simplifies administration in public health initiatives
Common use
Biltricide is indicated for the treatment of infections caused by Schistosoma species, including S. haematobium, S. mansoni, S. japonicum, S. mekongi, and S. intercalatum. It is also effective against most other trematode infections such as clonorchiasis and opisthorchiasis. The medication is particularly valuable in mass drug administration programs implemented by health organizations in endemic regions, where it serves as the primary intervention for controlling schistosomiasis transmission. Treatment is typically administered after confirmed diagnosis through parasitological examination, though presumptive treatment may be indicated in high-prevalence areas or during outbreak situations.
Dosage and direction
Dosage is weight-based and varies according to the infecting species. For schistosomiasis, the standard regimen is 40 mg/kg body weight administered either as a single dose or in two divided doses taken 4-6 hours apart. For S. japonicum and S. mekongi infections, the recommended dose is 60 mg/kg divided into three doses at 4-6 hour intervals. Tablets should be swallowed whole with liquid during a meal, as food significantly enhances bioavailability. The tablets have a bitter taste and may cause gagging if chewed or retained in the mouth. For patients who cannot swallow tablets whole, crushed tablets may be mixed with a small amount of liquid or semi-solid food and administered immediately.
Precautions
Hepatic function should be assessed before treatment initiation, as extensive metabolism occurs in the liver. Use with caution in patients with hepatic impairment, though no specific dosage adjustment is routinely recommended. Patients should be advised that dizziness or drowsiness may occur, potentially affecting the ability to drive or operate machinery. Due to the potential for inflammatory reactions to dying parasites, treatment may temporarily exacerbate symptoms in cases of heavy infection, particularly cerebral schistosomiasis. Pregnancy category B: should be used during pregnancy only if clearly needed, though the WHO recommends treatment for infected pregnant women in endemic areas after the first trimester. Nursing mothers should exercise caution, as praziquantel is excreted in breast milk.
Contraindications
Biltricide is contraindicated in patients with known hypersensitivity to praziquantel or any component of the formulation. It should not be administered for ocular cysticercosis, as parasite destruction within the eye may cause irreversible damage. Use is contraindicated in patients with Taenia solium cysticercosis, as the resulting inflammatory response to dying cysts may precipitate neurological complications. The medication is generally avoided during the first trimester of pregnancy unless the potential benefit justifies the potential risk to the fetus.
Possible side effect
Most adverse reactions are mild and transient, typically resolving within 24 hours. Common side effects include abdominal discomfort or pain, nausea, vomiting, headache, dizziness, and malaise. Less frequently, patients may experience pruritus, urticaria, arthralgia, myalgia, low-grade fever, or eosinophilia. These reactions are often related to parasite death and the host inflammatory response rather than direct drug toxicity. Serious side effects are rare but may include cardiac arrhythmias, seizures (particularly in patients with neurocysticercosis), or severe hypersensitivity reactions. Elevated liver enzymes may occur but typically normalize without intervention.
Drug interaction
Praziquantel metabolism is induced by cytochrome P450 inducers such as carbamazepine, phenytoin, phenobarbital, and rifampin, which may significantly reduce plasma concentrations and efficacy. Concomitant administration with these agents should be avoided, or dosage adjustment considered. Conversely, cimetidine, a CYP inhibitor, may increase praziquantel bioavailability. Grapefruit juice may inhibit CYP3A4 metabolism and increase drug levels. Dexamethasone may decrease praziquantel concentrations through induction of metabolism. Chloroquine may reduce bioavailability when administered concurrently.
Missed dose
As Biltricide is typically administered as a single or single-day treatment regimen, the concept of “missed dose” primarily applies to divided dose protocols. If a dose is missed within the treatment day, it should be taken as soon as remembered, unless it is nearly time for the next scheduled dose. Doses should not be doubled. For mass drug administration programs where directly observed therapy is implemented, missed doses are typically managed by immediate administration or completion of the regimen the following day, depending on program protocols.
Overdose
Cases of overdose are rare due to the drug’s wide therapeutic index. Symptoms may include extension of common side effects, particularly gastrointestinal disturbances, dizziness, sedation, or sweating. In severe cases, impaired coordination or convulsions might occur. There is no specific antidote. Management is supportive and symptomatic, including gastric lavage if ingestion was recent. Monitoring of vital signs and cardiac function is recommended in significant overdose. Dialysis is not expected to be effective due to high protein binding and extensive metabolism.
Storage
Store at room temperature between 15-30°C (59-86°F) in a dry place protected from light. Keep in the original container with the lid tightly closed. Do not remove desiccant from the bottle. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Proper storage is particularly important in tropical climates where high temperatures and humidity may affect stability.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. Dosage and administration may vary based on specific clinical situation, parasite species, and patient factors. Always follow local treatment guidelines and prescribing information. The manufacturer’s complete prescribing information should be consulted before administration.
Reviews
Clinical studies consistently demonstrate high efficacy rates across schistosome species, with meta-analyses showing cure rates of 76-95% depending on species and intensity of infection. Field studies in mass drug administration programs confirm effectiveness in reducing parasite burden and morbidity in endemic communities. Healthcare providers report good tolerability in both children and adults, with the brief duration of side effects being particularly advantageous in public health settings. Some studies note varying efficacy based on transmission intensity and potential concerns about emerging resistance, though these remain areas of ongoing research. Overall, Biltricide maintains its status as the gold standard for schistosomiasis treatment after decades of clinical use.