The Pufferfish Keeper's Guide to Worming
- Macauley Sykes
- 5 days ago
- 8 min read
Spend any time among pufferfish keepers and you’ll quickly notice how often internal parasites are mentioned. It’s a topic that worries many aquarists, and for good reason. Parasites can weaken or even kill fish if left untreated. Yet, just as often, the subject is clouded by confusion. Misunderstandings about which parasites affect puffers, when treatment is truly needed, and how to use worming medications safely are widespread.
This guide is designed to clear up that confusion. Here, we’ll look at the most common internal parasites seen in pufferfish, explain the signs to watch for, and outline the proven treatments that actually work. The aim is simple: to help you worm your pufferfish effectively and responsibly, with the confidence that you’re acting in your fish’s best interests.
Why do we treat parasites?
Internal parasites aren’t harmless hitchhikers. They steal nutrients, injure the gut lining, and sap energy the fish needs for growth and immunity. In juveniles, this can lead to stunted growth; in adults, progressive weight loss and declining condition.
In the wild, fish live in vast, flowing environments where parasite stages are diluted and hosts disperse. Many worm species also require intermediate hosts (e.g., copepods, tubifex, insect larvae), so exposure is episodic and spread across space. Wild fish can still carry heavy parasite loads, but reinfection pressure is tempered by scale and movement.
An aquarium is a closed, crowded system that recycles water. Parasites with direct life cycles (including many intestinal protozoa and some nematodes) can multiply quickly and cycle back into the same fish or tankmates. If we add live invertebrate foods, we may also reintroduce the intermediate hosts needed by indirect worms, allowing those cycles to continue. The result is escalating parasite numbers and, without treatment, a real risk of malnutrition and death.
Signs and symptoms of internal parasites
Internal parasites are often invisible until the burden becomes significant, but there are several warning signs that pufferfish keepers should watch for.
Some are subtle, while others only appear once the infection is advanced:
Loss of condition. The fish may appear thin despite eating, or lose weight steadily over time. In juveniles this can present as stunting, with the fish failing to grow at a normal rate.
Change in appetite. Some infected puffers eat ravenously but still waste away, while others go off food altogether. A sudden or prolonged loss of appetite is always a red flag.
Abnormal faeces. Long, stringy, pale, or clear faeces often suggest a problem in the gut. In some cases, worms may even be visible protruding from the vent.
Swollen or sunken belly. Depending on the parasite, the abdomen may look bloated (from irritation or blockage) or drawn in (from nutrient depletion).
Lethargy and weakness. Fish carrying a heavy parasite load may become withdrawn, less active, or unable to maintain normal posture and swimming strength.
Poor recovery from stress. Newly imported or moved puffers that fail to bounce back, remain thin, or refuse food are often battling hidden internal parasites.
Visible worms (Camallanus spp.). Perhaps the most obvious sign of internal nematode infection is the appearance of small, red, thread-like worms protruding from the anus. These worms are often mistaken for faeces at first, but unlike waste, they remain anchored to the fish. By the time Camallanus worms are visible externally, the infection is already well-established and requires prompt treatment.
It’s important to note that these signs can also be caused by other health issues (such as bacterial infections or poor water quality). However, when several of these symptoms appear together (especially weight loss, abnormal faeces, appetite changes, or visible worms) internal parasites should be strongly suspected.
Where do parasites come from?
If internal parasites are so damaging, the next logical question is: how do they get into our aquariums in the first place?
The short answer is that parasites arrive with the fish or with the food.
Every infection has a source, and in the case of pufferfish, there are several common pathways:
Breeding farms and wholesalers: Most puffers available to hobbyists come from large commercial breeding facilities. In these high-density systems, parasites spread easily, and even if some batches are treated, others may carry infections through unnoticed.
Shared water systems: Many wholesalers and shops run multiple tanks on a single central filtration system. One infected shipment can contaminate many other tanks in a matter of hours.
