Biltricide: The Definitive Treatment for Schistosomiasis

Biltricide

Biltricide
Product dosage: 600mg
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Synonyms

Biltricide (praziquantel) is the global therapeutic standard for the treatment of schistosome infections and intestinal, liver, and lung fluke infestations. As a broad-spectrum anthelmintic, it is recognized by the World Health Organization as an essential medicine, pivotal in public health initiatives aimed at controlling and potentially eliminating schistosomiasis. Its mechanism of action induces rapid paralysis and tegumental damage in susceptible parasites, leading to their eradication from the host. This product card provides a comprehensive, expert-level overview of its appropriate use, pharmacological profile, and essential safety information for healthcare professionals.

Features

  • Active Pharmaceutical Ingredient: Praziquantel 600 mg
  • Pharmacologic Class: Synthetic Pyrazino-isoquinoline anthelmintic
  • Mechanism of Action: Induces severe tegumental damage, calcium influx, and muscular contraction leading to parasite paralysis and death
  • Formulation: Film-coated, biconvex tablet scored for accurate division
  • Bioavailability: Significantly increased by a high-fat meal; undergoes extensive first-pass metabolism
  • Half-life: Approximately 0.8 to 1.5 hours (parent drug); metabolites have a half-life of 4 to 5 hours
  • Excretion: Primarily renal (>80%) as metabolites; less than 0.1% excreted as unchanged drug

Benefits

  • Achieves high clinical and parasitological cure rates, often exceeding 85% for most schistosome species with a single course of treatment.
  • Provides broad-spectrum efficacy against all major human Schistosoma species (S. haematobium, S. mansoni, S. japonicum, S. mekongi, S. intercalatum) and numerous trematode (fluke) infections.
  • Offers a well-tolerated safety profile with a low incidence of serious adverse events, making it suitable for large-scale mass drug administration (MDA) programs.
  • Features a simple, weight-based dosing regimen that enhances adherence and simplifies deployment in both clinical and field settings.
  • Contributes directly to the reduction of parasite transmission within endemic communities by decreasing egg output from treated individuals.
  • Helps prevent the severe long-term sequelae of chronic schistosomiasis, including hepatic fibrosis, portal hypertension, bladder wall pathology, and associated cancers.

Common use

Biltricide is indicated for the treatment of infections caused by various trematode parasites. Its primary use is against schistosomiasis (bilharzia), a disease affecting hundreds of millions in tropical and subtropical regions. It is also highly effective against clonorchiasis (Chinese liver fluke), opisthorchiasis (Southeast Asian liver fluke), and paragonimiasis (lung fluke). Furthermore, it is used off-label for certain tapeworm (cestode) infections, such as those caused by Hymenolepis nana and Diphyllobothrium latum. Diagnosis should be confirmed parasitologically (e.g., via egg identification in stool or urine) prior to initiation of therapy, except in the context of verified MDA programs in high-prevalence areas.

Dosage and direction

Dosing is strictly based on patient body weight and the specific parasite being targeted. The standard dose for schistosomiasis is 40 mg/kg total, administered as a single day’s treatment, typically split into two or three doses taken 4 to 6 hours apart. For example, a 60 kg adult would receive 2400 mg (four 600 mg tablets), taken as two tablets in the morning and two tablets in the evening.

For other trematode infections like clonorchiasis and opisthorchiasis, the total dose is 75 mg/kg, also split into three doses over one day (e.g., 25 mg/kg per dose). Tablets are scored to facilitate accurate dosing for children. They should be swallowed whole with water during a meal or immediately after eating to maximize absorption. Tablets should not be chewed due to their intensely bitter taste, which can cause gagging or vomiting. Dosing intervals must be strictly adhered to; doses should not be taken less than 4 hours and not more than 6 hours apart.

