Biltricide

Biltricide (praziquantel) is an anthelmintic medication recognized as the gold standard treatment for parasitic infections caused by schistosomes and liver flukes. As a broad-spectrum antiparasitic agent, it demonstrates high efficacy against all clinically significant species of Schistosoma, making it indispensable in both clinical practice and public health initiatives. The World Health Organization includes praziquantel on its List of Essential Medicines, underscoring its critical role in global parasitic disease control. Its mechanism of action causes rapid paralysis and tegumental damage to susceptible parasites, leading to their elimination from the host.

Features

• Contains praziquantel as the active pharmaceutical ingredient
• Available in 600 mg film-coated tablets
• Exhibits activity against all Schistosoma species pathogenic to humans (S. haematobium, S. mansoni, S. japonicum, S. mekongi, and S. intercalatum)
• Effective against liver flukes (Clonorchis sinensis and Opisthorchis viverrini)
• Demonstrates high oral bioavailability, especially when taken with food
• Manufactured under strict pharmaceutical quality control standards
• Typically administered as a single-day or one-day treatment regimen
• Stable at room temperature when stored properly

Benefits

• Achieves parasitological cure rates exceeding 85% in most schistosome infections with appropriate dosing
• Provides rapid resolution of symptoms including hematuria, abdominal pain, and diarrhea in schistosomiasis patients
• Helps prevent long-term complications of chronic parasitic infections such as hepatic fibrosis, portal hypertension, and bladder wall pathology
• Contributes to breaking the transmission cycle of schistosomiasis in endemic communities
• Enables simplified treatment regimens that support adherence and mass drug administration programs
• Demonstrates a favorable safety profile with most adverse effects being mild and transient

Common use

Biltricide is primarily indicated for the treatment of schistosomiasis (bilharzia), a parasitic disease affecting hundreds of millions in tropical and subtropical regions. It is equally effective against infections caused by all human-pathogenic Schistosoma species. Additionally, it is used for the treatment of clonorchiasis and opisthorchiasis (liver fluke infections), particularly in endemic areas of Asia. The medication may also be employed off-label for other trematode infections, though such use should be guided by specialist parasitological consultation. In public health contexts, Biltricide serves as the cornerstone of schistosomiasis control programs, often administered through school-based or community-wide preventive chemotherapy campaigns.

Dosage and direction

Dosage is based on body weight and the specific parasite being treated. For schistosomiasis, the standard dose is 40-60 mg/kg total, typically divided into two or three doses administered 4-6 hours apart in a single day. For liver fluke infections, the recommended dosage is 75 mg/kg total divided into three doses administered at 4-6 hour intervals on the same day. Tablets should be swallowed whole with water during or immediately after a meal to enhance absorption. The tablets have a bitter taste and should not be chewed or crushed. For patients who have difficulty swallowing, tablets may be broken in half but should not be further divided. Dosing in pediatric patients follows the same mg/kg guidelines as for adults.

Precautions

Patients should be screened for potential neurocysticercosis before treatment, as praziquantel may exacerbate neurological symptoms in cases of cerebral parasitosis. Caution is advised in patients with hepatic impairment, as metabolism may be affected. Those with cardiac conditions warrant careful monitoring due to potential transient ECG changes. Pregnancy category B: should be used during pregnancy only if clearly needed, though the WHO recommends treatment for pregnant and lactating women in endemic areas when the benefit outweighs risk. Breastfeeding may continue during treatment. Patients should be advised that dizziness or drowsiness may occur, and they should avoid driving or operating machinery until they know how the medication affects them.

Contraindications

Biltricide is contraindicated in patients with known hypersensitivity to praziquantel or any component of the formulation. It should not be used for the treatment of ocular cysticercosis due to the potential for irreversible eye damage. Use is contraindicated in patients with a history of seizures or uncontrolled epilepsy unless appropriate anticonvulsant cover is provided. The medication is generally avoided in the first trimester of pregnancy unless the clinical situation warrants urgent treatment and no alternatives exist.

Possible side effect

The most frequently reported adverse reactions are generally mild and transient, occurring within hours of administration and resolving within 24-48 hours. Common side effects include abdominal discomfort or pain, nausea, vomiting, headache, dizziness, and malaise. Less frequently, patients may experience mild and transient elevation of liver enzymes, urticaria, fever, or drowsiness. Rare but serious side effects include cardiac arrhythmias, seizures (particularly in patients with neurocysticercosis), and severe hypersensitivity reactions. The side effect profile may be more pronounced in heavily infected individuals due to the simultaneous destruction of numerous parasites.

Drug interaction

Praziquantel metabolism is induced by cytochrome P450 inducers such as carbamazepine, phenytoin, phenobarbital, and rifampicin, which may significantly reduce its plasma concentrations and efficacy. Conversely, inhibitors of CYP3A4 like cimetidine, ketoconazole, and erythromycin may increase praziquantel levels. Grapefruit juice may increase bioavailability and should be avoided around dosing time. Concomitant use with dexamethasone may decrease praziquantel concentrations. Chloroquine has been shown to reduce praziquantel bioavailability when administered concurrently.

Missed dose

As Biltricide is typically administered as a single-day treatment, the concept of “missed dose” applies primarily to the timing between doses on treatment day. If a dose is missed within the treatment day, it should be taken as soon as possible unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doses should not be doubled. For multi-day regimens (used in some specific cases), if a full day is missed, consultation with a healthcare provider is recommended to determine the appropriate course of action.

Overdose

Cases of overdose have been reported, with symptoms including extension of the common adverse effects, particularly gastrointestinal distress, dizziness, and sweating. In severe cases, arrhythmias or convulsions may occur. There is no specific antidote for praziquantel overdose. Management should be supportive and symptomatic, including monitoring of vital signs and cardiac function. Gastric lavage may be considered if performed soon after ingestion. Dialysis is not expected to be effective due to high protein binding and extensive metabolism of the drug.

Storage

Store at room temperature between 15-30°C (59-86°F) in the original container. Protect from light and moisture. Keep the container tightly closed when not in use. Do not store in bathrooms or other areas with high humidity. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly discard any unused medication after treatment completion.

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. While every effort has been made to ensure accuracy, prescribing information may change. Healthcare providers should consult current prescribing information and relevant guidelines before initiating therapy. The manufacturer does not assume liability for any aspects of medical care administered with the aid of this information.

Reviews

Clinical studies consistently demonstrate high efficacy rates for Biltricide across various parasitic infections. A systematic review of 35 trials found cure rates of 94.7% for S. haematobium, 91.3% for S. mansoni, and 94.1% for S. japonicum infections. The medication is widely regarded by tropical medicine specialists as the treatment of choice for schistosomiasis due to its proven effectiveness, generally favorable tolerability, and practical administration schedule. In mass drug administration programs, community acceptance remains high, with most adverse events being self-limiting and requiring minimal medical intervention. Ongoing research continues to confirm its position as an essential tool in global parasitic disease control.