Should Praziquantel Be Taken With Food?
Yes, praziquantel should be taken with food to significantly increase its absorption and plasma levels, thereby improving therapeutic efficacy. 1
Evidence for Food Administration
Taking praziquantel with a high-carbohydrate meal substantially increases plasma drug concentrations compared to fasting administration. A clinical study in 18 neurocysticercosis patients demonstrated that administering praziquantel with a high-carbohydrate diet significantly elevated plasma levels and improved treatment effectiveness as measured by lesion disappearance. 1
The pharmacokinetic benefit is clinically meaningful:
- Praziquantel undergoes extensive first-pass metabolism, resulting in inherently low plasma levels when taken on an empty stomach 1
- Food co-administration overcomes this limitation by enhancing drug absorption 1
- Computer simulations and clinical data confirm that high-carbohydrate meals represent an optimal strategy for maximizing praziquantel bioavailability 1
Practical Administration Guidelines
Administer praziquantel with meals, preferably those containing carbohydrates, to optimize drug levels. This applies across the standard dosing regimens used for various parasitic infections:
- For schistosomiasis: 40 mg/kg as a single dose with food 2
- For intestinal tapeworms (T. saginata): 10 mg/kg as a single dose with food 3
- For liver flukes: 25 mg/kg three times daily for 2-3 consecutive days, each dose with food 2
Important Caveat Regarding Corticosteroids
Avoid concurrent dexamethasone administration, as it reduces praziquantel levels through increased hepatic metabolism. 2 If corticosteroids are necessary (such as in neurocysticercosis treatment), prednisolone is preferred over dexamethasone to minimize drug-drug interactions. 2
Clinical Context
While the evidence specifically addresses neurocysticercosis treatment, the pharmacokinetic principles apply universally to all praziquantel indications since the drug's absorption characteristics remain constant regardless of the target parasite. 1 The combination of food with praziquantel represents a simple, cost-free intervention that meaningfully improves treatment outcomes without additional adverse effects. 1