Mebendazole: Difference between revisions

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=====Liver=====
=====Liver=====
*Liver function test elevations [[AST]] (SGOT), [[ALT]] (SGPT), and [[GGT]]]  
*Liver function test elevations [[AST]] ([[SGOT]]), [[ALT]] ([[SGPT]]), and [[GGT]]
*[[Hepatitis]] when mebendazole was taken for prolonged periods and at dosages substantially above those recommended.
*[[Hepatitis]] when mebendazole was taken for prolonged periods and at dosages substantially above those recommended.


Line 50: Line 50:
*[[Neutropenia]]  
*[[Neutropenia]]  
*[[Agranulocytosis]]
*[[Agranulocytosis]]
|drugInteractions=Preliminary evidence suggests that cimetidine inhibits mebendazole metabolism and may result in an increase in plasma concentrations of mebendazole.
|drugInteractions=*Preliminary evidence suggests that [[cimetidine]] inhibits mebendazole metabolism and may result in an increase in plasma concentrations of mebendazole.
|FDAPregCat=C
|FDAPregCat=C
|useInPregnancyFDA=Mebendazole has shown [[embryotoxic]] and [[teratogenic]] activity in pregnant rats at single oral doses as low as 10 mg/kg (approximately equal to the human dose, based on mg/m2). In view of these findings the use of mebendazole is not recommended in pregnant women. Although there are no adequate and well-controlled studies in pregnant women, a postmarketing survey has been done of a limited number of women who inadvertently had consumed mebendazole during the first trimester of pregnancy. The incidence of spontaneous [[abortion]] and malformation did not exceed that in the general population. In 170 deliveries on term, no [[teratogenic risk]] of mebendazole was identified.
|useInPregnancyFDA=*Mebendazole has shown [[embryotoxic]] and [[teratogenic]] activity in pregnant rats at single oral doses as low as 10 mg/kg (approximately equal to the human dose, based on mg/m2). In view of these findings the use of mebendazole is not recommended in pregnant women. Although there are no adequate and well-controlled studies in pregnant women, a postmarketing survey has been done of a limited number of women who inadvertently had consumed mebendazole during the first trimester of pregnancy. The incidence of spontaneous [[abortion]] and malformation did not exceed that in the general population. In 170 deliveries on term, no [[teratogenic risk]] of mebendazole was identified.
|useInNursing=It is not known whether mebendazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when mebendazole is administered to a nursing woman.
|useInNursing=*It is not known whether mebendazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when mebendazole is administered to a nursing woman.
|useInPed=The drug has not been extensively studied in children under two years; therefore, in the treatment of children under two years the relative benefit/risk should be considered.
|useInPed=*The drug has not been extensively studied in children under two years; therefore, in the treatment of children under two years the relative benefit/risk should be considered.
|useInReproPotential=In [[carcinogenicity]] tests of mebendazole in mice and rats, no carcinogenic effects were seen at doses as high as 40 mg/kg (one to two times the human dose, based on mg/m2) given daily over two years. Dominant lethal mutation tests in mice showed no mutagenicity at single doses as high as 640 mg/kg (18 times the human dose, based on mg/m2). Neither the spermatocyte test, the F1 translocation test, nor the Ames test indicated mutagenic properties. Doses up to 40 mg/kg in mice (equal to the human dose, based on mg/m2), given to males for 60 days and to females for 14 days prior to gestation, had no effect upon fetuses and offspring, though there was slight maternal toxicity.
|useInReproPotential=*In [[carcinogenicity]] tests of mebendazole in mice and rats, no carcinogenic effects were seen at doses as high as 40 mg/kg (one to two times the human dose, based on mg/m2) given daily over two years. Dominant lethal mutation tests in mice showed no mutagenicity at single doses as high as 640 mg/kg (18 times the human dose, based on mg/m2). Neither the spermatocyte test, the F1 translocation test, nor the Ames test indicated mutagenic properties. Doses up to 40 mg/kg in mice (equal to the human dose, based on mg/m2), given to males for 60 days and to females for 14 days prior to gestation, had no effect upon fetuses and offspring, though there was slight maternal toxicity.
|monitoring=Periodic assessment of organ system functions, including hematopoietic and hepatic, is advisable during prolonged therapy.
|monitoring=*Periodic assessment of organ system functions, including hematopoietic and hepatic, is advisable during prolonged therapy.
|overdose=In the event of accidental overdosage, gastrointestinal complaints lasting up to a few hours may occur. Vomiting and purging should be induced
|overdose=*In the event of accidental overdosage, gastrointestinal complaints lasting up to a few hours may occur. [[Vomiting]] and [[purging]] should be induced
|drugBox=[[file:MbendazolDB2.png|thumb|none|600px]]
|drugBox={{Drugbox2
|mechAction=Mebendazole inhibits the formation of the worms’ microtubules and causes the worms’ glucose depletion.
| verifiedrevid = 457797273
|structure=Mebendazole is methyl 5-benzoylbenzimidazole-2-carbamate and has the following structural formula:
| IUPAC_name = methyl (5-benzoyl-1''H''-benzimidazol-2-yl)carbamate
| image = Mebendazole Structure.png
| width = 300
 