Transport and handling: During shipping, puffers may share water with other species from all over the world, providing ample opportunities for cross-contamination.
Live and frozen foods: Parasite life cycles often involve intermediate hosts such as snails, copepods, or insect larvae. Feeding contaminated live foods (or poorly processed frozen foods) can directly introduce infective stages into an otherwise parasite-free tank.
Wild-caught fish: Wild pufferfish almost always arrive with parasites. In nature, these infections are often balanced by the scale of the ecosystem, but in captivity, they can rapidly overwhelm the host.
The key point is this: parasites don’t spontaneously appear in aquaria; they hitchhike in.
That’s why quarantine and preventive worming are so important. Even fish that look healthy, or come from apparently “clean” sources, can be carrying hidden parasites that only reveal themselves weeks or months later.
What should I use to treat my pufferfish?
When it comes to worming pufferfish, two ingredients stand out as safe, effective, and widely trusted: levamisole and praziquantel. Together, they cover the vast majority of internal parasites you are likely to encounter. Other wormers do exist, but most have limitations or are better reserved for specialist use.
Note: This guide is intended for hobby use. If your puffer shows severe or persistent symptoms, consult a qualified aquatic vet before administering medication.
Levamisole: the first line of defence
Levamisole is the treatment of choice for nematodes (roundworms), including the well-known Camallanus. These worms are by far the most common internal parasites seen in puffers, especially in farmed or recently imported fish.
Levamisole works by overstimulating the worms’ nicotinic acetylcholine receptors, which causes paralysis. Once immobilised, the worms detach from the intestinal wall and are expelled naturally.
Key points:
Highly effective against most intestinal nematodes.
Safe for puffers when dosed correctly.
Administered as a bath or via medicated water.
Ideal as the first treatment in almost all cases of suspected worm burden.
Praziquantel: for cestodes and trematodes
Praziquantel is the gold-standard treatment for cestodes (tapeworms) and trematodes (flukes). While these parasites are less frequently encountered than nematodes, they can still cause severe malnutrition and wasting if left untreated.
Praziquantel disrupts the parasite’s surface membrane, leading to rapid death and expulsion.
Key points:
Effective against tapeworms and flukes.
Safe for puffers when used at the correct dose.
Administered either in the water or via medicated feed.
Best reserved for confirmed or strongly suspected flatworm infections, or as a follow-up if levamisole alone has not resolved the problem.
Other effective wormers (situational use)
A few other anthelmintics have seen use in aquaria, but they are generally less hobbyist-friendly:
Fenbendazole (benzimidazole class): Effective against some nematodes and cestodes. Poorly soluble in water, so it works best when incorporated into medicated feed, which puffers may refuse. Limited uptake if appetite is already poor.
Flubendazole (benzimidazole class): More soluble than fenbendazole and available in some aquarium formulations. Effective against nematodes and some trematodes. It can harm invertebrates such as snails and shrimp, so use it with care.
Piperazine: Historically used against nematodes, usually in medicated food and largely superseded by levamisole, which is more effective and easier to administer.
Ivermectin: A powerful broad-spectrum antiparasitic, but with a very narrow safety margin in fish. Cases of toxicity are well-documented, and it is not recommended for use by hobbyists outside of direct veterinary supervision.
Emamectin benzoate: Sera Med Nematol contains emamectin benzoate, combined with solvents in a patented formulation. While levamisole and praziquantel remain your primary tools for nematodes and flatworms, emamectin-based Nematol offers another proven option for nematodes, especially Camallanus, Capillaria, and pinworms.
The bottom line
For most pufferfish keepers, levamisole should be the first line of defence. It reliably clears the nematodes that cause the bulk of problems in captive puffers. Praziquantel complements it by covering the less common, but still significant, tapeworms and flukes.
Fenbendazole and flubendazole can be useful in certain circumstances, but they come with practical limitations. Piperazine and ivermectin are now considered outdated or too risky for routine use.
