Phenytoin and carbamazepine decrease oral bioavailability of praziquantel

Bittencourt, P. R. M.; Gracia, C. M.; Martins, Rand Randall; Fernandes, A. G.; Diekmann, H. W.; Jung, Wookjae

doi:10.1212/wnl.42.3.492

Cited by 92 publications

(33 citation statements)

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“…Seizures are usually well controlled with monotherapy at standard doses. [80,81] In acute symptomatic seizures or seizures due inflammation may be benefit from corticosteroids or other anti-inflammatory medication.…”

Section: Treatmentmentioning

confidence: 99%

“…Levels of praziquantel and the ABZ metabolite albendazole sulfoxide are extremely variable from patient to patient and they are both decreased by AEDs and levels of praziquantel decreased by corticosteroids. [80,81,100,101] A potential approach would be to treat until the MRI shows initial degeneration of all the cysts and then continue treatment while steroids are tapered. Combined albendazole and praziquantel therapy seems safe and promising in initial reports.…”

Section: Treatmentmentioning

confidence: 99%

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Diagnosis and treatment of neurocysticercosis

Nash

Garcı́a²

2011

Nat Rev Neurol

199

198

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Neurocysticercosis, a major cause of acquired seizures and epiilepsy, is caused by infection with the larval cystic form of the tapeworm, Taenia solium. CT and MRI imaging, development of sensitive and specific diagnostic methods, and discovery of relatively effective anti-cestode drugs, revolutionized knowledge of the burden of infection and disease and led to effective treatments. Here we review the rationale of treatment, the essential role of inflammation in the genesis of disease and its exacerbation as a result of anti-parasitic treatment, and limitations in the efficacy of current anti-parasitic and anti-inflammatory treatments. The importance of “end stage” calcified granulomas as foci of seizures and epilepsy with and without perilesional edema in endemic populations has recently been recognized. New information indicates perilesional inflammation around some calcified foci is associated with seizures and perilesional edema, which suggests that anti-inflammatory treatments may play a role in controlling or preventing epilepsy in these patients. Most importantly, neurocysticercosis is one of the few diseases that can be eradicated, an accomplishment that would prevent millions of cases of epilepsy.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Diagnosis and treatment of neurocysticercosis

Nash

Garcı́a²

2011

Nat Rev Neurol

199

198

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“…Also, bioavailability of albendazole increases with co-administration of steroids and is not affected by phenytoin and carbamezepine, 55 whereas that of praziquantel decreases with co-administration of steroids, 56 and with phenytoin and carbamezepine which are generally used as first line anticonvulsants in patients with seizures due to NCC. 57 Albendazole is currently the drug of choice for treatment of NCC .…”

Section: Choice Of Cysticidal Drugmentioning

confidence: 99%

Neurocysticercosis in children

Singhi

2009

Indian J Pediatr

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Neurocysticercosis (NCC) is a common cause of seizures and neurologic disease. Although there may be variable presentations depending on the stage and location of cysts in the nervous system, most children (> 80%) present with seizures particularly partial seizures. About a third of cases have headache and vomiting. Diagnosis is made by either CT or MRI. Single enhancing lesions are the commonest visualization of a scolex confirms the diagnosis. Some cases have multiple cysts with a characteristic starry-sky appearance. Management involves use of anticonvulsants for seizures and steroids for cerebral edema. The use of cysticidal therapy continues to be debated. Controlled studies have shown that cysticidal therapy helps in increased and faster resolution of CT lesions. Improvement in long-term seizure control has not yet been proven. Children with single lesions have a good outcome and seizure recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal NCC has a guarded prognosis but it is rare in children. In endemic areas NCC must be considered in the differential diagnosis of seizures and various other neurological disorders.

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“…Also, praziquantel interacts with anti-epileptic drugs [27],[28], thus altering its bioavailability. In contrast, corticosteroids interact with albendazole by decreasing the rate of elimination of albendazole sulfoxide, which is the active metabolite of albendazole, thus increasing serum concentrations of albendazole sulfoxide [29],[30].…”

Section: Discussionmentioning

confidence: 99%

Albendazole versus Praziquantel in the Treatment of Neurocysticercosis: A Meta-analysis of Comparative Trials

et al. 2008

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BackgroundNeurocysticercosis, infection of the brain with larvae of Taenia solium (pork tapeworm), is one of several forms of human cysticercosis caused by this organism. We investigated the role of albendazole and praziquantel in the treatment of patients with parenchymal neurocysticercosis by performing a meta-analysis of comparative trials of their effectiveness and safety.Methods and Principal FindingsWe performed a search in the PubMed database, Cochrane Database of Controlled Trials, and in references of relevant articles. Six studies were included in the meta-analysis. Albendazole was associated with better control of seizures than praziquantel in the pooled data analysis, when the generic inverse variance method was used to combine the incidence of seizure control in the included trials (patients without seizures/[patients×years at risk]) (156 patients in 4 studies, point effect estimate [incidence rate ratio] = 4.94, 95% confidence interval 2.45–9.98). In addition, albendazole was associated with better effectiveness than praziquantel in the total disappearance of cysts (335 patients in 6 studies, random effects model, OR = 2.30, 95% CI 1.06–5.00). There was no difference between albendazole and praziquantel in reduction of cysts, proportion of patients with adverse events, and development of intracranial hypertension due to the administered therapy.ConclusionsA critical review of the available data from comparative trials suggests that albendazole is more effective than praziquantel regarding clinically important outcomes in patients with neurocysticercosis. Nevertheless, given the relative scarcity of trials, more comparative interventional studies—especially randomized controlled trials—are required to draw a safe conclusion about the best regimen for the treatment of patients with parenchymal neurocysticercosis.

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Phenytoin and carbamazepine decrease oral bioavailability of praziquantel

Cited by 92 publications

References 0 publications

Diagnosis and treatment of neurocysticercosis

Diagnosis and treatment of neurocysticercosis

Neurocysticercosis in children

Albendazole versus Praziquantel in the Treatment of Neurocysticercosis: A Meta-analysis of Comparative Trials

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