<!--Clinical data-->
| tradename = Generic (formerly ''Vermox'')
| Drugs.com = {{drugs.com|monograph|mebendazole}}
| MedlinePlus = a682315
| pregnancy_AU = B3
| pregnancy_US = C
| legal_AU = S2
| legal_CA = OTC
| legal_UK = GSL
| legal_US = RX only
| routes_of_administration = Oral
 
<!--Pharmacokinetic data-->
| bioavailability = 2-10%
| protein_bound = 95%
| metabolism = [[Hepatic]] (extensive)
| elimination_half-life = 3-6 hours
| excretion = Faeces, urine (5-10%)
 
<!--Identifiers-->
| CASNo_Ref = {{cascite|correct|CAS}}
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 31431-39-7
| ATC_prefix = P02
| ATC_suffix = CA01
| ATC_supplemental = {{ATCvet|P52|AC09}}
| PubChem = 4030
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00643
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 3890
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 81G6I5V05I
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00368
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 6704
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 685
 
<!--Chemical data-->
| C=16 | H=13 | N=3 | O=3
| molecular_weight = 295.293 g/mol
| smiles = O=C(c2cc1c(nc(n1)NC(=O)OC)cc2)c3ccccc3
| InChI = 1/C16H13N3O3/c1-22-16(21)19-15-17-12-8-7-11(9-13(12)18-15)14(20)10-5-3-2-4-6-10/h2-9H,1H3,(H2,17,18,19,21)
| InChIKey = OPXLLQIJSORQAM-UHFFFAOYAP
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C16H13N3O3/c1-22-16(21)19-15-17-12-8-7-11(9-13(12)18-15)14(20)10-5-3-2-4-6-10/h2-9H,1H3,(H2,17,18,19,21)
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = OPXLLQIJSORQAM-UHFFFAOYSA-N
| melting_point = 288.5
}}
|mechAction=*Mebendazole inhibits the formation of the worms’ [[microtubules]] and causes the worms’ [[glucose]] depletion.
|structure=*Mebendazole is methyl 5-benzoylbenzimidazole-2-carbamate and has the following structural formula:
[[file:MebStr.png|thumb|none|600px]]
[[file:MebStr.png|thumb|none|600px]]
|PK=Following administration of 100 mg twice daily for three consecutive days, plasma levels of mebendazole and its primary metabolite, the 2-amine, do not exceed 0.03 mcg/mL and 0.09 mcg/mL, respectively. All metabolites are devoid of anthelmintic activity. In man, approximately 2% of administered mebendazole is excreted in urine and the remainder in the feces as unchanged drug or a primary metabolite.
|PK=*Following administration of 100 mg twice daily for three consecutive days, plasma levels of mebendazole and its primary metabolite, the 2-amine, do not exceed 0.03 mcg/mL and 0.09 mcg/mL, respectively. All metabolites are devoid of anthelmintic activity. In man, approximately 2% of administered mebendazole is excreted in urine and the remainder in the feces as unchanged drug or a primary metabolite.
|howSupplied=Mebendazole 100 mg, chewable, round, light peach-colored, unscored tablets, debossed “93” and “107” on one side and plain on the other side, supplied in  
|howSupplied=*Mebendazole 100 mg, chewable, round, light peach-colored, unscored tablets, debossed “93” and “107” on one side and plain on the other side, supplied in  
[[file:Captura de pantalla 2014-12-29 a la(s) 10.07.10.png|thumb|none|600px]]
[[file:Captura de pantalla 2014-12-29 a la(s) 10.07.10.png|thumb|none|600px]]
|storage=Store at 20° to 25°C (68° to 77°F)
|storage=Store at 20° to 25°C (68° to 77°F)
Line 73: Line 130:
|fileName=Insert.png
|fileName=Insert.png
}}
}}
__NOTOC__
{{Mebendazole}}
'''''For patient information, click <u>[[Mebendazole (patient information)|here]]</u>'''''.
{{CMG}}
==Overview==
'''Mebendazole''' is a [[benzimidazole]] drug that is used to treat infestations by [[worm]]s including [[pinworm]]s,[[roundworm]]s, [[tapeworm]]s, [[hookworm]]s, and [[whipworm]]s. The active ingredient in Pripsen powder is piperazine.
==Category==
Anthelmintic
==US Brand Names==
MEBENDAZOLE<sup>®</sup>
==FDA Package Insert==
'''  [[Mebendazole description|Description]]'''
'''| [[Mebendazole clinical pharmacology|Clinical Pharmacology]]'''
'''| [[Mebendazole indications and usage|Indications and Usage]]'''
'''| [[Mebendazole contraindications|Contraindications]]'''
'''| [[Mebendazole warnings and precautions|Warnings and Precautions]]'''
'''| [[Mebendazole adverse reactions|Adverse Reactions]]'''
'''| [[Mebendazole drug interactions|Drug Interactions]]'''
'''| [[Mebendazole overdosage|Overdosage]]'''
'''| [[Mebendazole dosage and administration|Dosage and Administration]]'''
'''| [[Mebendazole how supplied|How Supplied]]'''
'''| [[Mebendazole labels and packages|Labels and Packages]]'''
==Mechanism of Action==
Mebendazole ([[Carbon|C]]<sub>16</sub>[[Hydrogen|H]]<sub>13</sub>[[Nitrogen|N]]<sub>3</sub>[[Oxygen|O]]<sub>3</sub>) causes slow immobilization and death of the worms by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where [[helminths]] dwell.  It is a [[spindle poison]] that induces [[chromosome]] [[nondisjunction]].
==References==
{{Reflist|2}}
[[Category:Antibiotics]]
[[Category:Wikinfect]]

