Makindo Medical Notes

💊 Praziquantel is a key anti-parasitic drug used worldwide. ⚠️ Side effects often occur because dying parasites release antigens → triggering host immune reactions. 📈 The heavier the parasite burden, the more severe the side effects. 🏥 Patients with cerebral cysticercosis should be hospitalised during treatment and given steroids to reduce CNS complications.

📖 About

• Always check the BNF or equivalent for up-to-date prescribing advice.
• Widely used in tropical medicine programmes to treat helminth infections.
• Metabolised by CYP3A4 in the liver.

⚙️ Mode of Action

• Increases calcium ion permeability in parasite cell membranes → tetanic contraction, paralysis, and death of the parasite 🪱.
• Damages parasite tegument, exposing it to host immune attack.

📌 Indications

• Schistosomiasis (S. haematobium, S. mansoni, S. japonicum).
• Tapeworm infections (Taenia solium, Hymenolepis nana).
• Liver flukes (clonorchiasis, opisthorchiasis).
• Cysticercosis & hydatid disease (with caution, usually specialist care).

💊 Example Doses (BNF must be checked)

• Tapeworm (Taenia solium): 5–10 mg/kg PO, single stat dose after a light breakfast.
• Tapeworm (Hymenolepis nana): 25 mg/kg PO, single stat dose.
• Schistosomiasis (S. haematobium, S. mansoni): 20 mg/kg PO, then repeat 20 mg/kg after 4–6 hours (same day).
• Schistosomiasis (S. japonicum): 20 mg/kg PO every 8 hours for one day.
• ⚠️ Doses vary by species, infection site, and local guidelines — always confirm with BNF or specialist parasitology protocols.

🔗 Interactions

• CYP3A4 inducers (e.g., rifampicin, carbamazepine) ↓ praziquantel levels.
• CYP3A4 inhibitors (e.g., cimetidine, azoles) ↑ drug levels.
• See BNF for full list.

⚠️ Cautions

• Severe hepatic impairment → altered metabolism.
• Epilepsy or pre-existing CNS lesions (risk of seizures during cysticercosis treatment).
• Heavily parasitised patients → risk of severe systemic inflammatory response when parasites die.

⛔ Contraindications

• Hypersensitivity to praziquantel.
• Ocular cysticercosis (risk of vision-threatening inflammation).
• See BNF for further details.

💥 Side Effects

• Common: headache 🤕, dizziness, abdominal pain, nausea, vomiting.
• Neurological: ataxia, drowsiness, seizures (especially in CNS infections).
• Allergic-type: rash, pruritus, urticaria.
• In cerebral cysticercosis: CNS deterioration (seizures, meningism, arachnoiditis) due to inflammatory reaction → must co-administer corticosteroids 🧠.

📚 References

• BNF – Praziquantel
• WHO Guidelines for Helminth Control