Mebendazole (Vermox, Astazole) is an orally available medicine that is used to treat worms infestations including pinworm, roundworm, hookworm, and hydatic cystic disease.

Mebendazole (Vermox, Astazole) Uses:

• Intestinal nematode infection:

  • Not for use patients with age <2 years.
  • Effective against Ancylostoma duodenale (hookworms), Ascaris lumbricoides (roundworms), Enterobius vermicularis (pinworms), and Trichuris trichiura (whipworms) infestation.

• Off Label Use of Mebendazole in Adults:

  • Capillariasis
  • Echinococcosis, cystic (Echinococcus granulosus)
  • Toxocariasis
  • Trichinellosis (Trichinella spiralis)
  • Trichostrongyliasis

Other drugs used to treat worms infestations include:

Albendazole (Zentel) and

Praziquantel

Mebendazole (Vermox, Astazole) Dose in Adults:

Dose in the treatment of Ancylostoma duodenale or Necator americanus (hookworm):

• Oral:
  • 100 mg x twice a day x 3 days OR 
  • 500 mg x single dose.
• Can be repeated in 3 weeks if still evidence of infestation after initial treatment.

Mebendazole (Vermox, Astazole) Dose in the treatment of Ascariasis (roundworm):

• Oral:
  • 100 mg x twice a day x 3 days OR 
  • 500 mg x single dose.
• Can be repeated in 3 weeks if still evidence of infestation after initial treatment.

Dose in the treatment of Capillariasis (off-label):

• Oral:
  • 200 mg x twice a day x for 20 days.

Mebendazole (Vermox, Astazole) Dose as an alternative agent in the treatment of Echinococcus, cystic  (off-label):

• Oral:
  • 40 to 50 mg/kg/day x in 3 divided doses x 3 to 6 months.

Mebendazole (Vermox, Astazole) Dose in the treatment of Enterobiasis (pinworm):

• Oral:
  • 100 mg x single dose (manufacturer's labeling)
• Can be repeated in 2 weeks.

Mebendazole (Vermox, Astazole) Dose in the treatment of Toxocariasis (off-label):

• Oral:
  • 100 to 200 mg x twice a day x 5 days.

Mebendazole (Vermox, Astazole) Dose in the treatment of Trichinellosis (Trichinella spiralis) (off-label):

• Oral:
  • 200 to 400 mg x 3 times a day x 3 days initially

Then

•  400 to 500 mg x 3 times a day x 10 days.

Mebendazole (Vermox, Astazole) Dose in the treatment of Trichostrongyliasis (off-label):

• Oral:
  • 100 mg x twice a day x 3 days.

Mebendazole (Vermox, Astazole) Dose in the treatment of Trichuriasis (whipworm):

• Oral:
  • 100 mg x twice a day x 3 days;
• Repeat in 3 weeks if evidence of intestinal infestation after initial treatment.

Mebendazole (Vermox, Astazole) Dose in Children:

Mebendazole (Vermox, Astazole) Dose in the treatment of Ancylostoma duodenale or Necator americanus (hookworm):

• Children and Adolescents (Limited data in children <2 years):

  • Oral:
    • 100 mg x twice a day x 3 days OR
    • 500 mg x single dose;
  • Can be repeated in 3 weeks if there is evidence of intestinal infestation after initial treatment.

Mebendazole (Vermox, Astazole) Dose in the treatment of Ascariasis (roundworm):

• Children and Adolescents (Limited data in children < 2 years):

  • Oral:
    • 100 mg x twice a day x 3 days OR 
    • 500 mg once as a single dose;
  • Can be repeated in 3 weeks if there is evidence of intestinal infestation after initial treatment.

Mebendazole (Vermox, Astazole) Dose in the treatment of Capillariasis:

• Children and Adolescents:

  • Oral:
    • 200 mg x twice a day x 20 to 30 days.

Mebendazole (Vermox, Astazole) Dose in the treatment of Enterobiasis (pinworm):

• Children and Adolescents (Limited data in children <2 years):

  • Oral:
    • 100 mg x single dose, can be repeated after 2 weeks.

Mebendazole (Vermox, Astazole) Dose in the treatment of Toxocariasis (roundworm, ocular larva migrans, visceral larva migrans): Limited data available:

• Children and Adolescents:

  • Oral:
    • 100 to 200 mg x twice a day x 5 days.

Mebendazole (Vermox, Astazole) Dose in the treatment of Trichinellosis (trichinosis; Trichinella species): Limited data available:

• Children and Adolescents:

  • Oral:
    • 200 to 400 mg x 3 times a day x 3 days,
  • Then
    • 400 to 500 mg x 3 times a day x 10 days.

Mebendazole (Vermox, Astazole) Dose in the treatment of Trichuriasis (whipworm):

• Children and Adolescents (Limited data in children <2 years):

  • Oral:
    • 100 mg x twice a day x 3 days;
  • Can be repeated in 3 weeks if there is evidence of intestinal infestation after initial treatment.