Latest revision as of 17:26, 24 February 2015

Mebendazole
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alberto Plate [2]

Disclaimer

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Overview

Mebendazole is a broad-spectrum anthelmintic that is FDA approved for the treatment of Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (common roundworm), Ancylostoma duodenale (common hookworm), Necator americanus (American hookworm) in single or mixed infections. Common adverse reactions include rash, abdominal pain, constipation, diarrhea and headache.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

The same dosage schedule applies to children and adults. The tablet may be chewed, swallowed, or crushed and mixed with food.

If the patient is not cured three weeks after treatment, a second course of treatment is advised. No special procedures, such as fasting or purging, are required.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Mebendazole in adult patients.

Non–Guideline-Supported Use

Capilaria Infection
  • Dosage: 200 mg PO q12h for 20 days[1][2]
Cestodes Infections
  • Dosage
    • Taenias: 300 mg q12h for 3-6 days[3]
    • Echinococcus: Mebendazol erradicates Echinococcus granulosus, but only slows down growth of Echinococcus multilocularis [1]
Filariasis
  • Dosage: 300 mg/day PO for 28-45 days[4]

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Mebendazole in pediatric patients.

Non–Guideline-Supported Use

Capilaria Infection
  • Dosage: 200 mg PO q12h for 20 days[1][2]

Contraindications

Mebendazole is contraindicated in persons who have shown hypersensitivity to the drug.

Warnings

There is no evidence that mebendazole, even at high doses, is effective for hydatid disease. There have been rare reports of neutropenia and agranulocytosis when mebendazole was taken for prolonged periods and at dosages substantially above those recommended.

Adverse Reactions

Clinical Trials Experience

Gastrointestinal
Hypersensitivity
Central Nervous System
Liver
  • Liver function test elevations AST (SGOT), ALT (SGPT), and GGT
  • Hepatitis when mebendazole was taken for prolonged periods and at dosages substantially above those recommended.
Hematologic

Postmarketing Experience

There is limited information regarding Mebendazole Postmarketing Experience in the drug label.

Drug Interactions

  • Preliminary evidence suggests that cimetidine inhibits mebendazole metabolism and may result in an increase in plasma concentrations of mebendazole.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): C

  • Mebendazole has shown embryotoxic and teratogenic activity in pregnant rats at single oral doses as low as 10 mg/kg (approximately equal to the human dose, based on mg/m2). In view of these findings the use of mebendazole is not recommended in pregnant women. Although there are no adequate and well-controlled studies in pregnant women, a postmarketing survey has been done of a limited number of women who inadvertently had consumed mebendazole during the first trimester of pregnancy. The incidence of spontaneous abortion and malformation did not exceed that in the general population. In 170 deliveries on term, no teratogenic risk of mebendazole was identified.


Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Mebendazole in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Mebendazole during labor and delivery.

Nursing Mothers

  • It is not known whether mebendazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when mebendazole is administered to a nursing woman.

