Niclosamide inhibits helminthic oxidative phosphorylation. An increase in ATPase activity may also contribute to its efficacy. Niclosamide is effective in the treatment of beef, pork, and fish tapeworms. It is NOT effective for hydatid infections or cysticercosis. Piperazine is metabolised to a nitrosamine, however this is not thought to contribute to its action nor to increase the risk of cancer in patients.
Piperazine is an older compound that is little used now except in persistent infections.
Piperazine should not be used in patients with epilepsy, renal failure, or hepatic failure. It also decreases embryogenesis in offspring of the worm. It may also be used in other roundworm infections. It is only approved for use in humans as an immunomodulator and will be covered in that section. The increase acetylcholine release and also inhibit acetylcholinesterase, thus causing ganglionic and myoneural stimulation and paralysis.