Praziquantel is an [[anthelmintic]] effective against flatworms. As of 2005, praziquantel is the primary treatment for human [[schistosomiasis]], for which it is usually effective in a single dose. It is also used to treat [[echinococcosis]], [[cysticercosis]], [[intestine|intestinal]] [[tapeworm]]s and the [[liver fluke|liver flukes]] except for [[fascioliasis]]. In [[veterinary]] medicine it is widely used against [[tapeworm]]s, going by the trade name of Droncit.
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==Mechanism of Action==
:* Dosage
Although the mode of action is not exactly known at present, there is experimental evidence that Praziquantel increases the permeability of the membranes of parasite cells (certain schistosomes) for calcium ions. The drug thereby induces contraction of the parasites resulting in paralysis in the contracted state. The dying parasites are dislodged from their site of action in the host organism and may enter systemic circulation or may be destroyed by host immune reaction (phagocytosis). Additional mechanisms - focal disintegrations and disturbances of oviposition (laying of eggs) - are seen in other types of sensitive parasites.
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Another hypothesis on the mechanism of action of praziquantel has been recently reported. The drug seems to interfere with adenosine uptake, in cultured worms. This effect may have therapeutical relevance given that the schistosome, as the taenia and the echinococcus (other praziquantel sensistive parasites), is unable to synthesize purines ''de novo''.
==Historical Perspective==
* Dosing Information
Praziquantel was developed in the laboratories for parasitological research of [[Bayer AG]] in Germany (Elberfeld) in the mid 1970s. Since then it has proven indispensable in more and more indications and is recognized as such by the [[World Health Organization]].
:* Dosage
==Pharmacokinetics==
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Praziquantel is well (approximately 80%) absorbed from the GI Tract. Due to extensive first pass metabolization only relatively small amounts enter systemic circulation. Praziquantel has a serum halflife of 0.8 to 1.5 hours (metabolites 4 to 5 hours) in adults with normal renal and liver function. In patients with significantly impaired liver function (Child Pugh classes B and C) the serum halflife is increased to 3 to 8 hours. Praziquantel and its metabolites are mainly excreted in the urine, within 24 hours after a single oral dose 70 to 80% are recovered in urine, but less than 0.1% are found as the unchanged drug.
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Praziquantel is metabolized through the cytochrome P450 pathway 3A4. Agents that induce or inhibit Cyp450 3A4 (ie phenytoin, rifampin, azole antifungals) will have an effect the metabolism of praziquantel.
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==Side effects==
* Developed by:
The majority of side-effects develop due to the killing of [[parasites]], release of contents of parasites and consequent host immune reactions. The heavier the parasite burden, the heavier and more frequent the side effects normally are.
* Class of Recommendation:
* Central Nervous System: Frequent are [[dizziness]], [[headache]] and malaise. [[Drowsiness]], [[somnolence]], [[fatigue (physical)|fatigue]] and [[Vertigo (medical)|vertigo]] have also been seen. Almost all patients with cerebral [[cysticercosis]] experience CNS side effects related to the cell-death of the parasites ([[headache]], worsening of preexisting neurological problems, [[seizures]], [[arachnoiditis]], and [[meningism]]). These side effects may be life-threatening and can be reduced by coadministration of [[steroids]]. It is strongly recommended that all patients with cerebral [[cysticercosis]] are hospitalized during treatment.
* Strength of Evidence:
* GI Tract: Approximately 90% of all patients have [[abdominal pain]] or cramps with or without nausea and vomiting. [[Diarrhea]] may develop and may be severe with colicky. [[Sweating]], [[fever]], and sometimes bloody stools may emerge together with [[diarrhea]].
* Dosing Information
* Liver : Asymptomatic and transient increases of liver enzymes ([[AST]] and [[ALT]]) are noted frequently (up to 27%). No case of symptomatic liver damage has ever been seen so far.
:* Dosage
* Sensitivity Reactions : [[Urticaria]], [[rash]], [[pruritus]] and [[eosinophilia]] in White Blood Counts.
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* Other Locations/Body as a Whole : [[Low back pain]], [[myalgia]], [[arthralgia]], [[fever]], [[sweating]], various cardiac [[arrhythmias]], and [[hypotension]].
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
==References==
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{{Reflist|2}}
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[[Category:Antibiotics]]
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[[Category:Wikinfect]]
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:* Description
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|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
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|administration=* Oral
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|overdose====Acute Overdose===
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Black Box Warning
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Overview
Praziquantel is a that is FDA approved for the of . There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
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Dosing Information
Dosage
Condition2
Dosing Information
Dosage
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Dosing Information
Dosage
Condition4
Dosing Information
Dosage
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Praziquantel in adult patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Praziquantel in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding FDA-Labeled Use of Praziquantel in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Praziquantel in pediatric patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Praziquantel in pediatric patients.
Contraindications
Condition1
Warnings
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Description
Precautions
Description
Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Praziquantel in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Praziquantel in the drug label.
