Piperazine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Piperazine: From Enterobiasis and Ascariasis to Echinococcus granulosus Infection
One-Sentence Summary
Piperazine is an anthelmintic originally used to treat pinworm (enterobiasis) and roundworm (ascariasis) infections. The TxGNN model predicts it may be effective for Echinococcus granulosus infectious disease, but there are currently 0 clinical trials and 0 publications supporting this specific prediction, so it rests on model output alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Enterobiasis, ascariasis (the approved indication text on the Singapore licence is blank) |
| Predicted New Indication | Echinococcus granulosus infectious disease |
| TxGNN Prediction Score | 97.74% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 1 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the data compiled for this report. Based on general pharmacological knowledge, piperazine acts as a GABA-receptor agonist that causes flaccid paralysis in nematodes such as Ascaris and Enterobius, allowing the worms to be expelled from the gut.
Echinococcus granulosus is a cestode (tapeworm), not a nematode. No piperazine activity against cestodes is documented in the data compiled for this report. The high score (0.977) is therefore a model prediction only. The relationship to the original indication is that both are parasitic infections, but the mechanistic link is weak.
Other predictions in the list share the same limitation. Alveolar echinococcosis (96.3%) and cystic echinococcosis (89.3%) are also cestode diseases without supporting evidence. Several unrelated predictions, such as citrullinemia, urea cycle disorder and mastocytosis, have no apparent mechanistic connection to piperazine and probably reflect shared graph neighbourhoods rather than independent signals.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available for Echinococcus granulosus infection.
For the related predicted indication of cystic echinococcosis, two papers were retrieved, but neither shows piperazine efficacy:
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 15269042 | 2004 | In vitro/Ex vivo | AJR Am J Roentgenol | Effect of various scolicidal, sclerosing and pharmacologic agents on hydatid cyst membrane integrity |
| 877439 | 1977 | Veterinary/Animal | Res Vet Sci | Niclosamide and its piperazine salt in dogs: virtually inactive against 28-day-old E. granulosus, with possible low activity against older worms |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN02935P | MEI-MEI WORM SYRUP 750 mg/5 ml (Sunward Pharmaceutical Private Limited) | Syrup | Not stated in the licence data |
Safety Considerations
- Disease associations flagged in the knowledge graph (not label text): epilepsy, kidney disease, pyoureter, liver disease, gallbladder disease.
- Drug Interactions: 14 interactions were identified.
- Major: bupropion, tramadol, iopamidol, iohexol
- Moderate: picosulfuric acid, polyethylene glycol 3350 with electrolytes, sodium sulfate, iodide I-131, iodide I-123, amifampridine, fluphenazine, chlorpromazine, Ginkgo biloba, lindane
- Population note: Piperazine is renally cleared and neurotoxic at high exposure, so neonatal or renally impaired populations need particular caution.
Please refer to the package insert for label warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction is supported only by the model score. Piperazine acts on nematodes, while E. granulosus is a cestode, and there are no trials or literature showing activity. The licence also lacks approved indication text and label safety data.
To proceed, the following is needed:
- Preclinical data (in vitro scolicidal or in vivo activity) showing piperazine acts against Echinococcus
- Confirmation of the mechanism of action (MOA) and its relevance to cestodes
- Package insert warnings and contraindications from the Health Sciences Authority (HSA)
- A comparison against established echinococcosis therapy (e.g., benzimidazoles)
- A safety plan for patients with epilepsy, renal or hepatic impairment, and for the major drug interactions listed above
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.