Bithionol is an alternative to triclabendazole for the treatment of fascioliasis (sheep liver fluke). Bithionol is also an alternative drug in the treatment of pulmonary paragonimiasis.
After ingestion, bithionol reaches peak blood levels in 4–8 hours. Excretion appears to be mainly via the kidney.
For treatment of paragonimiasis and fascioliasis, the dosage of bithionol is 30–50 mg/kg in two or three divided doses, given orally after meals on alternate days for 10–15 doses. For pulmo-nary paragonimiasis, cure rates are over 90%. For cerebral parago-nimiasis, repeat courses of therapy may be necessary.
Adverse effects, which occur in up to 40% of patients, are gener-ally mild and transient, but occasionally their severity requires interruption of therapy. These problems include diarrhea, abdom-inal cramps, anorexia, nausea, vomiting, dizziness, and headache. Skin rashes may occur after a week or more of therapy, suggesting a reaction to antigens released from dying worms.Bithionol should be used with caution in children younger than 8 years of age because there has been limited experience in this age group.