Is it safe to use praziquantel with progesterone?

Praziquantel with Progesterone: Safety Assessment

Praziquantel can be safely used with progesterone, as there are no documented drug-drug interactions between these medications, and both can be administered concurrently without dose adjustments. 1, 2

Key Safety Considerations

No Direct Drug Interaction

• Praziquantel does not interact with progesterone or other progestins, and no dose adjustments are required when these medications are used together 3, 1
• The critical drug interaction to avoid with praziquantel is dexamethasone, which significantly reduces praziquantel serum levels through increased hepatic metabolism 3, 1, 2
• If corticosteroids are necessary alongside praziquantel, prednisolone (20-30 mg daily for 5 days) should be used instead of dexamethasone 3, 1, 2

Progesterone Use During Praziquantel Treatment

• Progesterone-containing medications (including vaginal progesterone, oral micronized progesterone, and progestin-containing contraceptives) can be continued during praziquantel therapy 3
• There is no evidence that progesterone affects praziquantel efficacy or increases adverse events 1, 2

Special Population: Pregnancy

Safety in Pregnant Women

• Praziquantel is safe during pregnancy, including all trimesters, and the World Health Organization recommends treating pregnant women with schistosomiasis 4, 5, 6
• Randomized controlled trials in Uganda and the Philippines demonstrated that praziquantel treatment during pregnancy had no significant effect on birth weight and caused minimal side-effects similar to non-pregnant subjects 6
• A prospective study of 25 pregnant Sudanese women treated with praziquantel (40 mg/kg) across all trimesters showed no maternal deaths, stillbirths, or congenital abnormalities 4

Progesterone During Pregnancy

• Vaginal progesterone is recommended for pregnant individuals with short cervix (≤20 mm) to reduce preterm birth risk, and this can be safely administered if praziquantel treatment is needed 3
• There is no contraindication to using praziquantel in pregnant women receiving progesterone supplementation 3, 4, 6

Administration Guidelines

Dosing Recommendations

• Praziquantel should always be administered with food to optimize absorption, regardless of concurrent progesterone use 1, 2
• Standard dosing for schistosomiasis is 40 mg/kg as a single oral dose 1, 2
• For liver flukes, the dose is 25 mg/kg three times daily for 2-3 consecutive days 1, 2

Monitoring

• No additional monitoring is required when praziquantel and progesterone are used together beyond standard monitoring for each medication individually 3, 1
• Antiepileptic drug levels (phenytoin, carbamazepine) should be monitored during praziquantel treatment, as levels may decrease 1

Common Pitfalls to Avoid

• Do not confuse dexamethasone with other corticosteroids or progesterone – only dexamethasone significantly reduces praziquantel levels 3, 1, 2
• Do not discontinue progesterone therapy unnecessarily when praziquantel treatment is indicated, as there is no interaction 3, 1
• Do not delay praziquantel treatment in pregnant women receiving progesterone supplementation, as both medications are safe to use together 3, 4, 6