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Pronunciation
(me BEN da zole)
Index Terms
Brand Names: Canada
Pharmacologic Category
Use: Labeled Indications
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)
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).
Lactation
Excretion in breast milk unknown/use caution
Breast-Feeding Considerations
Since only 2% to 10% of mebendazole is absorbed, it is unlikely that it is excreted in breast milk in significant quantities (CDC, 2010)
Contraindications
Hypersensitivity to mebendazole or any component of the formulation
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:
• Pediatrics: Experience with use in children <2 years of age is limited; convulsions in infants <1 year have been reported (rare) postmarketing.
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)
Metabolism/Transport Effects
None known.
Drug Interactions
Aminoquinolines (Antimalarial): May decrease the serum concentration of Anthelmintics. Risk C: Monitor therapy
CarBAMazepine: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
Fosphenytoin: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
MetroNIDAZOLE: Mebendazole may enhance the adverse/toxic effect of MetroNIDAZOLE. Particularly the risk for Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis may be increased. Risk D: Consider therapy modification
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. Risk D: Consider therapy modification
MetroNIDAZOLE (Topical): Mebendazole may enhance the adverse/toxic effect of MetroNIDAZOLE (Topical). Particularly the risk for Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis may be increased. Risk D: Consider therapy modification
Phenytoin: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Mebendazole serum levels may be increased if taken with food.
Storage
Store at 15°C to 30°C (59°F to 86°F). Protect from light.
Mechanism of Action
Inhibits the formation of helminth microtubules; selectively and irreversibly blocks glucose uptake and other nutrients in susceptible adult intestine-dwelling helminths
Pharmacodynamics/Kinetics
Distribution: Vd: 1-2 L/kg; to liver, fat, muscle, plasma, and hepatic cysts
Protein binding: 90% to 95%
Metabolism: Extensively hepatic
Bioavailability: ~20%
Half-life elimination: 3-6 hours
Time to peak, serum: 2-4 hours
Excretion: Primarily feces; urine (~2%)
Dosage
Oral: Children ≥2 years and Adults:
Canadian manufacturer 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 or 4 weeks (manufacturer's labeling); treatment should include family members in close contact with patient (Med Lett, 2007)
Unlabeled dosing:
Ancylostoma duodenale (hookworm), Ascaris lumbricoides (roundworm), Necator americanus (hookworm), Trichuris trichiura (whipworm): 500 mg as a single dose (Med Lett, 2007)
Unlabeled 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: Oral
Tablets may be chewed, swallowed whole, or crushed and mixed with food. Tablets may be administered with or without food.
Monitoring Parameters
Periodic hematologic, hepatic, and renal function; check for helminth ova in feces within 3-4 weeks following the initial therapy
Patient Education
Tablets may be chewed, swallowed whole, or crushed and mixed with food. Increase dietary intake of fruit juices. All family members and close friends should also be treated. To reduce possibility of reinfection, wash hands and scrub nails carefully with soap and hot water before handling food, before eating, and before and after toileting. Keep hands out of mouth. Disinfect toilet daily and launder bed linens, undergarments, and nightclothes daily with hot water and soap. Do not go barefoot and do not sit directly on grass or ground. May cause abdominal pain, nausea, vomiting, or hair loss (reversible). Report skin rash or itching, unusual fatigue or sore throat, unresolved diarrhea or vomiting, or CNS changes.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause dizziness
Mental Health: Effects on Psychiatric Treatment
Carbamazepine may decrease the effects of mebendazole; may rarely cause neutropenia; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Since worm infestations are easily transmitted, all persons sharing same household should be treated. Teach transmission prevention.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, chewable, oral: 100 mg [DSC]
Pricing: U.S. (www.drugstore.com)
Chewable (Mebendazole)
100 mg (1): $17.97
References
Canete R, Escobedo AA, Gonzalez ME, et al, "Randomized Clinical Study of Five Days Apostrophe Therapy With Mebendazole Compared to Quinacrine in the Treatment of Symptomatic Giardiasis in Children," World J Gastroenterol, 2006, 12(39):6366-70.
Centers for Disease Control and Prevention (CDC), "Parasites - Enterobiasis (also known as Pinworm Infection)," 2010. Available at http://www.cdc.gov/parasites/pinworm/health_professionals/index.html
Chandy E and McCarthy J, "Evidence Behind the WHO Guidelines: Hospital Care for Children: What Is the Most Appropriate Treatment for Giardiasis?" J Trop Pediatr, 2009, 55(1):5-7.
de Silva N, Guyatt H, and Bundy D, “Anthelmintics. A Comparative Review of Their Clinical Pharmacology,” Drugs, 1997, 53(5):769-88.
Diav-Citrin O, Shechtman S, Arnon J, et al, "Pregnancy Outcome After Gestational Exposure to Mebendazole: A Prospective Controlled Cohort Study," Am J Obstet Gynecol, 2003, 188(1):282-5.
“Drugs for Parasitic Infections,” Med Lett Drugs Ther, 2007, 5(suppl):e1-14.
Gyorkos TW, Larocque R, Casapia M, et al, "Lack of Risk of Adverse Birth Outcomes After Deworming in Pregnant Women," Pediatr Infect Dis J, 2006, 25(9):791-4.
Hotez PJ, “Hookworm Disease in Children,” Pediatr Infect Dis J, 1989, 8(8):516-20.
International Brand Names
Lexi-Comp.com
Last full review/revision March 2012
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