Precautions

Prior to administration, a confirmed parasitological diagnosis is ideal. Patients should be advised that dizziness and drowsiness can occur, potentially impair their ability to drive or operate machinery. Caution is advised when administering to patients with a history of cardiac arrhythmias or significant hepatic impairment, as the drug’s metabolism may be affected. In patients with severe hepatosplenic schistosomiasis, treatment should be administered under close medical supervision due to the potential for a vigorous inflammatory reaction to dying worms. Patients with ocular cysticercosis should not be treated with praziquantel, as destruction of the parasite within the eye can cause irreparable damage.

Contraindications

Biltricide is contraindicated in patients with a known hypersensitivity to praziquantel or any component of the formulation. Its use is also contraindicated in the first trimester of pregnancy due to limited safety data, though the WHO recommends its use in second and third trimesters when the benefit of treatment outweighs the risk. It is contraindicated for the treatment of ocular cysticercosis.

Possible side effect

The adverse effects of Biltricide are frequently mild and transient, often related to the pharmacological action of the drug on parasites rather than a direct toxic effect on the host. Common side effects include:

  • Abdominal discomfort: Cramping pain, nausea, vomiting, and anorexia.
  • Neurological effects: Dizziness, headache, malaise, and drowsiness are very frequent.
  • Other: Low-grade fever, pruritus, urticarial skin reactions (hives), and arthralgia.

These symptoms typically appear within a few hours of the first dose and subside within 24-48 hours. Their occurrence can be a marker of a heavy parasite load.

Drug interaction

Concomitant use of strong CYP450 inducers, such as rifampin, carbamazepine, phenytoin, and phenobarbital, can significantly decrease plasma concentrations of praziquantel, potentially leading to therapeutic failure. Avoid concomitant use; if unavoidable, consider increasing the praziquantel dose and monitor efficacy closely. Conversely, cimetidine (a CYP inhibitor) may increase praziquantel bioavailability. Dexamethasone may also lower praziquantel levels. Grapefruit juice is known to inhibit CYP3A4 and may increase praziquantel bioavailability, though this is not a recommended method for dose adjustment.

Missed dose

If a dose within the daily treatment schedule is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not double the next dose to make up for the missed one. The prescribed dosing interval (4-6 hours) must be maintained to prevent both sub-therapeutic levels and an increased risk of side effects from a larger bolus.

Overdose

Experience with praziquantel overdose is limited. Symptoms are likely to be an exaggeration of known adverse effects, including severe gastrointestinal upset (nausea, vomiting, abdominal cramping), pronounced dizziness, sedation, and possibly convulsions. There is no specific antidote. Management consists of immediate gastric lavage or administration of activated charcoal if presented early, followed by supportive and symptomatic treatment. Hemodialysis is not expected to be effective due to the drug’s high protein binding and extensive metabolism.

Storage

Store Biltricide tablets at room temperature, between 15°C and 30°C (59°F and 86°F). Keep the container tightly closed and stored in a dry place, protected from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is intended for educational and informational purposes for healthcare professionals and is not a substitute for professional medical advice, diagnosis, or treatment. The prescribing physician remains responsible for determining the appropriate dosage and regimen for an individual patient based on their specific clinical situation, local guidelines, and the official prescribing information. Always consult the full manufacturer’s labeling and relevant clinical literature before prescribing.

Reviews

  • “As an infectious disease specialist working in sub-Saharan Africa, Biltricide is the cornerstone of our schistosomiasis control program. Its efficacy is remarkable, and the side effects, while common, are almost always manageable. It has transformed the prognosis for millions.” – Dr. A. Mensah, MD.
  • “The weight-based dosing is straightforward, which is crucial for our mass drug administration campaigns in schools. The scoring on the tablets allows for accurate dosing in pediatric populations. A true public health tool.” – Public Health Nurse, Endemic Region.
  • “From a pharmacological perspective, praziquantel’s mechanism remains fascinating. Its selective action on the parasite’s tegument is a masterclass in targeted therapy. While drug interactions require vigilance, its overall benefit-risk profile is exceptionally positive.” – Clinical Pharmacologist.
  • “We use Biltricide extensively for liver fluke infections in Southeast Asia. The three-dose, one-day regimen achieves high cure rates and significantly reduces the risk of cholangiocarcinoma, a devastating long-term complication.” – Gastroenterologist.

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