Pediatric Use

  • The drug has not been extensively studied in children under two years; therefore, in the treatment of children under two years the relative benefit/risk should be considered.

Geriatic Use

There is no FDA guidance on the use of Mebendazole in geriatric settings.

Gender

There is no FDA guidance on the use of Mebendazole with respect to specific gender populations.

Race

There is no FDA guidance on the use of Mebendazole with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Mebendazole in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Mebendazole in patients with hepatic impairment.

Females of Reproductive Potential and Males

  • In carcinogenicity tests of mebendazole in mice and rats, no carcinogenic effects were seen at doses as high as 40 mg/kg (one to two times the human dose, based on mg/m2) given daily over two years. Dominant lethal mutation tests in mice showed no mutagenicity at single doses as high as 640 mg/kg (18 times the human dose, based on mg/m2). Neither the spermatocyte test, the F1 translocation test, nor the Ames test indicated mutagenic properties. Doses up to 40 mg/kg in mice (equal to the human dose, based on mg/m2), given to males for 60 days and to females for 14 days prior to gestation, had no effect upon fetuses and offspring, though there was slight maternal toxicity.

Immunocompromised Patients

There is no FDA guidance one the use of Mebendazole in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Mebendazole Administration in the drug label.

Monitoring

  • Periodic assessment of organ system functions, including hematopoietic and hepatic, is advisable during prolonged therapy.

IV Compatibility

There is limited information regarding the compatibility of Mebendazole and IV administrations.

Overdosage

  • In the event of accidental overdosage, gastrointestinal complaints lasting up to a few hours may occur. Vomiting and purging should be induced

Pharmacology

Template:Px
Mebendazole
Systematic (IUPAC) name
methyl (5-benzoyl-1H-benzimidazol-2-yl)carbamate
Identifiers
CAS number 31431-39-7
ATC code P02CA01 Template:ATCvet
PubChem 4030
DrugBank DB00643
Chemical data
Formula Template:OrganicBox atomTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox 
Mol. mass 295.293 g/mol
SMILES eMolecules & PubChem
Physical data
Melt. point 288.5 °C (551 °F)
Pharmacokinetic data
Bioavailability 2-10%
Protein binding 95%
Metabolism Hepatic (extensive)
Half life 3-6 hours
Excretion Faeces, urine (5-10%)
Therapeutic considerations
Pregnancy cat.

B3(AU) C(US)

Legal status

Pharmacy Only (S2)(AU) ?(CA) GSL(UK) ?(US)

Routes Oral

Mechanism of Action

  • Mebendazole inhibits the formation of the worms’ microtubules and causes the worms’ glucose depletion.

Structure

  • Mebendazole is methyl 5-benzoylbenzimidazole-2-carbamate and has the following structural formula:

Pharmacodynamics

There is limited information regarding Mebendazole Pharmacodynamics in the drug label.

Pharmacokinetics

  • Following administration of 100 mg twice daily for three consecutive days, plasma levels of mebendazole and its primary metabolite, the 2-amine, do not exceed 0.03 mcg/mL and 0.09 mcg/mL, respectively. All metabolites are devoid of anthelmintic activity. In man, approximately 2% of administered mebendazole is excreted in urine and the remainder in the feces as unchanged drug or a primary metabolite.

Nonclinical Toxicology

There is limited information regarding Mebendazole Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Mebendazole Clinical Studies in the drug label.

How Supplied

  • Mebendazole 100 mg, chewable, round, light peach-colored, unscored tablets, debossed “93” and “107” on one side and plain on the other side, supplied in

Storage

Store at 20° to 25°C (68° to 77°F)

Images

Drug Images

{{#ask: Page Name::Mebendazole |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Mebendazole |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Mebendazole Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Mebendazole interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

There is limited information regarding Mebendazole Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ 1.0 1.1 1.2 Keystone JS, Murdoch JK (1979). "Mebendazole". Ann Intern Med. 91 (4): 582–6. PMID 484964.
  2. ↑ 2.0 2.1 "Drugs for parasitic infections". Med Lett Drugs Ther. 34 (865): 17–26. 1992. PMID 1567506.
  3. ↑ Chavarria AP, Villarejos VM, Zeledón R (1977). "Mebendazole in the treatment of taeniasis solium and taeniasis saginata". Am J Trop Med Hyg. 26 (1): 118–20. PMID 842772.
  4. ↑ Van Hoegaerden M, Ivanoff B, Flocard F, Salle A, Chabaud B (1987). "The use of mebendazole in the treatment of filariases due to Loa loa and Mansonella perstans". Ann Trop Med Parasitol. 81 (3): 275–82. PMID 3478004.

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