Mebendazole

Pronunciation

Class: Anthelmintics
VA Class: AP200
CAS Number: 31431-39-7

Introduction

Anthelmintic agent; benzimidazole derivative.107

Uses for Mebendazole

Ascariasis

Treatment of ascariasis caused by Ascaris lumbricoides.100 107 147 Albendazole, ivermectin, and mebendazole are drugs of choice.100 147

Enterobiasis

Treatment of enterobiasis caused by Enterobius vermicularis (pinworm).100 107 147 Albendazole, mebendazole, and pyrantel pamoate are drugs of choice.100 147

Filariasis

Treatment of filariasis caused by Mansonella perstans.124 128 129 130 131 132 133 134 135 136 147 Mebendazole and albendazole are drugs of choice.124 128 129 130 131 132 133 134 135 136 147 Antihistamines or corticosteroids also may be indicated to decrease allergic reactions secondary to disintegration of microfilariae following treatment.147

Treatment of onchocerciasis (filariasis caused by Onchocerca volvulus).114 115 116 117 Drug of choice is ivermectin.138 139 140 141 142 147

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Hookworm Infections

Treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus in single or mixed infections.100 107 147 Drugs of choice are albendazole, mebendazole, and pyrantel pamoate.100 147

Treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm).147 Treatment of choice is mebendazole, albendazole, pyrantel pamoate, or endoscopic removal of worms.147

Toxocariasis (Visceral Larva Migrans)

Treatment of toxocariasis (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms).100 147 Albendazole and mebendazole are drugs of choice.100 147 Concomitant corticosteroids may be indicated in severe cases with cardiac, ocular, or CNS involvement.100 147 Treatment may not be effective for ocular larva migrans; inflammation may be reduced by corticosteroid injections, and surgery may be necessary for secondary damage.100

Trichinellosis

Treatment of trichinellosis (trichinosis) caused by Trichinella spiralis.100 147 Drug of choice is mebendazole; albendazole is an alternative.147 Concomitant corticosteroids usually recommended, especially for severe disease.100 125 127 147 Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.100

Trichostrongyliasis

Treatment of trichostrongyliasis caused by Trichostrongylus.147 Pyrantel pamoate is drug of choice; albendazole and mebendazole are alternatives.147

Trichuriasis

Treatment of trichuriasis caused by Trichuris trichiura (whipworm).100 107 Mebendazole is drug of choice; albendazole and ivermectin are alternatives.100 147

Capillariasis

Treatment of capillariasis caused by Capillaria philippinensis.147 Mebendazole is drug of choice; albendazole is an alternative.147

Dracunculiasis

Has been used in the treatment of Dracunculus medinensis (guinea worm) infection.147 Reportedly kills worm directly.147 Treatment of choice is slow extraction of worm and wound care.147

Angiostrongyliasis

Has been used in conjunction with corticosteroids for the treatment of eosinophilic meningitis caused by Angiostrongylus cantonensis.147 152 May shorten course of infection, but not number of relapses.147 152 Infection usually self-limited.147 No drug proven effective; some patients have worsened when treated.147

Intestinal Tapeworm Infection

Has been used in the treatment of intestinal infections caused by adult forms of tapeworms including Hymenolepis nana (dwarf tapeworm), Taenia saginata (beef tapeworm), and T. solium (pork tapeworm).a Drugs of choice are praziquantel and nitazoxanide.100 147

Hydatid Disease

Has been used for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus (dog tapeworm).a The manufacturer states that there is no evidence of efficacy in hydatid disease, even at high doses.107 Treatment of choice is surgery; perioperative use of an anthelmintics may be indicated to minimize the risk of intraoperative dissemination of daughter cysts.147 Albendazole is drug of choice when an anthelmintic is indicated.147

Has been used for the treatment of alveolar hydatid disease caused by E. multiocularis.100 147 Surgical excision of the larval mass is the recommended and only reliable treatment.100 147 Although efficacy has not been definitely established, continuous albendazole (or mebendazole) therapy has been associated with clinical improvement in some nonresectable cases.100 147

Giardiasis

Has been used for treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis).151 Metronidazole, tinidazole, and nitazoxanide are drugs of choice.100 147

Mebendazole Dosage and Administration

Administration

Oral Administration

Administer orally107 without regard to meals.107

Tablets may be chewed, swallowed whole, or crushed and mixed with food.107 Special diets, fasting, or purgation prior to administration not necessary.107

