Headache praziquantel

Praziquantel paralyses both adult worms and larvae. It is extensively metabolised. Praziquantel may cause nausea, headache, dizziness and drowsiness it cures with a single dose (or divided doses in one day). 

Used in the treatment of neurocysticercosis, albendazole (like praziquantel) can cause a CSF syndrome characterized by fever, headaches, meningism, and exacerbation of some or many of the neurological signs of the disease it is thought to be due to a local reaction to dying and dead larvae and can be attenuated by prednisone (SED-12, 707) (19,20). 

A one-day intensive course of praziquantel has been used experimentally, but results vary, and when there are multiple brain cysts present the outcome is poor (4). When used for this purpose in a dose of 25 mg/kg at 2-hour intervals, adverse effects included mild headache, dizziness, nausea, and vomiting. AH the adverse effects remitted with analgesics or dexamethasone 0.2 mg/kg/day and continued for 2 days. 

In a double-blind, randomized, placebo controlled trial of praziquantel in 42 patients with clonorchiasis and an open study in 32 patients, the adverse effects of praziquantel were transient and included nausea and vomiting (15%), vertigo (12%), hepatomegaly (4.5%), headache (1.5%), rash (1.5%), and hypotension (1.5%) (9). Of 20 patients who received placebo, one developed a transient skin rash, fever, and chills. There were minor and transient, albeit statistically significant, changes in hemoglobin and serum concentrations of total protein, uric acid, cholesterol, and bilirubin. 

A 66-year-old man with neurocysticercosis treated with glucocorticoids and praziquantel developed headache and confusion. He did not have a ventricular shunt inserted. A contrast-enhanced CT scan showed multiple focal enhancing lesions with mild edema. An MRI scan of the head was reported as being most consistent with neurocysticercosis. He was given dexamethasone 2 mg bd and praziquantel 50 mg/kg/day. A few days later his headache worsened, with nausea and drowsiness. After 2 weeks he became stuporose and had to be ventilated. A CT scan showed multiple areas of deep subcortical focal edema near the areas of previously enhancing cysts, a striatocapsular stroke, and obstructive hydrocephalus. Two weeks after the last dose of praziquantel and despite a ventriculostomy tube he died. 

Dose-dependent dizziness is a recognized effect in some 14% of cases at higher doses of praziquantel (SEDA-12, 267). Patients predisposed to epUepsy may develop convulsions, probably as a reaction to the death of the parasite (15). Headache (40%) and drowsiness (25 0%) have been common in some studies and the manufacturers warn against driving or operating machinery while taking praziquantel. 

Most patients treated for neurocysticercosis with praziquantel develop an early cerebrospinal fluid reaction a similar late reaction, some 2 weeks after treatment has finished, has also been described (16). In both cases clinical signs and sjmptoms can include papilledema, headache, nausea, vomiting, neck stiffness, and even focal seizures. Glucocorticoids can usually prevent or relieve both the early and late reactions, but they can also reduce efficacy by lowering plasma concentrations of the drug by some 50% (17). 

Praziquantel is a well tolerated and safe drug. However, it may produce some side effects, the most common of which are abdominal pain, nausea, anorexia, diarrhea or loose stools, dizziness, headache, pruritis, skin eruption and fever, which appear shortly after the drug administration [81,83]. These side effects are usually mild and dose related and disappear within 24 hours. Praziquantel has been found to be free of mutagenic, carcinogenic and teratogenic effects [81,83,84]. 

The treatment of cerebral or neurocysticercosis with praziquantel evokes some inflammatory problems related to the CSF reaction syndrome, which is characterised by headache, meningismus, fever and neurological problems. These side effects may be alleviated by simultaneous use of corticosteroids and praziquantel [87,88,91,96]. Accordingly more and more workers prefer to use corticosteroides, while treating cysticercosis of the brain with praziquantel. This combination protects the patients from the CSF reaction syndrome [97,98]. 

As described earlier, praziquantel is a safe and well tolerated drug with no serious side effects. The typical side effects of the drug are abdominal pain, nausea, diarrhea, headache, skin rash and fever. Rarely praziquantel may cause neuropsychiatric, cardiovascular and dermatological reactions, hepatic changes, delayed fatigue and inability to work. Care should be taken while treating patients with chronic and... 

TOXICITY, PRECAUTIONS, AND INTERACTIONS Abdominal discomfort, nausea, diarrhea, headache, dizziness, and drowsiness may occur shortly after taking praziquantel these direct effects are transient and dose-related. Indirect effects such as fever, pruritus, urticaria, rashes, arthralgia, and myalgia are noted occasionally and are related to parasite burden. In neurocysticer-cosis, inflammatory reactions to praziquantel may produce meningismus, seizures, mental changes, and CSF pleocytosis. These effects usually are delayed in onset, last 2-3 days, and respond to symptomatic therapy such as analgesics and anticonvulsants. 

Toxicity Common adverse effeets include headache, dizziness, malaise, and, less frequently, gastrointestinal irritation, skin rash, and fever. Praziquantel is contraindieated in oeular eysticercosis. 

The most common toxic effects of praziquantel are malaise, headache, dizziness, gastrointestinal irritation, urticaria, and fever. Some of these effects may be caused by dying parasites. 

Praziquantel (40 mg/kg), mefloquine (25 mg/kg), artesunate (3 doses of 4 mg/kg), and mefioquine + artesunate (3 doses of artesunate 100 mg - - mefloquine 250mg) have been compared in a randomized open trial in 83 schoolchildren with Schistosoma haematobium infections [22 ]. The effects on Schistosoma mansoni, malaria parasitemia, soil-transmitted helminths, and intestinal protozoa were also determined. Cure rates were 88%, 21 %, 25 %, and 61 % respectively. Both mefloquine-I-artesunate and praziquantel resulted in greater than 95% egg reduction rates. There were significantly lower egg reduction rates with artesunate (85%) and mefloquine (74%). In children co-infected with S. mansoni, praziquantel and mefloquine+artesunate, but not mefloquine and artesunate alone, resulted in high cure rates and egg reduction rates. Mefloquine, artesunate, and mefloquine-I-artesunate completely cured infections due to Plasmodium falciparum. There were no effects against soil-transmitted helminths and intestinal protozoa. There were four cases of mild headache (two with mefloquine and two with praziquantel) and two cases of moderate coughing (one with artesunate and one with mefloquine) both symptoms were also reported before treatment. There were 48 mild and 70 moderate adverse events recorded at 24,48, and 72 hours after... 

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