Praziquantel

Clinical deterioration may occur when treating schistosomiasis (eg, paradoxical reactions, serum sickness Jarisch-Herxheimer like reactions [sudden inflammatory immune response suspected to be caused by the release of schistosomal antigens]); reactions predominantly occur in patients treated during the acute phase of schistosomiasis

Can exacerbate CNS pathology due to schistosomiasis, paragonimiasis, or Taenia solium cysticercosis; consider whether to treat with praziquantel in patients with epilepsy or other CNS diseases; hospitalize patient for duration of treatment if infection found to be associated with cerebral cysticercosis

Evidence suggests treatment with praziquantel in the acute phase of infection may not prevent progression from asymptomatic infection to acute schistosomiasis, or from asymptomatic infection/acute schistosomiasis into chronic phase; may lead to potentially life-threatening events, for example, respiratory failure, encephalopathy, papilledema, and/or cerebral vasculitis

Bradycardia, ectopic rhythms, ventricular fibrillation, and AV blocks observed; monitor patients with cardiac arrhythmias during treatment

Reduced hepatic metabolism of praziquantel results in higher and sustained plasma concentrations of unmetabolized drug in patients with liver impairment; monitor for adverse reactions when administering the recommended dose to patients with hepatosplenic schistosomiasis who have moderate or severe liver impairment (Child-Pugh Class B or C)