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Thiabendazole (Topical)


VA CLASSIFICATION
Primary: AP200{01}

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

*Not commercially available in the U.S.

Not commercially available in Canada.



Category:


Anthelmintic (topical)—

Indications

Note: Because topical thiabendazole is not commercially available in the U.S. or Canada, the bracketed information and the use of the superscript 1 in this monograph reflect the lack of labeled (approved) indications for this medication.

Accepted

[Larva migrans, cutaneous (treatment)]1—Topical thiabendazole is used in the treatment of cutaneous larva migrans (creeping eruption) caused by Ancylostoma braziliense (dog and cat hookworm). {03} {04} {05} {06} {07} {08} {09} {10} {14} Recent reports and some medical experts have suggested the use of systemic ivermectin or albendazole as alternative treatment for cutaneous larva migrans if topical therapy with thiabendazole proves ineffective since its use for this indication is becoming obsolete. {04} {12} {13} {14} {15} {16} {17}

—Not all species or strains of a particular helminth may be susceptible to topical thiabendazole.

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    201.25

Mechanism of action/Effect:

Unknown; however, thiabendazole has been shown to inhibit helminth-specific enzyme fumarate reductase; vermicidal.

Absorption:

Some systemic absorption may occur from topical preparations applied to the skin.


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Topical thiabendazole may be systemically absorbed. However, problems in humans have not been documented.

Breast-feeding

Topical thiabendazole may be systemically absorbed. However, problems in humans have not been documented.

Pediatrics

Appropriate studies on the relationship of age to the effects of topical thiabendazole have not been performed in the pediatric population. However, pediatrics-specific problems that would limit the usefulness of this medication in children are not expected.


Geriatrics


Appropriate studies on the relationship of age to the effects of topical thiabendazole have not been performed in the geriatric population. However, no geriatrics-specific problems have been documented to date.

Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problem exists
Sensitivity to thiabendazole


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Thiabendazole (Topical).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to thiabendazole

Proper use of this medication
Applying directly to and approximately 5 to 7.5 cm around the slowly advancing end of each burrow or tunnel in the skin

» Compliance with full course of therapy

» Proper dosing
Missed dose: Applying as soon as possible; not applying if almost time for next dose

» Proper storage

Precautions while using this medication
Checking with physician if no improvement within a few days or if burrow or tunnel continues to advance


General Dosing Information
Thiabendazole topical suspension should be applied directly to the slowly advancing end of the larval burrow or tunnel in the skin. Since the larvae may have advanced beyond the site of inflammation in the skin, topical thiabendazole should also be applied approximately 5 to 7.5 cm around the presumed end of the burrow or tunnel.

Thiabendazole may also be applied topically as a cream in concentrations up to 15% in a water-soluble base.


Topical Dosage Forms

THIABENDAZOLE TOPICAL SUSPENSION

Note: Thiabendazole topical suspension is not commercially available in the U.S. or Canada; thiabendazole oral suspension is being used for topical application. The bracketed information and the use of superscript 1 in the Dosage Forms section reflect the lack of labeled (approved) indications for this product.


Usual adult and adolescent dose
[Cutaneous larva migrans (treatment)]1
Topical, to and around the advancing end of each larva burrow in the skin, two {05} {06} to four times {07} {08} {09} a day for two to seven days. {02} {03} {04} {08} {11}


Note: Concentrations of 10 to 15% have been recommended.


Usual adult prescribing limits
Up to six times a day.

Usual pediatric dose
[Cutaneous larva migrans (treatment)]1
See Usual adult and adolescent dose. {04}


Strength(s) usually available
U.S.—
Dosage form not commercially available. Thiabendazole oral suspension (500 mg per 5 mL) (Rx) [ Mintezol] {03} is the dosage form used when 10% thiabendazole topical suspension is prescribed. Higher concentrations require compounding

Canada—
Dosage form not commercially available. Compounding required.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • Shake well.
   • For external use only.
   • Continue medicine for full time of treatment.



Revised: 03/15/1994



References
  1. VA Medication Classification System, USP DI 1989: 2472.
  1. Panel comment, 3/90.
  1. Goldsmith RS. Clinical pharmacology of the anthelmintic drugs. In: Katzung BG, editor. Basic and clinical pharmacology. Norwalk: Appleton and Lange, 1992: 748-63.
  1. Abramowicz M, editor. Drugs for parasitic infections. Med Lett Drugs Ther 1993; 35(911): 111-22.
  1. Katz R, Hood RW. Topical thiabendazole for creeping eruption. Arch Dermat 1966; 94: 643-5.
  1. Thune PO. Creeping eruption of larva migrans. Int J Dermatol 1972; 11(4): 231-2.
  1. Sperber PA. Treatment of creeping eruption with orally and topically administered thiabendazole. J Florida MA; 1967: 54: 1059-61.
  1. Davis CM, Israel RM. Treatment of creeping eruption with topical thiabendazole. Arch Dermat 1968; 97: 325-6.
  1. Battistini F. Treatment of creeping eruption with topical thiabendazole. Tex Rep Biol Med 1969; 27(Suppl 2): 645-58.
  1. Mintezol Oral Suspension (MSD). In: PDR Physicians' desk reference. 47th ed. 1993. Montvale, NJ: Medical Economics Data, 1993: 1562.
  1. Reviewers' responses to monograph revision of 2/94.
  1. Panel comment, 2/94.
  1. Panel comment, 2/94.
  1. Chaudhry AZ, Longwirth DL. Cutaneous manifestations of intestinal helminthic infections. Dermatol Clin 1989; 7: 275-90.
  1. Caumes E, Datry A, Paris L, Dania M, Gentilini M, Gaxotte P. Efficacy of ivermectin in the therapy of cutaneous larva migrans. Arch Dermatol 1992; 128: 994-5.
  1. Jones SK, Reynolds NJ, Oliwiecki S, Harman RRM. Oral albendazole for the treatment of cutaneous larva migrans. Br J Dermatol 1990; 122: 99-101.
  1. Orihuela AR, Torres JR. Single dose of albendazole in the treatment of cutaneous larva migrans. Arch Dermatol 1990; 126: 398-99.
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