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Piperazine
General information
Piperazine is an antihelminthic drug that selectively blocks the neuromuscular cholinergic receptors of worms. It is readily absorbed, but has a highly variable half-life. The adult oral dose of 4 g of piperazine hydrate has been used extensively in the treatment of ascariasis. It has been abandoned in most developed countries, primarily because of concerns about possible carcinogenicity and electroencephalographic changes [ ].
General adverse effects and adverse reactions
In most patients, piperazine does not cause adverse reactions. Mild gastrointestinal disturbances may occur; neurotoxicity is rare. Eczematous skin reactions, lacrimation, rhinorrhea, joint pains, productive cough, and bronchospasm can develop after sensitization, especially with occupational exposure. Urticaria has also been reported. When hypersensitivity reactions occur it should be withdrawn and not used again in the same patient. Mononitrosylation of piperazine can occur in the stomach, releasing the potential carcinogen N-mono-nitrosopiperazine, but there is no direct proof of risk in human subjects.
Organs and systems
Cardiovascular
Cardiac conduction defects have been described in patients taking piperazine [ ]. In healthy volunteers piperazine reduced heart rate by up to 16% and prolonged the QT and JT intervals, with average increases of 9.7% and 11% respectively; it had no effect on the QRS complex [ ].
Respiratory
Allergic respiratory reactions can occur in patients taking piperazine, resulting in cough and bronchospasm [ ]. Rhinitis and asthma have also been reported through occupational exposure [ ].
Nervous system
Headache, dizziness, and somnolence occur in a small proportion of individuals who take piperazine [ ]. More serious neurological reactions occur rarely, but tend to be reported in young children, in people with neurological or renal disease, or after overdosage. Symptoms in such cases include ataxia, paresthesia, undue clumsiness, myoclonus, and nystagmus. Cerebellar ataxia has been infrequently reported, usually after overdose or in patients with renal insufficiency [ ]. Choreiform movements and an electroencephalogram with prominent slow waves have been reported as well as exacerbation of petit mal [ ] and absence seizures [ ]. In a child, horizontal nystagmus and hypotonia have been reported after a normal dose [ ].
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A previously well 23-month-old girl was given piperazine 65 mg/kg/day for 7 days for a suspected worm infestation and developed cerebellar ataxia after 8 days [ ]. Over the next 48 hours her symptoms gradually settled. She made a complete recovery 5 days later.
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