Pyrantel Pamoate

Class: Anthelmintics
VA Class: AP200
CAS Number: 22204-24-6
Brands: Ascarel, Pin-X, Reese’s Pinworm Medicine

Introduction

Anthelmintic; pyrimidine-derivative.a

Uses for Pyrantel Pamoate

Enterobiasis

Treatment of enterobiasis caused by Enterobius vermicularis (pinworm infection).102 105 106 108 109 May be used for self-medication.100 103 108 109 Drugs of choice for enterobiasis are pyrantel, mebendazole, or albendazole.102 105

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Ascariasis

Has been used for treatment of ascariasis caused by Ascaris lumbricoides.106 Drugs of choice for ascariasis are albendazole, ivermectin, or mebendazole.102 105

Intestinal Hookworm Infections

Treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus.102 105 Drugs of choice for intestinal hookworm infections are albendazole, mebendazole, or pyrantel.102 105

Treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm).102 Drugs of choice are albendazole, mebendazole, or pyrantel.102 When indicated, endoscopic worm extraction also is considered a treatment of choice for eosinophilic enterocolitis.102

Trichostrongyliasis

Treatment of trichostrongyliasis caused by Trichostrongylus.102 Pyrantel is the drug of choice; albendazole and mebendazole are alternatives.102

Oesophagostomiasis

May be effective for treatment of oesophagostomiasis caused by Oesophagostomum bifurcum.102 Albendazole is an alternative.102

Moniliformis Infections

Treatment of infections caused by Moniliformis moniliformis (thorny-headed worm).102

Pyrantel Pamoate Dosage and Administration

Administration

Oral Administration

Administer orally.108 109 May be taken without regard to meals;108 109 may be taken or mixed with milk or fruit juice.102 108 109

Shake oral suspension well before using.108

Special diet, fasting, or purgation prior to administration not necessary.a 108 109

Presence of pinworms should be confirmed visually before initiating self-medication.100 108 109

Dosage

Available as pyrantel pamoate; dosage expressed in terms of pyrantel.108 109

Pediatric Patients

Enterobiasis
Oral

11 mg/kg administered as a single dose; repeat dose after 2 weeks.102

Self-medication in children ≥2 years of age: 11 mg/kg administered as a single dose.108 109 Do not repeat treatment unless directed by a clinician.100 108 109

Treatment of all household contacts may be warranted when multiple or repeated symptomatic infections occur.102 105

Intestinal Hookworm Infections
Ancylostoma duodenale or Necator americanus
Oral

11 mg/kg once daily for 3 days.102

Perform a repeat stool examination 2 weeks after treatment; repeat dosing regimen if results are positive.105

Eosinophilic Enterocolitis Caused by Ancylostoma caninum (Dog Hookworm)
Oral

11 mg/kg once daily for 3 days.102

Trichostrongyliasis
Oral

11 mg/kg administered as a single dose.102

Moniliformis Infections
Oral

11 mg/kg administered as a single dose; repeat dose twice at 2-week intervals for a total of 3 doses.102

Adults

Enterobiasis
Oral

11 mg/kg administered as a single dose; repeat dose after 2 weeks.102

Self-medication: 11 mg/kg administered as a single dose.108 109 Do not repeat treatment unless directed by a clinician.100 108 109

Treatment of all household contacts may be warranted when multiple or repeated symptomatic infections occur.102 105

Intestinal Hookworm Infections
Ancylostoma duodenale or Necator americanus
Oral

11 mg/kg once daily for 3 days.102

Perform a repeat stool examination 2 weeks after treatment; repeat dosing regimen if results are positive.105

Eosinophilic Enterocolitis Caused by Ancylostoma caninum (Dog Hookworm)
Oral

11 mg/kg once daily for 3 days.102

Trichostrongyliasis
Oral

11 mg/kg administered as a single dose.102

Moniliformis Infections
Oral

11 mg/kg administered as a single dose; repeat dose twice at 2-week intervals for a total of 3 doses.102

Prescribing Limits

Pediatric Patients

Maximum single dose 1 g.102

Adults

Maximum single dose 1 g.102

Special Populations

No special population dosage recommendations at this time.a

Cautions for Pyrantel Pamoate

Contraindications

  • Known hypersensitivity to pyrantel or any ingredient in the formulation.a

Warnings/Precautions

General Precautions

Patients with Severe Malnutrition or Anemia

Use caution in patients with severe malnutrition or anemia.a Ideally, anemic, dehydrated, or malnourished patients should receive supportive therapy prior to administration of pyrantel.a

