Piperazine (Oral)

Piperazine is part of a group of medicines known as anthelmintics. Anthelmintics are used to treat worm infections.

Piperazine is used to treat:

• common roundworms (ascariasis) and
• pinworms (enterobiasis; oxyuriasis).

Piperazine works by making the worms unable to move. They are then removed from the body in the stool.

Piperazine is available only with your doctor's prescription.

It is important for your doctor to check your progress after treatment. This is to ensure that the infection is completely cleared and to allow your doctor to look for any unwanted effects.

If your symptoms do not improve after taking this medicine for the full course of treatment, or if they get worse, contact your doctor.

For patients taking piperazine for pinworms:

• In some patients, pinworms may return after treatment with piperazine. Washing (not shaking) all bedding and nightclothes (pajamas) after treatment may help prevent this.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the benefits it will provide. This is a decision you and your doctor will make together. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also inform your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Children may be especially sensitive to the effects of piperazine. This may increase the chance of side effects during treatment.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing the use of piperazine in the elderly with use in other age groups.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these situations, your doctor may want to adjust the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional knows if you are taking any of the medicines listed below. The following interactions have been selected based on their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may adjust the dose or how often you use one or both of the medicines.

• Duloxetine
• Epinephrine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or specific types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also lead to interactions. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical issues, especially:

• Kidney disease or
• Liver disease—Patients with kidney or liver disease may have an increased chance of side effects

• Seizure disorder, especially a history of epilepsy—Piperazine may worsen the condition.

Along with its necessary effects, a medicine may cause some unwanted effects. Not all of these side effects may occur, but if they do, they may require medical attention.

Check with your doctor right away if any of the following side effects happen:

Rare

• Blurring of vision
• clumsiness
• crawling or tingling feeling of the skin
• fever
• irregular, twisting movement, especially of the face, arms, and legs
• joint pain
• skin rash or itching

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you how to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue, are bothersome, or if you have any questions about them:

Less common

• Abdominal or stomach cramps or pain
• diarrhea
• dizziness
• drowsiness
• headache
• muscle weakness
• nausea or vomiting
• tremors

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

Chemical Class: Piperazine (class)

No special preparations or other steps (for example, special diet, fasting, other medicines, laxatives, or enemas) are necessary before, during, or immediately after you take piperazine.

Piperazine may be taken with or without food or on a full or empty stomach. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.

For patients taking the granules for oral solution form of piperazine:

• Dissolve the contents of 1 packet of granules in 57 mL (about 2 ounces) of water, milk, or fruit juice.
• Be sure to drink all of the liquid to get the full dose of medicine.

Take this medicine only as directed. Do not take more of it and do not take it more often than your doctor ordered. To do so may increase the chance of serious side effects.

To help clear up your infection completely, take this medicine in regularly spaced doses as ordered by your doctor. In some infections, a second treatment with this medicine may be required to clear up the infection completely. Do not miss any doses.

For patients taking piperazine for pinworms:

• Pinworms may be easily passed from one person to another, especially among persons in the same household. Therefore, all household members may have to be treated at the same time to prevent their infection or reinfection.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For granules for oral solution dosage form: For common roundworms or pinworms: Adults and teenagers—2 grams three times a day for one day. Treatment may need to be repeated in two weeks. Children—Dose is based on age and/or body weight. Treatment may need to be repeated in two weeks. Up to 2 years of age: Dose must be determined by your doctor. 2 to 8 years of age: 2 grams once a day for one day. 8 to 14 years of age: 2 grams two times a day for one day.
• For oral suspension dosage form: For common roundworms or pinworms: Adults and teenagers—1.8 grams every four hours for a total of three doses in one day. Treatment may need to be repeated in two weeks. Children—Dose is based on age. Treatment may need to be repeated in two weeks. Up to 2 years of age: 600 milligrams (mg) every four hours for a total of three doses in one day. 2 to 8 years of age: 1.2 grams every six hours for a total of two doses in one day. 8 to 14 years of age: 1.2 grams every four hours for a total of three doses in one day.
• For tablet dosage form: For common roundworms: Adults and teenagers—3.5 grams (piperazine hexahydrate) per day for two days in a row. Treatment may need to be repeated in one week. Children—Dose is based on body weight and must be determined by your doctor. However, the usual dose is 75 mg (piperazine hexahydrate) per kilogram (34 mg per pound) of body weight per day for two days in a row. Treatment may need to be repeated in one week. For pinworms: Adults and children—Dose is based on body weight and must be determined by your doctor. However, the usual dose is 65 mg (piperazine hexahydrate) per kilogram (29.5 mg per pound) of body weight per day for seven days in a row. Treatment may need to be repeated in one week.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.