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Mebendazole

Pronunciation

Pronunciation

(me BEN da zole)

Index Terms

  • Emverm
  • Vermox

Pharmacologic Category

  • Anthelmintic

Pharmacology

Inhibits the formation of helminth microtubules; selectively and irreversibly blocks glucose uptake and other nutrients in susceptible adult intestine-dwelling helminths

Distribution

Vd: 1-2 L/kg; to liver, fat, muscle, plasma, and hepatic cysts

Metabolism

Extensively hepatic

Excretion

Primarily feces; urine (~2%)

Time to Peak

Serum: 2-4 hours

Half-Life Elimination

3-6 hours

Protein Binding

90% to 95%

Use: Labeled Indications

Note: Not approved in the US

Treatment of Ancylostoma duodenale or Necator amiericanus (hookworms), Ascaris lumbricoides (roundworms), Enterobius vermicularis (pinworms), Strongyloides stercoralis (roundworm), Taenia solium (tapeworms), Trichuris trichiura (whipworms)

Use: Unlabeled

Treatment of Ancylostoma caninum (eosinophilic enterocolitis), Capillaria philippinensis (capillariasis), Giardia duodenalis (giardiasis), Mansonella perstans (filariasis), visceral larva migrans (toxocariasis)

Contraindications

Hypersensitivity to mebendazole or any component of the formulation

Dosage

Oral: Children ≥2 years; Adolescents, and Adults:

Canadian labeling:

Ancylostoma duodenale (hookworm), Necator americanus (hookworm), Ascaris lumbricoides (roundworm), Strongyloides stercoralis (roundworm), Taenia solium (tapeworms), Trichuris trichiura (whipworm), mixed infection: 100 mg twice daily for 3 days; repeat in 3 weeks if not cured with initial treatment

Enterobius vermicularis (pinworm): 100 mg as a single dose; repeat in 2 and 4 weeks (manufacturer’s labeling); treatment should include family members in close contact with patient (Med Lett, 2007)

Off-label dosing:

Ancylostoma duodenale (hookworm), Ascaris lumbricoides (roundworm), Necator americanus (hookworm), Trichuris trichiura (whipworm): 500 mg as a single dose (Med Lett, 2007)

Off-label uses:

Ancylostoma caninum (eosinophilic enterocolitis): 100 mg twice daily for 3 days (Med Lett, 2007)

Capillaria philippinensis (capillariasis): 200 mg twice daily for 20 days (Med Lett, 2007)

Giardia duodenalis (giardiasis): 200 mg 3 times daily for 5 days (Canete, 2006; Chandy, 2009)

Mansonella perstans (filariasis): 100 mg twice daily for 30 days (Med Lett, 2007)

Visceral larva migrans (toxocariasis): 100-200 mg twice daily for 5 days (Med Lett, 2007)

Dosage adjustment in renal impairment: No dosage adjustment provided in manufacturer's labeling.

Dosage adjustment in hepatic impairment: No dosage adjustment provided in manufacturer's labeling; however, undergoes extensive hepatic metabolism; use with caution as systemic exposure may be increased.

Administration

Tablets may be chewed, swallowed whole, or crushed and mixed with food. Tablets may be administered with or without food.

Storage

Store at 15°C to 30°C (59°F to 86°F). Protect from light.

Drug Interactions

Aminoquinolines (Antimalarial): May decrease the serum concentration of Anthelmintics. Monitor therapy

CarBAMazepine: May decrease the serum concentration of Mebendazole. Monitor therapy

Cimetidine: May increase the serum concentration of Mebendazole. Monitor therapy

Fosphenytoin: May decrease the serum concentration of Mebendazole. Monitor therapy

MetroNIDAZOLE (Systemic): Mebendazole may enhance the adverse/toxic effect of MetroNIDAZOLE (Systemic). Particularly the risk for Stevens-Johnson syndrome or toxic epidermal necrolysis may be increased. Avoid combination

Phenytoin: May decrease the serum concentration of Mebendazole. Monitor therapy

Adverse Reactions

Frequency not defined.

Central nervous system: Dizziness, drowsiness, headache, seizure

Dermatologic: Alopecia, angioedema, exanthema, itching, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Gastrointestinal: Abdominal pain, diarrhea, vomiting

Hematologic: Agranulocytosis, eosinophilia, hemoglobin decreased, leukopenia, neutropenia

Hepatic: Alkaline phosphatase increased, ALT increased, AST increased, GGT increased, hepatitis

Renal: BUN increased, cylindruria, glomerulonephritis, hematuria

Miscellaneous: Hypersensitivity reactions (anaphylactic, anaphylactoid)

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Neutropenia and agranulocytosis have been reported with high doses and prolonged use.

Disease-related concerns:

• Hepatic impairment: Use with caution; systemic exposure may be increased with hepatic impairment.

• Hydatid disease: Not effective for hydatid disease.

Concurrent drug therapy issues:

• Metronidazole: Concomitant use with metronidazole should be avoided; may increase the risk of adverse events including Stevens-Johnson syndrome and toxic epidermal necrolysis.

Special populations:

• Pediatric: Experience with use in children <2 years of age is limited; convulsions in infants <1 year have been reported (rare) postmarketing.

Monitoring Parameters

Periodic hematologic, hepatic, and renal function; check for helminth ova in feces within 3-4 weeks following the initial therapy

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies; adverse pregnancy outcomes have not been observed following use in pregnancy (Diav-Citrin, 2003; Gyorkos, 2006). Treatment of pinworm in pregnancy may be considered; however, the CDC suggests postponing therapy until the third trimester when possible (CDC, 2010).

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