Treatment of enterobiasis caused by Enterobius vermicularis (pinworm). Albendazole, mebendazole, and pyrantel pamoate are drugs of choice.
Filariasis
Treatment of filariasis caused by Mansonella perstans†. Mebendazole and albendazole are drugs of choice. Antihistamines or corticosteroids also may be indicated to decrease allergic reactions secondary to disintegration of microfilariae following treatment.
Treatment of onchocerciasis† (filariasis caused by Onchocerca volvulus). Drug of choice is ivermectin.
Hookworm Infections
Treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus in single or mixed infections. Drugs of choice are albendazole, mebendazole, and pyrantel pamoate.
Treatment of eosinophilic enterocolitis† caused by Ancylostoma caninum (dog hookworm). Treatment of choice is mebendazole, albendazole, pyrantel pamoate, or endoscopic removal of worms.
Toxocariasis (Visceral Larva Migrans)
Treatment of toxocariasis† (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms). Albendazole and mebendazole are drugs of choice. Concomitant corticosteroids may be indicated in severe cases with cardiac, ocular, or CNS involvement. Treatment may not be effective for ocular larva migrans; inflammation may be reduced by corticosteroid injections, and surgery may be necessary for secondary damage.
Trichinellosis
Treatment of trichinellosis† (trichinosis) caused by Trichinella spiralis. Drug of choice is mebendazole; albendazole is an alternative. Concomitant corticosteroids usually recommended, especially for severe disease. Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.
Trichostrongyliasis
Treatment of trichostrongyliasis† caused by Trichostrongylus. Pyrantel pamoate is drug of choice; albendazole and mebendazole are alternatives.
Trichuriasis
Treatment of trichuriasis caused by Trichuris trichiura (whipworm). Mebendazole is drug of choice; albendazole and ivermectin are alternatives.
Capillariasis
Treatment of capillariasis† caused by Capillaria philippinensis. Mebendazole is drug of choice; albendazole is an alternative.
Dracunculiasis
Has been used in the treatment of Dracunculus medinensis† (guinea worm) infection. Reportedly kills worm directly. Treatment of choice is slow extraction of worm and wound care.
Angiostrongyliasis
Has been used in conjunction with corticosteroids for the treatment of eosinophilic meningitis caused by Angiostrongylus cantonensis†. May shorten course of infection, but not number of relapses. Infection usually self-limited. No drug proven effective; some patients have worsened when treated.
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). Drugs of choice are praziquantel and nitazoxanide.
Hydatid Disease
Has been used for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus† (dog tapeworm). The manufacturer states that there is no evidence of efficacy in hydatid disease, even at high doses. Treatment of choice is surgery; perioperative use of an anthelmintics may be indicated to minimize the risk of intraoperative dissemination of daughter cysts. Albendazole is drug of choice when an anthelmintic is indicated.
Has been used for the treatment of alveolar hydatid disease caused by E. multiocularis†. Surgical excision of the larval mass is the recommended and only reliable treatment. Although efficacy has not been definitely established, continuous albendazole (or mebendazole) therapy has been associated with clinical improvement in some nonresectable cases.
Giardiasis
Has been used for treatment of giardiasis† caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis). Metronidazole, tinidazole, and nitazoxanide are drugs of choice.
Dosage and Administration
Administration
Oral Administration
Administer orally without regard to meals.
Tablets may be chewed, swallowed whole, or crushed and mixed with food. Special diets, fasting, or purgation prior to administration not necessary.
Dosage
Pediatric Patients
Ascariasis
Oral
100 mg twice daily for 3 consecutive days.
Alternatively, single 500-mg dose has been recommended.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Enterobiasis
Oral
Single 100-mg dose. Some clinicians recommend a second 100-mg dose 2 weeks later.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Filariasis
Filariasis caused by Mansonella perstans
Oral
100 mg twice daily for 30 days.†
Hookworm Infections
Intestinal Hookworm Infections
Oral
100 mg twice daily for 3 consecutive days.
