Apalutamide
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Drug reference
Praziquantel
Anthelmintic (pyrazinoisoquinoline) · Anti-parasitic
Also known as Biltricide, Prazi, PZQ
START
Schistosomiasis 40 mg/kg single dose; neurocysticercosis 50 mg/kg/day divided ×14–30 d WITH corticosteroid
TYPICAL MAX
Indication/weight-defined (flukes up to 75 mg/kg/day; neurocysticercosis 50 mg/kg/day)
STOP IF
Severe hypersensitivity, severe neurological deterioration (cysticercosis — manage inflammation)
WATCH
Corticosteroid cover for neurocysticercosis, exclude ocular cysticercosis before treating, hepatic dose caution, take with food
CDSCO approvedSchedule HJan AushadhiATC P02BA01
KDIGO 2024 + manufacturer label
- ONSET
- 2h · absorption
- PEAK
- 2h · Cmax
- t½
- 1.5h · parent t½
- DURATION
- 1d · treatment-day
EXCRETION
Hepatic CYP3A4; ~80% renal metabolites
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Considered acceptable when treatment indicated (WHO permits in schistosomiasis incl. pregnancy) — benefit usually outweighs
FDA category + note
Top interactionssee all 12 →
- ApalutamideSevereDatabaseDDInter
- CarbamazepineSevereDatabaseDDInter
- EnzalutamideSevereDatabaseDDInter
- FosphenytoinSevereDatabaseDDInter
Available in India
10 branded formulations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Increases parasite cell-membrane permeability to calcium → tetanic muscular contraction, paralysis and tegument disruption (immune attack) of trematodes and cestodes.
Indications
Schistosomiasis (all species)Liver, lung and intestinal flukes (clonorchiasis, opisthorchiasis, paragonimiasis, fascioliasis variable)Tapeworm infections / neurocysticercosis (with corticosteroid cover)
Dosing
- Adult
- Schistosomiasis: 40 mg/kg single dose (or 20 mg/kg ×2). Flukes: 25 mg/kg three times in one day. Neurocysticercosis: 50 mg/kg/day divided ×14–30 days with corticosteroid.
- Pediatric
- ≥4 years: weight-based as adult (per indication).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Reduce dose / caution in moderate–severe hepatic impairment (increased levels; hepatosplenic schistosomiasis).
- Geriatric
- No specific adjustment.
- Max dose
- Indication/weight-defined (e.g. up to 75 mg/kg/day for flukes; neurocysticercosis 50 mg/kg/day)
Pharmacokinetics
Onset
Antiparasitic over the treatment day(s)
Peak effect
Cmax ~1–3 h
Duration
Single-day or short course
Half-life
~0.8–1.5 h (metabolites ~4 h)
Bioavailability
Well absorbed; extensive first-pass (food/cimetidine increase levels)
Protein binding
~80%
Metabolism
Extensive hepatic CYP (CYP3A4 major; CYP2B/2C)
Excretion
Renal (~80% as metabolites within 24 h)
Contraindications
- Ocular cysticercosis (parasite destruction → irreparable eye lesion)
- Concomitant strong CYP enzyme inducers reducing efficacy (relative)
- Hypersensitivity to praziquantel
Side effects
Common
Abdominal pain/discomfort, nauseaHeadache, dizzinessMalaise, drowsinessUrticaria (host response to dying parasites)
Serious
- Neurological deterioration in neurocysticercosis (inflammatory response — give corticosteroids)
- Severe hypersensitivity reactions
- Arrhythmia (rare); seizures (cerebral cysticercosis)
- Irreversible eye damage in ocular cysticercosis
Pregnancy & lactation
Pregnancy
Considered acceptable when treatment indicated (WHO permits in schistosomiasis incl. pregnancy) — benefit usually outweighs
Lactation
Compatible — small amounts in milk; brief interruption historically advised but generally considered safe
Drug interactions
Carbamazepine
Severe
Database
Reduced bioavailability of praziquantel.
May necessitate the use of higher doses of praziquantel. Anticonvulsant treatment should be continued through the course of anthelmintic medication.
Source: DDInter
Enzalutamide
Severe
Database
Clinical effect not specified
Source: DDInter
Fosphenytoin
Severe
Database
Clinical effect not specified
Source: DDInter
Lumacaftor
Severe
Database
Clinical effect not specified
Source: DDInter
Mitotane
Severe
Database
Clinical effect not specified
Source: DDInter
Phenobarbital
Severe
Database
Reduced bioavailability of praziquantel.
Source: DDInter
Phenytoin
Severe
Database
Lower blood levels of praziquantel, potentially leading to therapeutic failure in conditions like neurocysticercosis.
May necessitate the use of higher doses of praziquantel. Anticonvulsant treatment should be continued through the course of anthelmintic medication.
Source: DDInter
Primidone
Severe
Database
Clinical effect not specified
Source: DDInter
Rifabutin
Severe
Database
Clinical effect not specified
Source: DDInter
Rifampicin
Severe
Database
Clinical effect not specified
Source: DDInter
Rifapentine
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Ask House about Praziquantel
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19