Praziquantel

How it works

It increases parasite cell membrane permeability to calcium, causing sustained muscular contraction, paralysis and tegumental damage that exposes the worm to host immune attack.

Prescribing in practice

• It is contraindicated in ocular cysticercosis, and in neurocysticercosis it can provoke harmful inflammatory reactions, so specialist supervision and consideration of corticosteroid cover are required.
• Concomitant strong hepatic enzyme inducers can markedly lower praziquantel concentrations and reduce efficacy.
• Tablets are best taken with food and swallowed whole to limit the bitter taste that may cause gagging.

Monitoring

Routine laboratory monitoring is not generally required, but neurological status should be observed when treating central nervous system parasitic disease.

Counselling the patient

• Take the tablets with food and swallow them whole with water.
• Drowsiness or dizziness can occur, so take care with driving until you know how it affects you.
• Report severe headache or neurological symptoms if being treated for an infection involving the brain.

Evidence & guidelines

Praziquantel is the WHO-recommended drug of choice for all forms of schistosomiasis.