Piperazine Citrate
Indications
Piperazine Citrate is used for:
Enterobiasis, Ascariasis
Adult Dose
Oral
Ascariasis
Adult: 4.5 g as a single dose repeated once after 14 days.
Alternatively, may be given as a preparation with senna in a single dose of 4 g of the phosphate, repeat dose mthly for up to 3 mth if needed; same dosage regimen may also be used to prevent ascariasis.
Enterobiasis
Adult: 2.25 g once daily for 7 days, 2nd course may be repeated after an interval of 7 days.
Alternatively, may be given as a preparation with senna in a single dose of 4 g of the phosphate, repeat dose after 14 days.
Child Dose
Oral
Ascariasis
Child: As a single dose, repeated once after 14 days.
<1 yr: 120 mg/kg (only upon medical advice),
1-3 yr: 1.5 g,
4-5 yr: 2.25 g,
6-8 yr: 3 g,
9-12 yr: 3.75 g.
Alternatively, may be given as a preparation with senna in a single dose of 4 g of the phosphate, repeat dose mthly for up to 3 mth if needed; same dosage regimen may also be used to prevent ascariasis.
Enterobiasis
Child: <1 yr: 45-75 mg/kg (only upon medical advice),
1-3 yr: 750 mg,
4-6 yr: 1.125 g,
7-12 yr: 1.5 g,
>12 yr: same as adult dose. To be taken once daily for 7 days, 2nd course may be repeated after an interval of 7 days.
Alternatively, for children >6 yr: May be given as a preparation with senna in a single dose of 4 g of the phosphate; repeat dose after 14 days.
Renal Dose
Administration
May be taken with or without food.
Contra Indications
Severe renal impairment, epilepsy. Pregnancy.
Precautions
Hepatic impairment, neurological conditions, mild to moderate renal impairment. Lactation.
Pregnancy-Lactation
Interactions
Antagonism if pyrantel and piperazine are used together. Piperazine may potentiate extrapyramidal effects of chlorpromazine and other phenothiazines.
Adverse Effects
Side effects of Piperazine Citrate :
Nausea, vomiting, colic, abdominal pain, diarrhoea, urticaria, skin rashes, headache, bronchospasm, dizziness, nystagmus, ataxia, paraesthesia, myoclonic contractions, choreiform movements, muscular incoordination (worm wobble), confusion, EEG abnormalities, blurred vision.
Potentially Fatal: Stevens-Johnson syndrome, bronchospasm and angioedema.
Mechanism of Action
Piperazine is effective against the intestinal nematodes roundworm (Ascaris lumbricoides), pinworm and threadworm (Enterobius vermicularis). It produces a neuromuscular block resulting in muscle paralysis of the worms which are consequently dislodged and expelled in the faeces.