Biltricide (Praziquantel)

Introduction

Biltricide is a prescription-only antiparasitic medication whose active ingredient is praziquantel. It is supplied as a 600 mg oral tablet and belongs to the class of anthelmintics that target flat-worm infections. The drug is approved in many countries for the treatment of schistosomiasis (including Schistosoma mansoni, S. haematobium and S. japonicum) and for infections caused by the tapeworm Taenia solium (neurocysticercosis) and Diphyllobothrium species. Biltricide is manufactured by Merck Sharp & Dohme (MSD) and is marketed worldwide under the Biltricide brand name, while other well-known praziquantel products are marketed under brand names such as Cysticide, Zentel, and Prazinex.

The medication is taken as a single dose for most indications, although specific regimens vary with the parasite species and disease severity. Off-label use, such as experimental treatment of certain trematode infections, has been reported in the scientific literature, but these applications have not received formal regulatory approval.

What is Biltricide?

Biltricide is the trade name for a tablet that contains 600 mg of praziquantel, a synthetic cyclohexylamine that has been the drug of choice for broad-spectrum fluke infections since the s. The product is manufactured by MSD and distributed in more than 50 countries.

Biltricide is the generic version of well-known medications, containing the active compound praziquantel. Our online pharmacy provides this generic alternative as a cost-effective treatment option.

Praziquantel is classified as an anthelmintic belonging to the tetrahydropyrimidine group. It is listed on the World Health Organization (WHO) Model List of Essential Medicines for its proven efficacy, safety profile, and low cost.

How Biltricide Works

Praziquantel exerts its antiparasitic effect primarily by increasing the permeability of the worm’s tegument (outer membrane) to calcium ions. This rapid influx of calcium causes intense muscular contraction and paralysis of the parasite. Within minutes, the immobilized worm detaches from host tissues and is exposed to host immune mechanisms, leading to its death and subsequent clearance.

Key pharmacokinetic features include:

• Absorption: Peak plasma concentrations are reached within 1-2 hours after oral administration.
• Distribution: The drug is widely distributed, crossing the blood-brain barrier, which is essential for treating neurocysticercosis.
• Metabolism: Primarily hepatic via CYP3A4, producing inactive metabolites.
• Elimination: Approximately 80 % is excreted in the urine as unchanged drug within 24 hours; the terminal half-life is about 1.5-2 hours.

Because praziquantel is rapidly cleared, a single high dose provides sufficient exposure to achieve maximal parasite killing while limiting systemic exposure.

Conditions Treated with Biltricide

1. Schistosomiasis (Bilharzia)

• Species: S. mansoni, S. haematobium, S. japonicum.
• Rationale: The drug’s ability to penetrate the worm’s tegument and cause rapid paralysis makes it highly effective against adult schistosomes lodged in the mesenteric veins, bladder plexus, or hepatic portal system.

2. Neurocysticercosis (Taenia solium larval infection of the central nervous system)

• Rationale: Praziquantel’s good cerebrospinal fluid penetration and potent cysticidal activity reduce viable cysts, leading to symptom improvement and seizure control when combined with corticosteroids.

3. Intestinal Tapeworm Infections (Diphyllobothrium latum, Taenia saginata, Taenia solium)

• Rationale: The drug disrupts the muscular integrity of scolex and proglottids, causing rapid expulsion of the tapeworm.

4. Other Trematode Infections (Clonorchis sinensis, Opisthorchis viverrini - where approved)

• Rationale: Similar mechanisms of tegumental disruption apply, and clinical trials report high cure rates, supporting inclusion in national treatment guidelines in endemic regions.

Biltricide is administered as a single oral dose (usually 40 mg/kg for schistosomiasis; 50 mg/kg for neurocysticercosis) or divided into two doses 12 hours apart for certain tapeworm infections, according to local prescribing information.

Off-Label and Investigational Uses of Biltricide

All off-label applications are unapproved by the FDA, EMA, or other regulatory bodies. They should be considered only after a thorough risk-benefit assessment by a qualified healthcare professional.

Is Biltricide the Right Medication for You?