Dosage

Pediatric Patients

Ascariasis
Oral

100 mg twice daily for 3 consecutive days.107 147

Alternatively, single 500-mg dose has been recommended.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Enterobiasis
Oral

Single 100-mg dose.107 147 Some clinicians recommend a second 100-mg dose 2 weeks later.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Filariasis
Filariasis caused by Mansonella perstans
Oral

100 mg twice daily for 30 days.147

Hookworm Infections
Intestinal Hookworm Infections
Oral

100 mg twice daily for 3 consecutive days.107 147

Alternatively, single 500-mg dose has been recommended.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Eosinophilic Enterocolitis Caused by Ancylostoma caninum
Oral

100 mg twice daily for 3 consecutive days.147

Toxocariasis (Visceral Larva Migrans)
Oral

100–200 mg twice daily for 5 days.147 Optimum duration of therapy not known; some clinicians recommend treatment for up to 20 days.147

Alternatively, 1 g 3 times daily (50 mg/kg daily) for 21 days reportedly was curative in a least one patient.123

Trichinellosis
Oral

200–400 mg 3 times daily for 3 days followed by 400–500 mg 3 times daily for 10 days.147

Trichostrongyliasis
Oral

100 mg twice daily for 3 consecutive days.147

Trichuriasis
Oral

100 mg twice daily for 3 consecutive days.107 147

Alternatively, single 500-mg dose has been recommended.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Capillariasis
Oral

200 mg twice daily for 20 days.147

Dracunculiasis
Oral

400–800 mg daily for 6 days.147

Adults

Ascariasis
Oral

100 mg twice daily for 3 consecutive days.107 147

Alternatively, single 500-mg dose has been recommended.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Enterobiasis
Oral

Single 100-mg dose.107 147 Some clinicians recommend a second 100-mg dose 2 weeks later.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Filariasis
Filariasis caused by Mansonella perstans
Oral

100 mg twice daily for 30 days.147

Onchocerciasis
Oral

1 g twice daily for 28 days.114 115 116

Hookworm Infections
Intestinal Hookworm Infections
Oral

100 mg twice daily for 3 consecutive days.107 147

Alternatively, single 500-mg dose has been recommended.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Eosinophilic Enterocolitis Caused by Ancylostoma caninum
Oral

100 mg twice daily for 3 consecutive days.147

Toxocariasis (Visceral Larva Migrans)
Oral

100–200 mg twice daily for 5 days.147 Optimum duration of therapy not known; some clinicians recommend treatment for up to 20 days.147

Alternatively, 1 g 3 times daily (50 mg/kg daily) for 21 days reportedly was curative in a least one patient.123

Trichinellosis
Oral

200–400 mg 3 times daily for 3 days followed by 400–500 mg 3 times daily for 10 days.147

Trichostrongyliasis
Oral

100 mg twice daily for 3 consecutive days.147

Trichuriasis
Oral

100 mg twice daily for 3 consecutive days.107 147

Alternatively, single 500-mg dose has been recommended.147

Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.107

Capillariasis
Oral

200 mg twice daily for 20 days.147

Dracunculiasis
Oral

400–800 mg daily for 6 days.147

Special Populations

No special population dosage recommendations at this time.

Cautions for Mebendazole

Contraindications

  • Hypersensitivity to the drug.107

Warnings/Precautions

Warnings

Myelosuppression

Neutropenia (including agranulocytosis) and/or thrombocytopenia has been reported in patients receiving high dosages (e.g., 30–50 mg/kg daily) for treatment of extraintestinal infections.103 107 111 113 120 Myelosuppression is usually reversible following discontinuance of the drug, but death has occurred rarely.113

Monitor organ system function (including hematopoietic and hepatic) periodically during prolonged mebendazole therapy.107

General Precautions

Minimal adverse effects associated with usual recommended dosages (i.e., 100–200 mg daily). Adverse effects appear to occur more frequently when higher dosages are used103 104 109 111 113 114 116 120 121 and may be related to effects resulting from drug-induced killing of parasites.104 107 108 109 114 116 121 122

Transient diarrhea107 108 119 147 and abdominal pain107 108 119 147 have occurred occasionally during treatment but usually have been associated with massive infections and expulsion of the helminths.107

