Mebendazole; Uses, Dosage, Side Effects, Interactions, Pregnancy

Mebendazole is a synthetic benzimidazole derivate an anthelmintic agent. Mebendazole interferes with the reproduction and survival of helminths by inhibiting the formation of their cytoplasmic microtubules, thereby selectively and irreversibly blocking glucose uptake. This results in a depletion of glycogen stores and leads to reduced formation of ATP required for survival and reproduction of the helminth. This eventually causes the helminths death.

Mebendazole is a (synthetic) broad-spectrum anthelmintic, member of the benzimidazole class of antiparasitic agents, which also includes thiabendazole, albendazole, and triclabendazole & used to treat infections caused by worms such as whipworm, pinworm, roundworm, and hookworm. Mebendazole, like other benzimidazoles, causes the death of parasites by interfering with the function of tubulin, an important protein in parasites, and preventing glucose uptake.

Mechanism of Action of Mebendazole

Mebendazole causes degenerative alterations in the tegument and intestinal cells of the worm by binding to the colchicine-sensitive site of tubulin, thus inhibiting its polymerization or assembly into microtubules. The loss of the cytoplasmic microtubules leads to impaired uptake of glucose by the larval and adult stages of the susceptible parasites and depletes their glycogen stores. Degenerative changes in the endoplasmic reticulum, the mitochondria of the germinal layer, and the subsequent release of lysosomes result in decreased production of adenosine triphosphate (ATP), which is the energy required for the survival of the helminth. Due to diminished energy production, the parasite is immobilized and eventually dies.

Indications of Mebendazole

Pinworm Infection (Enterobius vermicularis)
Whipworm Infection
Ascariasis
Angiostrongylosis
Capillariasis
Dracunculiasis
Echinococcus
Filariasis, Elephantiasis
Hookworm Infection (Necator or Ancylostoma)
Hydatid Disease
Trichinosis
Trichostrongylosis
Visceral Larva Migrans, Toxocariasis
Ancylostoma caninum infection
Ancylostoma duodenale infection
Ascaris lumbricoides infection
Capillariasis
Enterobius vermicularis infection
Giardiasis
Necatoriasis due to necator americanus
Strongyloides Stercoralis Infection
Taenia solium infection
Toxocariasis
Whipworm infection
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.

Therapeutic Indications of Mebendazole

Mebendazole is indicated as a primary agent for tichuriasis caused by Trichuris trichiura (whipworm).
Mebendazole is indicated in the treatment of multiple intestinal roundworm infections.
Mebendazole is indicated a primary agent for enterobiasis caused by Enterobius vermicularis (pinworm).
Mebendazole is used as a secondary agent in the treatment of trichinosis (trichinellosis) caused by Trichinella spiralis (pork worm). Systemic corticosteroids are used concurrently, especially in patients with severe symptoms, to minimize inflammatory reactions to Trichinella larvae. Echinococcus multilocularis (E. alveolaris).
Mebendazole is used in the treatment of gnathostomiasis caused by Gnathostoma spinigerum.
Mebendazole is used in the treatment of unilocular hydatid disease caused by E. granulosus. Mebendazole is used as a secondary agent in patients in whom surgery is contraindicated or has failed, in after-spill during surgery, or in recurrences. Very high doses may be effective.
Mebendazole is used in the treatment of capillariasis caused by Capillaria phillippinensis.
Mebendazole is indicated as a primary agent for hookworm disease caused by Ancylostoma duodenale (common hookworm; Old World hookworm) and Necator americanus (American hookworm; New World hookworm).
Mebendazole is indicated as a primary agent for ascariasis caused by Ascaris lumbricoides (common roundworm).

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Contra-Indications of Mebendazole

Reduction in the body’s resistance to infection
The acquired decrease of all cells in the blood
Low Blood counts due to bone marrow failure
Decreased neutrophils a type of white blood Cell
Liver Problems
Abnormal Liver Function Tests

Dosage of Mebendazole

Strengths

Tablet, chewable : 100mg ;500mg

Usual Adult Dose

Hookworm Infection (Necator or Ancylostoma)

100 mg orally twice a day for 3 days.

Whipworm Infection (Trichuris trichiura)

100 mg orally twice a day for 3 days.

Pinworm Infection (Enterobius vermicularis)

100 mg orally one time. This dose should be repeated in 2 weeks. All family members and close contacts should also be examined.

Angiostrongylosis

100 mg orally twice a day for 5 days.

Ascariasis

100 mg orally twice a day for 3 days.
If the biliary obstruction is also present, piperazine citrate 150 mg/kg initially, followed by 65 mg/kg every 12 hours for 6 doses by nasogastric tube is also recommended.

Capillariasis

200 mg orally twice a day for 20 days. Relapses may be treated with prolonged courses of therapy.

Trichostrongylosis

100 mg orally twice a day for 3 days.

Filariasis

100 mg orally one time. This dose should be repeated in 2 weeks. All family members and close contacts should also be examined.
Mansonella perstans infection – 100 mg twice daily for 30 days.

Trichinosis

200 to 400 mg orally three times a day for 3 days, then 400 to 500 mg three times a day for 10 days. Concomitant steroid therapy may be administered if the patient is symptomatic.