Biltricide is appropriate for adults (and, in many jurisdictions, children weighing at least 15 kg) who have confirmed infections with the parasites listed above. The medication is especially valuable when:

• The infection is confirmed by serology, stool microscopy, or imaging (e.g., brain MRI for neurocysticercosis).
• Rapid parasite clearance is required to prevent organ damage or transmission (e.g., schistosomiasis control programs).
• The patient can tolerate oral tablets and has no contraindicating conditions.

Contraindications (situations where Biltricide should not be used):

• Known hypersensitivity to praziquantel or any tablet excipients.
• Severe hepatic insufficiency (Child-Pugh class C) because metabolism may be markedly impaired.
• Pregnancy in the first trimester for neurocysticercosis (risk-benefit must be evaluated).

Cautions (use with extra monitoring):

• Co-administration with CYP3A4 inducers (e.g., rifampin) may reduce exposure.
• Patients with cardiac arrhythmias should be observed after dosing due to occasional transient QT-interval prolongation.

If any of the above conditions apply, alternative therapies or modified dosing strategies should be discussed with a qualified provider.

Risks, Side Effects, and Interactions

Common

• Gastrointestinal discomfort (nausea, abdominal pain, dyspepsia).
• Headache and mild dizziness.
• Fatigue or transient weakness.

These events usually resolve within 24 hours and do not require specific treatment. Taking the tablet with food can lessen stomach upset.

Rare

• Transient elevation of hepatic enzymes (ALT, AST).
• Allergic skin reactions (rash, pruritus).
• Mild leukopenia noted in isolated case reports.

Patients experiencing these symptoms should be evaluated, but discontinuation is rarely needed.

Serious

• Severe hypersensitivity (angioedema, anaphylaxis).
• Cardiac arrhythmias (prolonged QT interval, especially in patients on other QT-prolonging drugs).
• Seizure exacerbation in neurocysticercosis if corticosteroid cover is inadequate.

Any of these events require immediate medical attention and cessation of therapy.

Drug-Drug Interactions

• CYP3A4 inducers (rifampin, carbamazepine, St. John’s wort) → lower praziquantel levels, possibly reducing efficacy.
• CYP3A4 inhibitors (ketoconazole, erythromycin, grapefruit juice) → modestly increase plasma concentrations; monitor for toxicity.
• Phenobarbital and phenytoin → may speed praziquantel clearance.

Drug-Food Interactions

• High-fat meals can increase praziquantel absorption by up to 30 %. This effect is generally not clinically significant but may be used intentionally when higher exposure is desired (e.g., neurocysticercosis).
• Alcohol should be avoided for at least 24 hours before and after dosing to reduce the risk of dizziness and hepatic strain.

Use: Dosing, Missed Dose, Overdose

Standard Dosing (Adults)

The tablet strength is 600 mg; the total number of tablets is calculated based on the patient’s weight and the prescribed mg/kg dose.

Missed Dose

If a dose is forgotten and it is still within 4 hours of the scheduled time, take it immediately. If more than 4 hours have elapsed, skip the missed dose and resume the regular schedule. Do not double-dose to compensate.

Overdose

Acute overdose (> 20 g) is rare but may cause severe gastrointestinal upset, dizziness, hypotension, and cardiac arrhythmia. Management is primarily supportive:

• Monitor vital signs and cardiac rhythm.
• Provide intravenous fluids if hypotensive.
• Activated charcoal may be considered if presentation is within one hour of ingestion.
• No specific antidote exists; symptomatic treatment is the mainstay.

Prompt medical evaluation is essential in any suspected overdose.

FAQ

• What should I do with Biltricide tablets when traveling internationally?

  • Store the tablets in their original blister pack, away from excessive heat or humidity. Carry them in hand luggage to avoid temperature extremes in cargo holds, and keep a copy of the prescription or a physician’s letter to satisfy customs if required.

• Can I take Biltricide with antacids or probiotics?

  • Antacids do not significantly affect praziquantel absorption and can be taken concomitantly. Probiotic supplements are also safe, as they act locally in the gut and do not interact with the drug’s metabolism.