Specific Populations

Pregnancy

Category C.107

Embryotoxic and teratogenic in rats when given as a single oral dose as low as 10 mg/kg (approximately equal to the human dose on a mg/m2 basis).107 Use during pregnancy, especially during the first trimester, only when potential benefits justify possible risks to the fetus.107

Lactation

Not known if distributed into milk; use with caution in nursing women.107

Pediatric Use

Only limited experience in children <2 years of age;107 use in this age group only when potential benefits justify possible risks.107

Common Adverse Effects

Nausea,103 108 119 120 vomiting,103 108 120 headache,105 108 114 116 119 tinnitus,119 numbness,119 dizziness,105 108 114 116 119 fever,103 104 106 109 114 116 119 122 abnormal liver function tests.107

Interactions for Mebendazole

Specific Drugs

Drug

Interaction

Comments

Carbamazepine

Decreased plasma mebendazole concentrations101 102

Unlikely to be clinically important unless treating extraintestinal infection (e.g., hydatid disease)101 102

Cimetidine

Increased plasma mebendazole concentrations107

Phenytoin

Decreased plasma mebendazole concentrations101 118

Unlikely to be clinically important unless treating extraintestinal infection (e.g., hydatid disease)101 118

Mebendazole Pharmacokinetics

Absorption

Bioavailability

Minimally (2–10%) absorbed from GI tract.a Peak plasma concentrations attained within approximately 0.5–7 hours after an oral dose; wide interpatient variation.a

Distribution

Extent

Not known whether distributed into milk.107

Plasma Protein Binding

Highly plasma protein bound.a

Elimination

Metabolism

Metabolized via decarboxylation to 2-amino-5(6)-benzimidazolyl phenylketone, which is devoid of anthelmintic activity.a

Elimination Route

2–10% of dose excreted in urine and remainder in feces as unchanged drug or principal metabolite.107 a

Half-life

2.8–9 hours.a

Stability

Storage

Oral

Chewable tablets

20–25°C.107

Actions and Spectrum

  • Broad-spectrum anthelmintic agent.107

  • Benzimidazole derivative structurally related to albendazole and thiabendazole.a

  • Inhibits formation of worms’ microtubules and causes glucose depletion in worms, leading to death of the parasite.107 Has no effect on blood glucose concentrations in humans.a

  • Active against certain nematodes (roundworms) pathogenic to humans, including Ancylostoma duodenale (hookworm), Angiostrongylus cantonensis, Ascaris lumbricoides (roundworm), Capillaria philippinensis (Philippine threadworm), Enterobius vermicularis (pinworm), Gnathostoma spinigerum, Necator americanus (hookworm), Strongyloides stercoralis (threadworm), Trichinella spiralis (pork worm), and Trichuris trichiura (whipworm). Reported to be filaricidal against Mansonella perstans and Onchocerca volvulus.a

  • Active against certain cestodes (tapeworms), including Hymenolepis nana (dwarf tapeworm), Taenia saginata (beef tapeworm), T. solium (pork tapeworm), and Echinococcus granulosus (hydatid cyst).a

Advice to Patients

  • Advise patients that mebendazole may be taken with or without food and that the tablets may be chewed, swallowed whole, or crushed and mixed with food.107

  • Importance of completing full course of therapy, even if feeling better after a few days.107

  • Importance of good hygiene to minimize reinfection, such as washing hands with soap and cleaning under fingernails often during the day (especially before eating and after using the toilet).107

  • When treating enterobiasis (pinworm infection), importance of following additional hygiene recommendations such as wearing tight underpants both day and night and changing them daily, cleaning the bedroom floor daily (avoiding dry sweeping that may stir up dust), washing bed linens and night clothes after treatment, and keeping toilet seats clean.107

  • When treating hookworm, whipworm, or roundworm infections, importance of following additional hygiene recommendations such as washing all fruits and vegetables thoroughly or cooking them well, wearing shoes, and using the bathroom.107

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.107

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.107

  • Importance of notifying clinician of persistent or worsening symptoms of infection.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Mebendazole

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, chewable

100 mg

Mebendazole Tablets

Teva

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Mebendazole 100MG Chewable Tablets (TEVA PHARMACEUTICALS USA): 1/$17.97 or 2/$22.76

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions February 1, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

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a. AHFS drug information 2007. McEvoy GK, ed. Mebendazole. Bethesda, MD: American Society of Health-System Pharmacists; 2007:[page 52].

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