Specific Populations

Pregnancy

Category C.107

Use during pregnancy only if benefits justify risks to the fetus and only when no alternative management is appropriate. a

Pregnant women considering self-medication for treatment of enterobiasis should do so only under the direction of a clinician.100 108 109

Pediatric Use

Safety and efficacy not established in children <2 years of age;a use in this age group only when potential benefits justify possible risks.a

Hepatic Impairment

Use with caution in patients with preexisting liver dysfunction.100

Individuals with liver disease considering self-medication for treatment of enterobiasis should do so only under direction of a clinician.108 109

Common Adverse Effects

GI disturbances (nausea,108 109 vomiting,108 109 tenesmus,a anorexia,a diarrhea,108 109 abdominal cramps,108 109 gastralgia), headache,108 109 dizziness. 108 109

Interactions for Pyrantel Pamoate

Specific Drugs

Drug

Interaction

Comments

Piperazine (no longer commercially available in the US)

Decreased efficacy of pyrantel and piperazinea

Do not administer concomitantlya

Pyrantel Pamoate Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from GI tract.a Peak serum concentrations occur 1–3 hours after a dose.a

Elimination

Metabolism

Partially metabolized in the liver.a

Elimination Route

Approximately 50% of an oral dose is excreted unchanged in feces; 7% excreted in urine as unchanged drug and metabolites.a

Stability

Storage

Oral

Suspension

<30°C, tight, light-resistant container.a

Actions and Spectrum

  • Pyrimidine-derivative anthelmintic agent.a

  • Depolarizing neuromuscular blocking agent.a Paralyzes worms which are then expelled from the GI tract by peristalsis.a

  • Active against Enterobius vermicularis (pinworm), Ascaris lumbricoides (roundworm), Ancylostoma duodenale (hookworm), Necator americanus (hookworm), and Trichostrongylus orientalis (hairworm).a

Advice to Patients

  • For self-medication of enterobiasis (pinworm infection), importance of providing patient a copy of manufacturer’s patient information.100

  • When using to treat enterobiasis, importance of treating all household members and importance of taking hygienic precautions to minimize reinfection, including wearing tight underpants both day and night, cleaning the bedroom floor by vacuuming or damp mopping for several days after treatment, washing and not shaking bed linens and night clothes after treatment, and keeping toilet seats clean.108 109 a

  • Importance of informing clinician if symptoms of enterobiasis persist after treatment.100 Importance of informing clinician if worms other than pinworms are present before or after therapy.100 108 109

  • Importance of informing clinician if abdominal disturbances (nausea, vomiting, diarrhea), headache, or dizziness persist or become bothersome after use of the drug.100 108 109

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., anemia, hepatic disease).a

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.a

  • 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.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Pyrantel Pamoate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Powder*

Suspension

250 mg (of pyrantel) per 5 mL*

Ascarel

Pfeiffer

Pin-X

Effcon

Pyrantel Pamoate Suspension

Reese’s Pinworm Medicine

Reese

Tablets

62.5 mg (of pyrantel)

Reese’s Pinworm Caplets

Reese

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 1, 2009. 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

100. Food and Drug Administration. Anthelmintic drug products for over-the-counter human use; final monograph. Fed Regist. 1986; 51:27756-60.

101. Food and Drug Administration. Anthelmintic drug products for over-the-counter human use; establishment of a monograph. Fed Regist. 1980; 45:59540-8.

102. Anon. Drugs for parasitic infections. From the Medical Letter website (). 2008 Aug.

103. Food and Drug Administration. Over-the-counter drug products; final monographs for antiemetic, antitussive, bronchodilator, and antihelmintic drug products; updating and technical changes; final rule. Fed Regist. 1988; 53:35808-10.

105. American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006.

106. Liu LX. Strongyloidiasis and other intestinal nematode infections. Infect Dis Clin North Am. 1993; 7:655-82. [PubMed 8254165]

107. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 8th ed. Baltimore, MD: Williams & Wilkins; 2008:1559.

108. Reese. Reese’s pinworm medicine (pyrantel pamoate) prescribing information. Cleveland, OH.

109. Reese. Reese’s pinworm caplets (pyrantel pamoate) prescribing information. Cleveland, OH.

a. AHFS drug information 2009. McEvoy GK, ed. Pyrantel. Bethesda, MD: American Society of Health-System Pharmacists; 2009:62-3.

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