Mebendazole safety in Pregnancy: Risk Category C

• Limited data exists on the safety of mebendazole in the first trimester.
  • However,The available research shows no increase in birth defects in women who have taken mebendazole in their first trimester..
• The majority of data available from studies on mebendazole use in pregnancy can be found during the second and the third trimesters.
• Worm infestations Neglecting to treat pregnancy issues during pregnancy can have adverse effects on the mother and baby.Iron deficiency anemia, low-birth weight babies, neonatal, and maternal deaths
• The World Health Organization (WHO), recommends Deworming pregnant women with mebendazole during the second and third trimesters People who live in villages or are in direct contact with contaminated soil have a higher risk of getting worms.
• The World Health Organization (WHO), also recommends Potential mothers can be dewormed by preventive measures Women of reproductive age who are treated with mebendazole have a higher risk of getting worms than those living in villages or in close contact with contaminated soil.

Mebendazole & Lactation:

• After oral administration, Mebendazole secretes in breast milk.But
  • It is not absorbed into the Systemic, and therefore breast milk secretion is limited.
  • After 13 hours of 100mg Mebendazole Ingestion, only one woman detected it in her breast milk.
  • A woman also participatedCessation of lactationAfter 3 months, the mother who was exclusively breastfeeding her child had to start mebendazole therapy (Rao 1983).
  • A prospective study showed that 1 out of 45 women were successful in achieving this goal.transient decreaseAfter mebendazole therapy, lactation is normal.
  • No data is available regarding adverse events in infants who are fed top-feed.
• When deciding whether to start mebendazole therapy in lactation, you must consider the benefits to the mother as well as the risk to the infant's health. However, mebendazole is generally safe during lactation.

Dose in Kidney Disease:

Renal dose adjustment not required.

Mebendazole (Vermox, Astazole) Dose in Liver disease:

Hepatic dose adjustment is not required; however,

• mebendazole undergoes extensive hepatic metabolism;
• use with caution as systemic exposure may be increased.

Side effects of Mebendazole (Vermox, Astazole):

• Gastrointestinal:

  • Abdominal pain
  • Anorexia
  • Diarrhea
  • Flatulence
  • Nausea
  • Vomiting

• Hepatic:

  • Hepatitis

Contraindications to Mebendazole (Vermox, Astazole):

Hypersensitivity to mebendazole and any component of the formulation

Warnings and precautions

• Suppression of bone marrow

  • High doses of long-term use have been linked to neutropenia and agranulocytosis. Monitor CBC if you are taking higher doses or for a longer time.

• Hepatic impairment

  • Be cautious; systemic exposure could be increased if you have hepatic impairment.

Mebendazole: Drug Interaction

Monitoring parameters:

During therapy, it is advised to periodically monitor

• • hematologic,
  • hepatic, and
  • renal function;
• Stool for ova should be requested within 3-4 weeks of therapy

How to administer Mebendazole (Vermox, Astazole)?

Oral: Can be taken with or without food, no interaction with food is noted.

• Tablet can be swallowed with or without food or can be chewed
• The syrup can be taken with or without food.

Mechanism of action of Mebendazole (Vermox, Astazole):

• It inhibits tubulin dimer polymerization by binding to the colchicine binding sites of b-tubulin.
• This results in inhibition of the formation of helminth microtubules.
• It also prevents the absorption of nutrients, including glucose, by intestinal-dwelling helminths.

Absorption:

• Oral: Only 5% to 10% of the drug is absorbed but is increased when taken with food.

Protein binding:

• 90% to 95%

Metabolism:

• Extensively hepatic

Half-life elimination:

• 3 to 6 hours

Excretion:

• Primarily excreted in feces as an unchanged drug and as primary metabolite;
• < 2% drug is excreted in urine

International Brand Names of Mebendazole:

• Emverm
• Vermox
• Adec
• Anelmin
• Antiox
• Antiver
• Astazole
• Azoel
• Benda
• Bendazole
• Benhol
• Big-Ben
• Combantrin-1
• Conquer
• Cremox
• D-Worm
• Daxol
• Diacor
• Diazolen
• Endal
• Fugacar
• Helben
• Hitolin
• Kaizole
• LOmbrix
• Lomper
• Madnil
• Mebedal
• Mebendazol
• Mebensole
• Mebex
• Mebez
• Mebezol
• Mebzol
• Nemasole
• Pantelmin
• Permax
• Quemox
• Revapol
• Ribamox
• Surfont
• Thelmox
• Toloxim
• Vermazol
• Vermicol
• Vermid
• Vermin
• Vermin-Dazol
• Vermox
• Vertizole
• Warca
• Wormazol
• Wormgo
• Wormin
• Wormizol
• Zadomen

Mebendazole Brand Names in Pakistan: