Biltricide: Targeted Treatment for Schistosomiasis and Fluke Infections
| Product dosage: 600mg | |||
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Synonyms | |||
Biltricide (praziquantel) is an anthelmintic medication recognized as the gold standard therapeutic intervention for schistosomiasis and infections caused by liver, lung, and intestinal 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 paralysis and tegumental damage in susceptible parasites, leading to effective eradication. This product card provides a comprehensive overview of Biltricide for healthcare professionals, detailing its pharmacological profile, clinical application, and essential safety information to support informed prescribing decisions.
Features
- Active ingredient: Praziquantel 600 mg film-coated tablets
- Pharmacologic class: Synthetic pyrazino-isoquinoline derivative anthelmintic
- Mechanism: Increases cell membrane permeability to calcium, causing tetanic contraction and tegument disintegration
- Broad-spectrum activity against all Schistosoma species pathogenic to humans
- Effective against cestodes (tapeworms) including Taenia saginata, Taenia solium, Diphyllobothrium latum, and Hymenolepis nana
- High oral bioavailability with significant first-pass metabolism
- Protein binding approximately 80%
- Elimination half-life of 0.8-1.5 hours (adults), 1-3 hours (children)
- Primarily metabolized by cytochrome P450 system and excreted renally
Benefits
- Achieves parasitological cure rates exceeding 85% for most schistosome infections with single-day administration
- Prevents the progression of chronic schistosomiasis complications including hepatosplenic disease, portal hypertension, and bladder wall pathology
- Reduces parasite egg burden, decreasing environmental contamination and transmission potential
- Single-dose regimen enhances treatment adherence in mass drug administration programs
- Well-established safety profile with extensive clinical experience spanning decades
- Critical role in morbidity control within endemic regions through regular treatment programs
Common use
Biltricide is indicated for the treatment of schistosomiasis caused by all human-pathogenic Schistosoma species (S. haematobium, S. mansoni, S. japonicum, S. mekongi, and S. intercalatum). Additionally, it is effective against clonorchiasis (Chinese liver fluke), opisthorchiasis (Southeast Asian liver fluke), paragonimiasis (lung fluke), and intestinal cestode infections including taeniasis, diphyllobothriasis, and hymenolepiasis. The medication is utilized both in individual clinical management and large-scale public health interventions in endemic areas, particularly in sub-Saharan Africa, Southeast Asia, and parts of South America.
Dosage and direction
Dosage varies according to the specific parasitic infection and patient factors. For schistosomiasis, the standard adult and pediatric (over 4 years) dose is 40 mg/kg body weight divided into two or three doses administered at 4-6 hour intervals in a single day. For S. japonicum and S. mekongi infections, the total dose may be increased to 60 mg/kg divided into two or three doses. For clonorchiasis and opisthorchiasis: 25 mg/kg three times daily for one day. For paragonimiasis: 25 mg/kg three times daily for two days. For tapeworm infections: 5-10 mg/kg as a single dose. Tablets should be swallowed whole with liquid during meals; splitting or chewing is not recommended due to bitter taste. Patients should be advised that tablets are best taken with food to enhance absorption and minimize gastrointestinal discomfort.
Precautions
Hepatic function should be assessed before treatment initiation, as impaired liver function may alter praziquantel metabolism. Use with caution in patients with cardiac conditions, as transient ECG changes have been reported. Ocular cysticercosis must be ruled out before treatment, as destruction of intraocular parasites may cause irreversible damage. Neurocysticercosis requires concomitant corticosteroid administration to mitigate inflammatory reactions to dying parasites. Pregnancy category B: use only if clearly needed, though WHO recommends treatment during pregnancy in endemic areas. Lactation: temporary cessation of breastfeeding for 72 hours post-treatment is advised due to secretion in milk. Patients should be cautioned against driving or operating machinery on treatment day due to potential dizziness and drowsiness.
