| Systematic (IUPAC) name | |
|---|---|
| (RS)-2-(Cyclohexanecarbonyl)-2,3,6,7-tetrahydro-1H-pyrazino[2,1-a]isoquinolin-4(11bH)-one | |
| Clinical data | |
| Trade names | Biltricide |
| AHFS/Drugs.com | monograph |
| MedlinePlus | a608048 |
| Pregnancy cat. | Only when clearly needed (lack of sufficient data in humans) |
| Legal status | U.S.: Rx-only (human use), over-the-counter (veterinary use)[1] |
| Routes | oral |
| Pharmacokinetic data | |
| Bioavailability | relatively small |
| Metabolism | hepatic |
| Half-life | 0.8 to 1.5 hours (Main Metabolites 4 to 5 hours) |
| Excretion | mainly in urine |
| Identifiers | |
| CAS number | 55268-74-1 |
| ATC code | P02BA01 QP52AA01 |
| PubChem | CID 4891 |
| DrugBank | EXPT02728 |
| ChemSpider | 4722 |
| UNII | 6490C9U457 |
| KEGG | D00471 |
| ChEMBL | CHEMBL976 |
| Chemical data | |
| Formula | C19H24N2O2 |
| Mol. mass | 312.411 |
| SMILES | eMolecules & PubChem |
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Praziquantel (Biltricide) is an anthelmintic effective against flatworms. Praziquantel is not licensed for use in humans in the UK; it is, however, available as a veterinary anthelmintic, and is available for use in humans on a named-patient basis.
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Praziquantel is used against Schistosoma.[1] As of 2005, praziquantel is the primary treatment for human schistosomiasis, for which it is usually effective in a single dose.[2]
Praziquantel is also used to treat liver flukes such as Clonorchis sinensis,[3] and against fascioliasis.[4]
Praziquantel is also used to treat paragonimiasis.
Praziquantel is also used to treat cestode (tapeworm) infections, including:
Praziquantel was developed in the laboratories for parasitological research of Bayer AG and Merck KGaA in Germany (Elberfeld and Darmstadt) in the mid 1970s. The World Health Organization includes it on its Model List of Essential Medicines.
Praziquantel is well absorbed (approximately 80%) from the gastrointestinal tract. However, due to extensive first-pass metabolism, only a relatively small amount enters systemic circulation. Praziquantel has a serum half-life of 0.8 to 1.5 hours in adults with normal renal and liver function. Metabolites have a half-life of 4 to 5 hours. In patients with significantly impaired liver function (Child Pugh classes B ll///d C), the serum half-life is increased to 3 to 8 hours. Praziquantel and its metabolites are mainly excreted renally; within 24 hours after a single oral dose, 70 to 80% is found in urine, but less than 0.1% as the unchanged drug. Praziquantel is metabolized through the cytochrome P450 pathway via CYP3A4. Agents that induce or inhibit CYP3A4 such as phenytoin, rifampin, and azole antifungals will affect the metabolism of praziquantel.
Praziquantel has a particularly dramatic effect on patients with schistosomiasis. Studies of those treated have shown that within six months of receiving a dose of praziquantel, up to 90% of the damage done to internal organs due to schistosomiasis infection can be reversed.[2]
Although the mode of action is not exactly known at present, there is experimental evidence that praziquantel increases the permeability of the membranes of schistosome cells towards 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 including focal disintegrations and disturbances of oviposition (laying of eggs) are seen in other types of sensitive parasites.
Another hypothesis concerning 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 sensitive parasites), is unable to synthesize purines such as adenosine de novo.
Bayer's Animal Health Division website states, "Praziquantel is active against cestodes (tapeworms). Praziquantel is absorbed, metabolized in the liver and excreted in the bile. Upon entering the digestive tract from the bile, cestocidal activity is exhibited. Following exposure to praziquantel, the tapeworm loses its ability to resist digestion by the mammalian host. Because of this, whole tapeworms, including the scolices, are very rarely passed after administration of praziquantel. In many instances only disintegrated and partially digested pieces of tapeworms will be seen in the stool. The majority of tapeworms are digested and are not found in the feces."[6]
The majority of side effects develop due to the release of the contents of the parasites as they are killed and the consequent host immune reaction. The heavier the parasite burden, the heavier and more frequent the side effects normally are.
A study found that the antibiotic rifampicin decreases plasma concentrations of praziquantel.[7]
Carbamazepine and phenytoin are reported to reduce the bioavailability of praziquantel.[8]
Chloroquine reduces the bioavailability of praziquantel.[9]
At least 2 studies indicate the drug cimetidine heightens praziquantel bioavailability.[10][11]
For schistosomiasis, the dose is 20 milligrams/kilogram by mouth every 4–6 hours for one day. For tapeworms, the dose is 5–25 mg/kg by mouth once. For liver fluke, the dose is 25 mg/kg by mouth every 4–6 hours for one day. These dosages are for patients over 4 years old, and are to be taken with food or a few minutes before a meal.
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Vetoquinol