Visceral Larva Migrans (Toxicariasis)

100 to 200 mg orally twice daily for 5 days. Coadministration of anti-inflammatory agents might be considered.

Echinococcus Infection

Hepatic Cystic infection -: 40 to 50 mg/kg per day, administered in three divided doses,

Hydatid Disease

Hepatic Cystic infection: 40 to 50 mg/kg per day, administered in three divided doses, Usual Adult Dose for Dracunculiasis
400 to 800 mg per day for 6 days.

Pediatric Dose

Hookworm Infection (Necator or Ancylostoma)

Nausea
Greater than or equal to 2 years: 100 mg orally twice a day for 3 days.

Whipworm Infection (Trichuris trichiura)

Greater than or equal to 2 years: 100 mg orally twice a day for 3 days.

Pinworm Infection (Enterobius vermicularis)

Greater than or equal to 2 years: 100 mg orally one time. This dose should be repeated in 2 weeks. All family members and close contacts should also be examined.

Angiostrongylosis

Greater than or equal to 2 years: 100 mg orally twice a day for 5 days.

Ascariasis

Greater than or equal to 2 years: 100 mg orally twice a day for 3 days. If the biliary obstruction is also present, piperazine citrate 150 mg/kg initially, followed by 65 mg/kg every 12 hours for 6 doses by nasogastric tube is also recommended.

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Capillariasis

Greater than or equal to 2 years: 200 mg orally twice a day for 20 days. Relapses may be treated with prolonged courses of therapy.

Filariasis

Greater than or equal to 2 years: 100 mg orally one time. This dose should be repeated in 2 weeks. All family members and close contacts should also be examined.
Mansonella perstans infection – 100 mg twice daily for 30 days.

Trichinosis

Greater than or equal to 2 years: 200 to 400 mg orally three times daily for 3 days, then 400 to 500 mg three times daily for 10 days. Steroids may be administered if the patient is symptomatic.

Visceral Larva Migrans (Toxicariasis)

Greater than or equal to 2 years: 100 to 200 mg orally twice daily for 5 days. Coadministration of anti-inflammatory agents might be considered.

Side Effects of Mebendazole

The most common

Common

Black, tarry stools
convulsions
a cough or hoarseness
fever with or without chills
the general feeling of tiredness or weakness
Drowsiness and lightheadedness the day after taking the medicine.
Confusion.
Numbed emotions.
Visual disturbances such as blurred vision or double vision.
Shaky movements and unsteady walk (ataxia).
Loss of memory (amnesia).
Muscle weakness.
Dizziness.
A headache.
Skin rashes.
Disturbances of the gut such as diarrhea, c onstipation, nausea, vomiting or abdominal pain.
Difficulty in passing urine (urinary retention).
Changes in sex drive.
Low blood pressure (hypotension).
Blood disorders.
Jaundice.
Unexpected aggression, restlessness or irritability (tell your doctor if you experience this).
Nightmares or hallucinations (tell your doctor if you experience this).

Serious

agitation
anxiety
behavioral changes, including aggressiveness, angry outbursts, bizarre behavior, or decreased inhibitions
confusion
increased trouble sleeping
memory problems
muscle spasms
shortness of breath
signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
sleepwalking

Drug Interactions of Mebendazole

Barbiturates: (Moderate) Barbiturates induce hepatic microsomal enzymes and may increase the metabolism of mebendazole if given concomitantly. This effect can cause decreased levels of plasma mebendazole but is probably important only in the treatment of extraintestinal infections, such as hydatid cyst disease, and not in the treatment of intestinal helminths.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Major) Avoid the concomitant use of mebendazole and metronidazole. Serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported with coadministration.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Major) Avoid the concomitant use of mebendazole and metronidazole. Serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported with coadministration.
Carbamazepine: (Moderate) Carbamazepine may potentially accelerate the hepatic metabolism of mebendazole. Dosage adjustments may be necessary, and closer monitoring of clinical and/or adverse effects is warranted when carbamazepine is used with mebendazole.
Cimetidine: (Minor) Cimetidine may reduce the metabolism of mebendazole and increase mebendazole serum concentrations. Adverse hematological effects have been observed during concurrent use of cimetidine with high doses or prolonged mebendazole therapy. In a study of 7 patients, cimetidine significantly increased mebendazole concentrations; however, it was not considered to be of therapeutic relevance. In another study of 8 patients, concomitant use of cimetidine and a 30-day mebendazole treatment regimen resulted in a significant increase in mebendazole serum concentrations.
Fosphenytoin: (Moderate) Mebendazole is metabolized by hepatic cytochrome P450 enzymes and other enzymes. Fosphenytoin induces hepatic microsomal enzymes and may increase the metabolism of mebendazole if given concomitantly.
Metronidazole: (Major) Avoid the concomitant use of mebendazole and metronidazole. Serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported with coadministration.
Phenytoin: (Moderate) Hydantoin anticonvulsants induce hepatic microsomal enzymes and may increase the metabolism of other drugs, including mebendazole, leading to reduced efficacy of the concomitant medication.
Rifamycins: (Moderate) Mebendazole is metabolized by hepatic cytochrome P450 enzymes and other enzymes. Rifamycins induce hepatic microsomal enzymes and may increase the metabolism of mebendazole if given concomitantly.