Alternatively, single 500-mg dose has been recommended.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Eosinophilic Enterocolitis Caused by Ancylostoma caninum
Oral
100 mg twice daily for 3 consecutive days.†
Toxocariasis (Visceral Larva Migrans)
Oral
100–200 mg twice daily for 5 days. Optimum duration of therapy not known; some clinicians recommend treatment for up to 20 days.†
Alternatively, 1 g 3 times daily (50 mg/kg daily) for 21 days reportedly was curative in a least one patient.†
Trichinellosis
Oral
200–400 mg 3 times daily for 3 days followed by 400–500 mg 3 times daily for 10 days.†
Trichostrongyliasis
Oral
100 mg twice daily for 3 consecutive days.†
Trichuriasis
Oral
100 mg twice daily for 3 consecutive days.
Alternatively, single 500-mg dose has been recommended.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Capillariasis
Oral
200 mg twice daily for 20 days.†
Dracunculiasis
Oral
400–800 mg daily for 6 days.†
Adults
Ascariasis
Oral
100 mg twice daily for 3 consecutive days.
Alternatively, single 500-mg dose has been recommended.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Enterobiasis
Oral
Single 100-mg dose. Some clinicians recommend a second 100-mg dose 2 weeks later.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Filariasis
Filariasis caused by Mansonella perstans
Oral
100 mg twice daily for 30 days.†
Onchocerciasis
Oral
1 g twice daily for 28 days.†
Hookworm Infections
Intestinal Hookworm Infections
Oral
100 mg twice daily for 3 consecutive days.
Alternatively, single 500-mg dose has been recommended.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Eosinophilic Enterocolitis Caused by Ancylostoma caninum
Oral
100 mg twice daily for 3 consecutive days.†
Toxocariasis (Visceral Larva Migrans)
Oral
100–200 mg twice daily for 5 days. Optimum duration of therapy not known; some clinicians recommend treatment for up to 20 days.†
Alternatively, 1 g 3 times daily (50 mg/kg daily) for 21 days reportedly was curative in a least one patient.†
Trichinellosis
Oral
200–400 mg 3 times daily for 3 days followed by 400–500 mg 3 times daily for 10 days.†
Trichostrongyliasis
Oral
100 mg twice daily for 3 consecutive days.†
Trichuriasis
Oral
100 mg twice daily for 3 consecutive days.
Alternatively, single 500-mg dose has been recommended.
Manufacturer recommends a second course of treatment if patient is not cured 3 weeks after mebendazole therapy.
Capillariasis
Oral
200 mg twice daily for 20 days.†
Dracunculiasis
Oral
400–800 mg daily for 6 days.†
Special Populations
No special population dosage recommendations at this time.
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. Myelosuppression is usually reversible following discontinuance of the drug, but death has occurred rarely.
Monitor organ system function (including hematopoietic and hepatic) periodically during prolonged mebendazole therapy.
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 used and may be related to effects resulting from drug-induced killing of parasites.
Transient diarrhea and abdominal pain have occurred occasionally during treatment but usually have been associated with massive infections and expulsion of the helminths.
Specific Populations
Pregnancy
Category C.
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). Use during pregnancy, especially during the first trimester, only when potential benefits justify possible risks to the fetus.
Lactation
Not known if distributed into milk; use with caution in nursing women.
Pediatric Use
Only limited experience in children <2 years of age; use in this age group only when potential benefits justify possible risks.
Unlikely to be clinically important unless treating extraintestinal infection (e.g., hydatid disease)
Pharmacokinetics
Absorption
Bioavailability
Minimally (2–10%) absorbed from GI tract. Peak plasma concentrations attained within approximately 0.5–7 hours after an oral dose; wide interpatient variation.
Distribution
Extent
Not known whether distributed into milk.
Plasma Protein Binding
Highly plasma protein bound.
Elimination
Metabolism
Metabolized via decarboxylation to 2-amino-5(6)-benzimidazolyl phenylketone, which is devoid of anthelmintic activity.
Elimination Route
2–10% of dose excreted in urine and remainder in feces as unchanged drug or principal metabolite.
Inhibits formation of worms’ microtubules and causes glucose depletion in worms, leading to death of the parasite. Has no effect on blood glucose concentrations in humans.
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.
Active against certain cestodes (tapeworms), including Hymenolepis nana (dwarf tapeworm), Taenia saginata (beef tapeworm), T. solium (pork tapeworm), and Echinococcus granulosus (hydatid cyst).
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.
Importance of completing full course of therapy, even if feeling better after a few days.
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).
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.
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.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.
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 09/2009. For the most current and up-to-date pricing information, please visit www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
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