Treatment — Triclabendazole has replaced bithionol as the treatment used for this infection.

Triclabendazole — The imidazole derivative, triclabendazole, is the drug of choice. Currently commercially available in some countries such as Egypt. Triclabendazole is given at a dose of 10 mg/kg for one or two days and is well tolerated. This drug is effective against both adult and immature flukes. Absorption is improved by postprandial administration.

Bithionol — Bithionol (30 to 50 mg/kg in three divided doses on alternate days for 10 to 15 doses) is often used for either acute or chronic phases of the infection . Side effects are quite common and include anorexia, nausea, abdominal pain, and pruritus. Reported cure rates vary from 50 to 90 percent . A repeat course of treatment may be necessary .

Other therapies — Unlike most other trematode infections, F. hepatica is commonly unresponsive to praziquantel. This has implications for mass chemotherapy to control fluke infections. Mebendazole and albendazole are also not effective. Emetine hydrochloride has been used in the past but is associated with frequent adverse effects and is now essentially outdated. Nitazoxanide (500 mg BID for 7 days) has also been reported to be efficacious, with a cure rate of 82.4 percent in one series

Nitazoxanide was well-tolerated and cure was achieved in 40 percent of children and 60 percent of adults.

During the acute hepatic stage, a short course of steroids can be given to individuals with severe symptoms, in addition to specific anti-trematode therapy .