Piperazine: Uses, Dosage, Side Effects and More

Generic Medicine Info Patient Medicine Information

This information is not country-specific. Please refer to the Malaysia prescribing information.

Generic Medicine Info

Indications and Dosage

Oral
Ascariasis

Adult: Doses are expressed in terms of piperazine hydrate. 4,500 mg as a single dose before the evening meal. If the patient is constipated, administer a laxative in the morning after treatment to facilitate expulsion of worms before the effects of the drug wear off. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Child: Doses are expressed in terms of piperazine hydrate. 1-2 years 1,125 mg; 3-8 years 2,250 mg; 9-12 years 3,000 mg; >12 years Same as adult dose. All doses are given as a single dose before the evening meal. If the patient is constipated, administer a laxative in the morning after treatment to facilitate expulsion of worms before the effects of the drug wear off. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).

Oral
Enterobiasis

Adult: Doses are expressed in terms of piperazine hydrate. 2,250 mg once daily for 7 days. May repeat the entire course after a 1-week interval for severe infections or if required. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Child: Doses are expressed in terms of piperazine hydrate. 1-<2 years 375 mg; 2-4 years 750 mg; 5-12 years 1,500 mg; >12 years Same as adult dose. All doses are given once daily for 7 days. May repeat the entire course after a 1-week interval for severe infections or if required. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).

Renal Impairment

Severe: Contraindicated. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).

Hepatic Impairment

Severe: Contraindicated. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).

Administration

Piperazine May be taken with or without food.

Contraindications

Hypersensitivity. Seizure disorders or history of epilepsy. Severe renal and hepatic impairment. Contraindications may vary among countries and between individual products (refer to specific product guidelines).

Special Precautions

Patient with anaemia, severe malnutrition, neurological disturbances. Mild to moderate renal and hepatic impairment. Avoid prolonged use. Children. Pregnancy and lactation.

Adverse Reactions

Eye disorders: Blurred vision, nystagmus. Rarely, cataracts.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain.
Immune system disorders: Hypersensitivity reactions (e.g. bronchospasm, angioedema, Stevens-Johnson syndrome).
Musculoskeletal and connective tissue disorders: Muscular incoordination and weakness.
Nervous system disorders: Headache, dizziness, drowsiness, ataxia, paraesthesia, myoclonic contractions, choreiform movements, tremors, seizures, absent reflexes.
Skin and subcutaneous tissue disorders: Rashes, urticaria.

Patient Counseling Information

Take the dose after breastfeeding, then express and discard milk for 8 hours after administration of piperazine. This drug may cause CNS depression, if affected, do not drive or operate machinery.

Monitoring Parameters

Perform stool exams for worms and ova.

Overdosage

Symptoms: Gastrointestinal disturbance, drowsiness, confusion, ataxia, decreased muscle tension, headaches, dizziness, tremors, choreiform movements, hyporeflexia, nystagmus, seizures, blurred vision, paralytic strabismus, and allergic reactions. Rarely, cataracts. Management: Symptomatic and supportive treatment. Maintain adequate fluid intake. Perform gastric lavage if ingestion is very recent. May administer anticonvulsants if indicated.

Drug Interactions

May potentiate the extrapyramidal effects of phenothiazines (e.g. chlorpromazine). Antagonised anthelmintic effect with pyrantel pamoate.

Action

Description:
Mechanism of Action: Piperazine is an anthelmintic indicated against Enterobius vermicularis (threadworm/pinworm) and Ascaris lumbricoides (roundworm). It inhibits the effect of acetylcholine at the neuromuscular junction, causing flaccid muscle paralysis in susceptible roundworms, which are then dislodged by the movement of the gut and expelled in the faeces.
Pharmacokinetics:
Absorption: Readily absorbed from the gastrointestinal tract.
Distribution: Enters breast milk.
Excretion: Via urine (partly as metabolites).

Chemical Structure

Storage

Store at or below 25°C. Protect from light. Storage recommendations may vary among individual products. Refer to specific product guidelines.

MIMS Class

Anthelmintics

ATC Classification

P02CB01 - piperazine ; Belongs to the class of piperazine and derivatives agents. Used as antinematodal.

References

Ascalix Syrup 4 g/30 mL (Wallace Manufacturing Chemists Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 11/08/2025.

Ascalix Syrup 750 mg/5 mL (Wallace Manufacturing Chemists Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 11/08/2025.

Brayfield A, Cadart C (eds). Piperazine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/08/2025.

Piperazine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/08/2025.

Disclaimer: This information is independently developed by MIMS based on Piperazine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2025 MIMS. All rights reserved. Powered by MIMS.com