By focusing on levamisole and praziquantel and applying them correctly, you can treat virtually all the important internal parasites that affect pufferfish safely and effectively.
Choosing products wisely
Now that you know the right active ingredients (levamisole HCl for nematodes and praziquantel for cestodes and trematodes), the next step is finding a product.
The golden rule is simple: pick products based on the active ingredients, not the brand name.
Fish-labelled products (simplest & safest)
These are the most user-friendly options for the majority of keepers.
Whenever possible, choose products formulated for ornamental fish. These come with clear instructions for aquarium use.
Levamisole (for nematodes)
eSHa -ndx (UK/EU)
Fritz Expel-P (US)
Cloverleaf Absolute Wormer + (UK/EU)
Praziquantel (for cestodes & trematodes)
eSHa gdex (UK/EU)
Hikari PraziPro (US/Canada)
Fritz PraziCleanse (US)
Waterlife FlukeFree (UK)
VetArk Fluke-Solve (UK)
Sera med Tremazol (EU/Asia)
Blue Planet Fluke & Tapeworm Tablets (Australia/NZ)
Antibiotic-based medications
It is important to be clear from the start: antibiotics are not wormers. They should never be used to treat worms in pufferfish unless specifically prescribed by a qualified aquatic veterinarian.
Some antibiotics and related drugs, most notably metronidazole, do have anti-parasitic effects, but these are limited to certain protozoans such as Hexamita or Spironucleus. These are not worms.
Nematodes, cestodes, and trematodes require true anthelmintics such as levamisole or praziquantel. Reaching for antibiotics in the hope of “worming” a fish is simply the wrong tool for the job.
There are also wider concerns:
Legal issues: In many countries, antibiotics are controlled substances that require a veterinary prescription. Using them without one may be illegal.
Gut health: Antibiotics do not discriminate between “good” and “bad” microbes. They can strip away the beneficial bacteria and other microorganisms that make up the fish’s gut microbiota — communities essential for digestion, growth, immunity, and disease resistance. Disruption of this balance often shows up as poor appetite, a weak condition, and greater vulnerability to infection.
Aquarium health: Antibiotics also harm the beneficial nitrifying bacteria in your filter. This can destabilise the nitrogen cycle, exposing fish to toxic spikes of ammonia or nitrite.
Antibiotic resistance: Perhaps most concerning, misuse contributes to the rise of resistant strains of bacteria such as Aeromonas, Pseudomonas, and Flavobacterium columnare. Infections that were once straightforward to treat can become extremely difficult (sometimes impossible) to cure.
In summary, while a veterinarian may prescribe antibiotics in certain cases of protozoan infection, they are not worming agents. Using them indiscriminately is unsafe for your fish, destabilises your aquarium, and fuels the global problem of antibiotic resistance. For actual worm infections, rely only on proven anthelmintics such as levamisole (for nematodes) and praziquantel (for tapeworms and flukes), used correctly and responsibly.
Post-Treatment Checklist
After worming, it’s important to support your pufferfish and their environment to prevent re-infestation and ensure full recovery.
1. Repeat the treatment if necessary
Most worming medications only kill adult worms, not eggs.
A second dose, 7–14 days later, is usually required (depending on the medication) to break the life cycle.
2. Vacuum the substrate
Expelled worms, eggs, and organic waste settle on the bottom.
Perform a deep gravel vacuum after each treatment to remove debris.
3. Carry out a large water change
Replace 50% or more of the tank water 24–48 hours after dosing, unless the product instructions state otherwise.
This removes medication residues and parasite waste products.
4. Monitor your fish closely
Watch for signs of stress or relapse: unusual swimming, refusal to eat, or abnormal faeces.
Record changes; if symptoms persist, consult a vet or repeat the worming cycle.
5. Improve nutrition
Offer a varied, high-quality diet to help the fish regain weight and condition.
6. Quarantine & prevention
Always quarantine new arrivals and worm them before introducing them to the main tank.
Avoid feeding live foods from unknown or unsafe sources.
Comments