Nausea 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). 

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 report from India the efficacy and safety of treatment of niclosamide-resistant Tenia saginata infections with praziquantel 10 mg/kg orally has been confirmed in 185 consecutive patients (7). Follow-up stool examinations at 4 and 12 weeks showed a cure rate of 96%. Eleven patients were lost to follow-up, and eight still produced proglottides at the end of 12 weeks. None passed the worm in their stools, since praziquantel destructs the worm, after which the scolex and worm are digested. Thirty patients (16%) reported minimal adverse effects, such as nausea (n = 4), abdominal discomfort (n = 10), and giddiness (n = 16). 

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. 

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 can cause dose-related nausea, vomiting, heartburn, and abdominal pain. For example, at doses of 30 mg/kg in schoolchildren there was stomachache in some 16% (SED-12, 775), while in a study with 40 mg/ kg 35% of users had abdominal pain (20). 

The efficacy and adverse effects of treatment with a single oral dose of praziquantel 40 mg/kg, in relation to egg counts and morbidity, have been studied in 611 primary schoolchildren infected with Schistosoma mansoni in Northeastern Ethiopia (22). Before treatment 40% of the patients had no symptoms and 30-40% complained of nausea, abdominal cramps, and/or bloody diarrhea. The symptoms before treatment were not related to nutritional status, intensity of S. mansoni egg excretion. 

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]. 

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. 

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