• How long does a Biltricide tablet stay stable in a tropical environment?

  • The tablet is stable for up to 24 months when stored at 15-30 °C and protected from moisture. In climates exceeding 30 °C, keep the medication in a cool, dry place or in an insulated container to maintain potency.

• Is Biltricide detectable in standard drug-testing panels?

  • Praziquantel is not included in routine employment or sports drug-testing panels because it is not a controlled substance and has no performance-enhancing properties.

• What are the inactive ingredients in a 600 mg Biltricide tablet?

  • The tablet contains microcrystalline cellulose, lactose monohydrate, povidone, magnesium stearate, and an anhydrous coating polymer. These excipients are listed on the product label and are generally well tolerated.

• Can Biltricide be used in patients with chronic kidney disease?

  • Praziquantel is predominantly eliminated unchanged in the urine, but renal impairment does not markedly affect its clearance. Dose adjustment is usually unnecessary for mild-to-moderate kidney disease, though severe renal failure warrants close monitoring.

• Why is a single high dose preferred over multiple low doses?

  • The drug’s short half-life means that high peak concentrations are needed to quickly induce calcium influx in the parasite’s tegument. A single dose maximizes this effect while minimizing overall drug exposure and the risk of cumulative side-effects.

• Is it safe to breastfeed while taking Biltricide?

  • Small amounts of praziquantel are excreted in breast milk, but concentrations are far below therapeutic levels. The WHO considers it compatible with breastfeeding; however, mothers should consult a pediatric specialist if the infant is premature or has a metabolic disorder.

• How does praziquantel differ from older anthelmintics like albendazole?

  • Praziquantel targets flatworms (flukes and tapeworms) by disrupting calcium homeostasis, whereas albendazole is a benzimidazole that interferes with microtubule formation and is primarily effective against nematodes. Their distinct mechanisms make them complementary in mixed-parasite infections.

• Can I store Biltricide tablets in a refrigerator to extend shelf life?

  • Refrigeration is unnecessary and may cause condensation on the tablets, potentially affecting the coating. Keep the medication at room temperature in a dry place for optimal stability.

Glossary

Anthelmintic

A class of drugs that expel or destroy parasitic worms (helminths) from the body.

Tegument

The outer protective membrane of flatworms; disruption of this layer leads to parasite death.

CYP3A4

An enzyme in the liver responsible for metabolizing many medications, including praziquantel; its activity can be altered by other drugs.

Neurocysticercosis

A disease caused by larval cysts of Taenia solium in the central nervous system, often presenting with seizures.

Buying Biltricide from Our Online Pharmacy

Patients who need Biltricide but face limited access through local pharmacies or high out-of-pocket costs can obtain the medication from our online pharmacy. Because we work directly with licensed overseas suppliers, we can provide the 600 mg tablets at a price that approaches the manufacturer’s wholesale cost, helping to reduce the financial burden on patients.

All Biltricide batches are sourced from GMP-certified facilities, and each shipment undergoes a strict quality-verification process before leaving the supplier’s warehouse. This ensures that the product you receive meets the same regulatory standards required for domestic distribution.

Delivery is handled discreetly: packages are unmarked, labelled only with a generic reference number, and shipped in secure, tamper-evident containers. Standard international shipping typically arrives within 7 days for express services and within 3 weeks for regular airmail, with tracking available for every order.

By using a pharmacy-broker model, our online pharmacy can offer a reliable, private, and cost-effective way to obtain Biltricide when conventional channels are unavailable or unaffordable.

Disclaimer

The information presented about Biltricide is intended for general educational purposes only and does not substitute professional medical advice. Treatment decisions, including those concerning off-label applications, should be made solely under the guidance of a qualified healthcare provider. Readers are presumed to be competent adults capable of making informed health choices. Our online pharmacy supplies Biltricide to individuals who may encounter limited availability through conventional pharmacies, insurance-based prescription programs, or who seek an affordable generic alternative. Always discuss any medication changes with your doctor before initiating, modifying, or discontinuing therapy.