Contraindications
Biltricide is contraindicated in patients with known hypersensitivity to praziquantel or any component of the formulation. It should not be administered to patients with known ocular cysticercosis due to risk of permanent ocular damage. Concomitant use with strong CYP450 inducers such as rifampin is contraindicated due to significant reduction in praziquantel plasma concentrations. Administration is contraindicated in patients with previous severe adverse reactions to praziquantel. The safety of Biltricide in children under 4 years has not been established, and use in this population is not recommended.
Possible side effect
The majority of adverse reactions are mild to moderate, transient, and dose-related. Common reactions include abdominal discomfort or pain (30-50%), nausea (15-30%), headache (15-25%), dizziness (15-25%), and malaise (10-20%). Less frequently observed effects include vomiting, fever, urticaria, and eosinophilia. These symptoms may represent both direct drug effects and host reactions to dying parasites. Neurological side effects including drowsiness, vertigo, and seizures are rare but may occur, particularly in patients with neurocysticercosis. Elevated liver enzymes have been reported in approximately 5-10% of patients, typically normalizing without intervention.
Drug interaction
Rifampin and other strong CYP3A4 inducers significantly reduce praziquantel bioavailability (up to 80%) and should be avoided. Carbamazepine, phenytoin, and phenobarbital may similarly decrease praziquantel concentrations. Dexamethasone may lower praziquantel levels by approximately 50%. Chloroquine reduces praziquantel bioavailability and should be administered separately. Cimetidine may increase praziquantel concentrations by inhibiting CYP450 metabolism. Grapefruit juice may increase bioavailability through inhibition of intestinal CYP3A4. Antiepileptic drugs may require dosage adjustment when treating neurocysticercosis. Concomitant administration with azole antifungals may increase praziquantel exposure.
Missed dose
In the context of single-day treatment regimens, the importance of completing the full prescribed course should be emphasized to patients. 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. Patients should not double the dose to make up for a missed dose. For multi-day regimens, if a dose is missed, it should be taken as soon as possible unless it is close to the time for the next dose, in which case the missed dose should be skipped. Healthcare providers should be contacted for guidance on whether extended treatment is necessary based on the timing of the missed dose.
Overdose
Cases of overdose are rare due to the drug’s rapid metabolism and excretion. Reported symptoms in overdose situations include gastrointestinal distress (nausea, vomiting, abdominal pain), dizziness, sedation, and sweating. In severe cases, impaired coordination and convulsions may occur. There is no specific antidote for praziquantel overdose. Management should be supportive and symptomatic, including gastric lavage if ingestion was recent and activated charcoal administration. Vital signs should be monitored, particularly cardiac function due to potential ECG changes. Patients should be observed for at least 24 hours with appropriate symptomatic treatment as needed.
Storage
Store at controlled room temperature between 15-30°C (59-86°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not remove the desiccant from the container. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Properly discard any unused medication after treatment completion. Do not flush medications down the toilet or pour into drains unless instructed to do so.
Disclaimer
This information is intended for healthcare professionals and should not replace clinical judgment. Dosage and treatment decisions must be made by qualified medical practitioners based on individual patient assessment. The prescribing physician should be familiar with the complete prescribing information before administering Biltricide. Local treatment guidelines and parasite susceptibility patterns should be considered when determining appropriate therapy. This document does not contain all possible information about this medication and should be used in conjunction with full prescribing information and current clinical guidelines.
Reviews
Clinical studies spanning four decades have consistently demonstrated Biltricide’s efficacy and safety profile. A meta-analysis of 35 randomized trials (n=8,942) confirmed cure rates of 76-95% across schistosome species with single-day treatment. Long-term follow-up studies show sustained reduction in parasite-related morbidity in treated populations. The medication is endorsed by WHO as the cornerstone of schistosomiasis control programs, with over 400 million treatments distributed annually. Healthcare providers report high patient acceptability despite transient side effects, noting the advantage of single-day administration over previous multi-day regimens. Ongoing research continues to support its position as first-line therapy for trematode and cestode infections.