Piperazine - Drug Information

Written by Vijayaganesh Kasinathan, B.Pharm, M.Pharm

Medically Checked by Dr. M. Sree Mohana Preetha, Doctor of Pharmacy on Nov 04, 2017

Generic Name : Piperazine
Pronunciation : pie-PER-ah-zeen

ICD Code : | Therapeutic Classification : Antihelmintics

Trade Name(s) :

International - Avizine 500mg, Piperazine citrate 500mg, Anypar Syrup

Overview of Piperazine

� Piperazine was introduced as an antihelminthic agent in the 1950s.
� It acts by mainly paralyzing the parasites, thereby the body expels the worms very easily. For this reason, piperazine is sometimes taken together with a purgative.
� The combination of other antihelminthics and purgative is banned in India.

Why is Piperazine Prescribed? (Indications)

Piperazine citrate is used as a second-line treatment for treating roundworm infections caused by Ascaris lumbricoides and pinworm infections caused by Enterobius vermicularis (oxyuris). It paralyses the worm which is then expelled by the digestive tract.

Although it is highly active against Ascaris and Enterobius, it is not commonly used because of its repeated doses while other anthelmintics offer single dose treatment.

When should Piperazine not to be taken? (Contraindications)

Piperazine is not recommended in patients with:

� Allergic to piperazine and its salts
� Kidney or liver disease as piperazine is metabolized by liver and excreted by the kidneys
� Seizure disorders
� Breastfeeding

What is the dosage of Piperazine?

1. Piperazine citrate tablets:

a) For treating roundworm (Ascaris) infection:
Adult dose:
� 3.5 g of piperazine hexahydrate a day orally for two consecutive days. The dose has to be repeated after a week, particularly in heavy infection.

Child dose:
� The dose is determined based on body weight.
� 75mg/kg of body weight daily for two consecutive days by mouth.
� The dose has to be repeated after a week, particularly in heavy infection.

b) For treating pinworm infections:
Adult and children dose:
� 65mg/kg of body weight daily orally for seven consecutive days.
� Treatment can be repeated after one week for a heavy infection.

2. Piperazine adipate oral suspension:

For treating roundworm or pinworm infections:
The recommended oral dose for Adult and children above 14 years is 1.8g orally for every 4 hours three times a day.
� Children below 2 years of age: 600mg, every 4 hours thrice daily
� 2 - 8 years of age: 1.2g every 6 hours twice a day
� 8 - 14 years of age: 1.2g every 4 hours three times daily

� It is recommended to repeat the treatment schedule after 2 weeks.

3. Piperazine adipate granules for oral suspension:

For treating roundworm or pinworm infections:
� For patients weighing 13.5 to 27.5 kg of body weight: 2g once a day for 1 day
� For patients weighing 27.5 to 41 kg of body weight: 2g twice a day for 1 day
� For patients weighing 41 kg of body weight and above: 2g thrice daily for 1 day

The treatment schedule may be repeated after 2 weeks.

How should Piperazine be taken?

� Piperazine comes as a tablet, syrup or granules and may be taken with food to avoid gastric discomfort.

What are the warnings and precautions for Piperazine?

� Continuous and repeated treatment with piperazine in children should be avoided. It should also be avoided in pregnancy, though it can be given if it is extremely necessary and no other option is available.
� Cautious use of piperazine in children is required because of the neurotoxic effects.
� In treating enterobiasis all the household members are to be treated simultaneously. Washing all nightdresses and bed clothes should be done to prevent reinfection.

What are the side effects of Piperazine?

Gastrointestinal: Abdominal cramps, diarrhea, nausea, and vomiting
Central Nervous System: Headache, vertigo, abnormal sensation of pricking or tingling, tremor, dizziness, drowsiness, seizures, ataxia (loss of control of body movements), confusion and memory loss
Eye: Blurred vision, rapid involuntary movement of eyes
Others: Skin reactions such as Stevens Johnson syndrome, muscle weakness, joint pain, fever and angioedema

What are the other precautions for Piperazine?

� Stool examination is required in patients before and after 2 weeks of piperazine treatment for ascariasis.
� Cellophane tape swabbing of the perianal area to determine the presence of eggs and examination to detect the adult worms before the treatment after 1 week of the treatment for enterobiasis is recommended.

What are the Drug Interactions of Piperazine?

� Piperazine may increase the risk of seizures caused by phenothiazine-containing drugs such as chlorpromazine.
� Pyrantel decreases the anti-helminthic effects of piperazine, therefore these two anti-worm medicines should not be administered together.
� A rare skin complication may occur due to the concomitant use of piperazine and ethylenediamine, a stabilizer used in topical creams.

What are the storage conditions for Piperazine?

� Store at a controlled temperature between 15�C and 30�C in a well-closed container.
� Keep out of reach to children.