Biltricide: Effective 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 treatment for schistosomiasis and various trematode infections. As the most widely prescribed agent in its class, it offers broad-spectrum activity against all human schistosome species and numerous other parasitic flukes. Its mechanism of action induces rapid paralysis and tegumental damage in susceptible parasites, leading to their elimination from the host. Supported by decades of clinical use and WHO recommendations, Biltricide represents a critical tool in global parasitic disease control programs.
Features
- Active ingredient: Praziquantel 600 mg per scored tablet
- Broad-spectrum activity against all Schistosoma species (S. haematobium, S. mansoni, S. japonicum, S. mekongi, and S. intercalatum)
- Effective against liver flukes (Clonorchis sinensis, Opisthorchis viverrini) and intestinal flukes (Fasciolopsis buski)
- Rapid onset of action with parasite elimination within 24-48 hours
- High cure rates (76-95% depending on species and infection intensity)
- Well-established safety profile with extensive clinical documentation
- WHO Essential Medicine List inclusion since 2002
- Temperature-stable formulation suitable for tropical climates
Benefits
- Achieves parasitological cure in the majority of treated patients with single-day administration
- Reduces parasite burden and associated morbidity including hepatosplenic disease, bladder pathology, and portal hypertension
- Interrupts disease transmission by eliminating egg-laying adult worms
- Supports public health initiatives through mass drug administration programs
- Minimizes development of anemia, malnutrition, and growth retardation in pediatric populations
- Prevents long-term complications including fibrosis, calcification, and potential malignant transformation
Common use
Biltricide is primarily indicated for the treatment of schistosomiasis (bilharzia) caused by infection with Schistosoma species. It is equally effective against infections caused by liver flukes (clonorchiasis and opisthorchiasis) and intestinal flukes (fasciolopsiasis). The medication is used both in individual clinical cases and in large-scale public health interventions in endemic regions. Its use is particularly valuable in school-aged children who bear the highest burden of schistosomiasis-related morbidity. Biltricide may be administered as part of integrated control programs alongside other anthelmintics for soil-transmitted helminths.
Dosage and direction
Dosage is based on body weight and the specific parasitic infection being treated. For schistosomiasis, the standard dose is 40 mg/kg body weight divided into two or three doses administered 4-6 hours apart in a single day. For liver fluke infections, the recommended dosage is 25 mg/kg three times daily for one or two days. Tablets should be swallowed whole with water during meals to minimize gastrointestinal discomfort and enhance absorption. The scored tablets allow for accurate dosing adjustments. Treatment may be repeated after 4-6 weeks if necessary, particularly in heavy infections or when follow-up demonstrates persistent parasitological evidence.
Precautions
Patients should be advised that dizziness or drowsiness may occur following administration, necessitating caution when operating machinery or driving vehicles. Those with ocular cysticercosis should receive concomitant corticosteroid therapy to prevent inflammatory reactions to dying parasites. Hepatic function should be monitored in patients with pre-existing liver disease, though dosage adjustment is generally not required. Pregnancy category B: should be used during pregnancy only if clearly needed, though WHO recommends treatment in pregnant and lactating women when risk of infection outweighs potential risk. Breastfeeding may continue normally during treatment.
Contraindications
Hypersensitivity to praziquantel or any component of the formulation constitutes an absolute contraindication. The medication is contraindicated in patients with known subarachnoid neurocysticercosis due to risk of inflammatory reactions that may increase intracranial pressure. Caution is warranted in patients with severe hepatic impairment, though no specific dosage adjustments have been established. Children under 4 years of age have limited safety data and require careful risk-benefit assessment before administration.
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. These include abdominal discomfort or pain with cramping, nausea, vomiting, headache, dizziness, and malaise. Less commonly reported effects include fever, urticaria, and mild skin reactions. Laboratory abnormalities may include transient elevation of liver enzymes. Severe reactions are rare but may include cardiac arrhythmias or seizures in predisposed individuals. Side effect frequency and intensity often correlate with parasite burden and resulting inflammatory responses to dying organisms.
Drug interaction
Praziquantel metabolism involves CYP3A4, resulting in several clinically significant interactions. Carbamazepine, phenytoin, and phenobarbital decrease praziquantel concentrations by approximately 50%, potentially requiring dosage adjustment. Conversely, azole antifungals (ketoconazole, itraconazole) and macrolide antibiotics may increase praziquantel levels. Chloroquine reduces bioavailability of praziquantel when administered concomitantly. Dexamethasone may decrease praziquantel concentrations through CYP induction. Grapefruit juice may increase bioavailability and should be avoided around dosing.
Missed dose
As Biltricide is typically administered as a single-day treatment regimen, the concept of “missed dose” applies primarily to the multi-dose schedules used for certain fluke infections. 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, missed treatments should be administered as soon as logistically feasible, preferably within the same transmission season.
Overdose
Cases of overdose are rare due to the medication’s wide therapeutic index. Symptoms may include extension of common side effects including severe gastrointestinal distress, dizziness, sedation, or sweating. There is no specific antidote. Management should include symptomatic and supportive care with attention to maintaining hydration. 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.
Storage
Store at controlled room temperature between 15-30°C (59-86°F). Protect from light and moisture. Keep in original container with tight closure. Do not remove desiccant from packaging. Tablets remain stable for 36 months from date of manufacture when stored properly. Do not use if tablets show signs of discoloration, cracking, or other physical deterioration. Keep out of reach of children and pets.
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. Always follow local prescribing guidelines and regulatory approvals. While every effort has been made to ensure accuracy, prescribing information may vary by region and is subject to change. Healthcare providers should consult current local prescribing information before administration.
Reviews
Clinical studies consistently demonstrate high efficacy and acceptable tolerability. A meta-analysis of 19 trials showed overall cure rates of 76.4% for S. mansoni and 94.7% for S. haematobium. Mass drug administration programs have reported coverage rates exceeding 75% with good community acceptance. Healthcare providers note the convenience of single-day dosing and the medication’s importance in integrated neglected tropical disease control. Patients generally report satisfaction with treatment despite transient side effects, particularly noting improvement in symptoms such as abdominal pain, hematuria, and fatigue within weeks of treatment.