Praziquantel (Praziquantel)
Also sold as: Biltricide, Cysticide, Prazimax
Pregnancy
Cat B
Lactation
Avoid
Schedule
H
Forms
Tablet 150mg +1
Indications
- Schistosomiasis (all species)
- Tapeworm infections (Taenia saginata, Taenia solium intestinal, Diphyllobothrium)
- Cysticercosis (Taenia solium) — intestinal and CNS forms
- Liver fluke (Clonorchis sinensis, Opisthorchis viverrini)
- Lung fluke (Paragonimus)
Adult Dosing
Schistosomiasis (S. haematobium, S. mansoni)
40 mg/kg/day in 2 divided doses on a single day
One-day treatment only
S. japonicum and S. mekongi: 60 mg/kg/day in 3 divided doses on one day
Tapeworms (Taenia saginata, Taenia solium intestinal, Diphyllobothrium latum)
5–10 mg/kg single dose
Single dose
Highly effective against adult tapeworms in the gut; very low dose needed
Neurocysticercosis (T. solium — CNS)
50 mg/kg/day in 3 divided doses
15 days with dexamethasone and antiepileptic cover
Albendazole is often preferred for NCC; praziquantel may be combined with albendazole in multi-cyst NCC. Avoid corticosteroids that reduce praziquantel levels — use prednisone rather than dexamethasone when possible.
Liver flukes (Clonorchis, Opisthorchis)
25 mg/kg three times daily
1–2 days
Lung fluke (Paragonimus)
25 mg/kg three times daily
2 days
Pediatric Dosing
Use with caution in children <4 years — limited data. Tablets can be divided.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any degree of renal impairment | No established dose adjustment — praziquantel is primarily metabolised hepatically; metabolites are renally excreted but parent drug exposure unchanged |
Hepatic Adjustment
Significant hepatic impairment increases praziquantel exposure (reduced first-pass metabolism). Use with caution — consider dose reduction in Child-Pugh B/C. Schistosomiasis itself causes hepatic fibrosis — monitor LFTs.
Pregnancy & Lactation
Pregnancy: Category B
Animal studies show no teratogenicity. WHO recommends praziquantel for schistosomiasis treatment during 2nd and 3rd trimester (benefit outweighs risk). Avoid in 1st trimester if possible.
Lactation: Avoid
Excreted in human breast milk — approximately 25% of maternal plasma concentration. Withhold breastfeeding on the day of treatment and for 72 hours after final dose.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Corticosteroids (dexamethasone) | Dexamethasone reduces praziquantel plasma levels by ~50% via CYP3A4 induction. For NCC treatment requiring steroids, use prednisone (weaker CYP3A4 inducer) instead of dexamethasone when possible. | Moderate |
| Rifampicin | Potent CYP3A4 inducer — reduces praziquantel AUC by approximately 85%, potentially rendering treatment ineffective. Avoid combination; if unavoidable, consider dose doubling with close monitoring. | Major |
| Cimetidine | Inhibits CYP3A4 — increases praziquantel plasma levels. Can be used intentionally to improve efficacy in NCC (similar strategy to dexamethasone for albendazole). | Moderate |
| Carbamazepine / Phenytoin | Potent CYP3A4 inducers — reduce praziquantel levels significantly. Problematic in NCC patients who require antiepileptics; if using these anticonvulsants, consider albendazole as primary anthelmintic. | Major |
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Side Effects
Common
- Nausea, vomiting, abdominal pain
- Headache
- Dizziness and drowsiness (avoid driving on treatment day)
- Fever (from dying parasites)
- Urticaria and pruritus
- Bloody diarrhoea (schistosomiasis — dying worms)
Serious / Discontinue If
- Seizures — in NCC patients as dying cysts cause cerebral inflammation; requires antiepileptic cover
- Cerebral oedema / raised intracranial pressure — in NCC (manage with dexamethasone/prednisone)
- Hepatic failure — rare; mainly in pre-existing severe hepatic disease
- Cardiac arrhythmias — rare; reported with very high doses
- Severe hypersensitivity reactions
Contraindications
- Ocular cysticercosis — must rule out retinal cysts before treating CNS cysticercosis (dying intraocular cysts can cause blindness)
- Hypersensitivity to praziquantel
- First trimester of pregnancy (relative)
- Co-administration with rifampicin (Major interaction rendering drug ineffective)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Biltricide 600mg | Bayer India | ₹285/6 tab |
| Prazimax 600mg | Sun Pharma | ₹195/6 tab |
Monitoring Required
- LFTs before and after treatment (especially in hepatic schistosomiasis)
- MRI or CT brain before and 1–3 months after completing NCC treatment
- Seizure monitoring in NCC patients — increase antiepileptic vigilance during treatment
- Stool and urine microscopy for schistosome eggs 4–6 weeks post-treatment (test of cure)
- Ophthalmology examination to rule out ocular cysticercosis before treating NCC
Patient Counseling Points
- Take tablets with a full meal — food increases absorption and reduces nausea
- Do NOT drive or operate heavy machinery on the day of treatment — dizziness and drowsiness are common
- Tablets should be swallowed whole with liquid — do not chew (very bitter taste)
- For schistosomiasis: you may notice blood in stool or urine in the first few days — this is normal as worms die
- For neurocysticercosis: you may have more seizures in the first week — this is expected; do not stop any of your medicines
- Avoid alcohol on treatment day and for 24 hours after
- Women: pause breastfeeding on day of treatment and for 3 days after the last dose
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Clinically reviewed by: Dr. Meenakshi Sharma, MD (Medicine), DM (Infectious Diseases), Consultant Tropical Medicine
Last reviewed: 2026-04-01
References
- WHO Model Prescribing Information — Drugs Used in Parasitic Diseases 2nd ed.
- Praziquantel Prescribing Information — Bayer India
- Del Brutto OH. Neurocysticercosis — Neurol Clin 2022
- IDSA 2017 Practice Guidelines for Cysticercosis
- WHO Guideline: Preventive chemotherapy for schistosomiasis 2022
- Praziquantel pharmacokinetics — Drug Metab Dispos 2003
- CDSCO Drug Monograph — Praziquantel