Version May 2024
Ascariasis (roundworm): Oral: 100 mg twice daily for 3 days or 500 mg as a single dose. Repeat in 3 weeks if not cured with initial treatment.
Capillariasis (off-label use): Oral: 200 mg twice daily for 20 days (Ref).
Echinococcus, cystic (alternative agent) (off-label use): Oral: 40 to 50 mg/kg/day in 3 divided doses for 3 to 6 months (Ref).
Toxocariasis (off-label use): Oral: 100 to 200 mg twice daily for 5 days (Ref).
Trichinellosis ( Trichinella spiralis ) (off-label use): Oral: 200 to 400 mg 3 times daily for 3 days, followed by 400 to 500 mg 3 times daily for 10 days (Ref).
Trichostrongyliasis (off-label use): Oral: 100 mg twice daily for 3 days (Ref).
Trichuriasis (whipworm): Oral: 100 mg twice daily for 3 days or 500 mg as a single dose; repeat in 3 weeks if not cured with initial treatment.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling; however, undergoes extensive hepatic metabolism; use with caution as systemic exposure may be increased.
Refer to adult dosing.
(For additional information see "Mebendazole: Pediatric drug information")
Note: Approved uses and ages may vary depending on product/manufacturer; consult labeling for specific information.
Ancylostoma duodenale or Necator americanus (hookworm): Children and Adolescents: Limited data available in children <2 years: Oral: 100 mg twice daily for 3 days or 500 mg once as a single dose; repeat in 3 weeks if not cured with initial treatment (Ref).
Ascariasis (Ascaris lumbricoides; roundworm): Children and Adolescents: Oral: 100 mg twice daily for 3 days or 500 mg once as a single dose. Treatment can be repeated in 3 weeks if not cured with initial treatment; the 3-day regimen may be preferred in patients who remain infected after initial treatment (Ref).
Capillariasis (Capillaria hepatica or Capillaria philippinensis): Limited data available: Children and Adolescents: Oral: 200 mg twice daily for 20 days (Ref).
Enterobiasis (Enterobius vermicularis; pinworm): Children and Adolescents: Limited data available in children <2 years: Oral: 100 mg as a single dose; repeat in 2 weeks (Ref).
Toxocariasis (roundworm; ocular or visceral larva migrans): Limited data available: Children and Adolescents: Oral: 100 to 200 mg twice daily for 5 days; however, longer duration may be necessary; optimal duration of treatment unknown (Ref).
Trichinellosis ( Trichinella species): Limited data available: Children and Adolescents: Oral: 200 to 400 mg 3 times daily for 3 days, then 400 to 500 mg 3 times daily for 10 days; longer duration or repeat courses may be needed if treatment is not initiated promptly (Ref).
Trichuriasis (Trichuris trichiura; whipworm): Children and Adolescents: Limited data in children <2 years: Oral: 100 mg twice daily for 3 days; repeat in 3 weeks if not cured with initial treatment (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling; however, undergoes extensive hepatic metabolism and systemic exposure may be increased; use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Gastrointestinal: Abdominal pain, anorexia, diarrhea, flatulence, nausea, vomiting
Hepatic: Hepatitis
<1%, postmarketing, and/or case reports: Abnormal hepatic function tests, agranulocytosis, alopecia, anaphylaxis, angioedema, decreased ejaculate volume (Parasitic Infections 2013), dizziness, glomerulonephritis, hepatitis, hypersensitivity reaction, leukopenia (Parasitic Infections 2013), neutropenia, seizure, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Hypersensitivity to mebendazole or any component of the formulation
Concerns related to adverse effects:
• Bone marrow suppression: Neutropenia and agranulocytosis have been reported with high doses and prolonged use. Monitor CBC if used at higher doses or for a prolonged duration.
Disease-related concerns:
• Hepatic impairment: Use with caution; systemic exposure may be increased with hepatic impairment.
There are limited data to support safety of mebendazole in neonates and infants. Seizures have been reported in pediatric patients <1 year of age who received mebendazole, but causality is unclear (Kahan 2021; manufacturer's labeling). In one large prospective trial (n=212; ages: 6 to <24 months) patients received mebendazole 500 mg or placebo every 3 months for a total of 317 mebendazole courses; there was no difference in adverse reactions between mebendazole and placebo groups (Montresor 2002). In a retrospective, uncontrolled study (n= 49; ages: 47 days to 11 months) patients received mebendazole 100 mg twice daily for 3 days prior to cardiac surgery; adverse reactions thought to be possibly related to therapy (watery diarrhea) were reported in 2 patients (ages: 4 months and 10 months) (Kahan 2021). No seizures were reported in either study (Kahan 2021; Montresor 2002).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet Chewable, Oral:
Emverm: 100 mg [contains corn starch, fd&c yellow #6 (sunset yellow), saccharin sodium]
No
Chewable (Emverm Oral)
100 mg (per each): $741.18
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Vermox: 100 mg [contains corn starch, fd&c yellow #6 (sunset yellow), saccharin sodium]
Vermox 500 mg chewable tablets are only available through Johnson & Johnson's Vermox Donation Program to help reduce the burden of soil-transmitted helminths in endemic countries. There are currently no plans to make Vermox 500 mg chewable tablets commercially available.
Oral:
Emverm: Administer with or without food. Tablets may be chewed, swallowed whole, or crushed and mixed with food.
Vermox (available through donation program): Administer with or without food. Chew tablets completely prior to swallowing; do not swallow whole. Tablet may also be added to 2 to 3 mL of water on a spoon; within 2 minutes a soft mass with semi-solid consistency will form and can be swallowed.
Oral: Administer with or without food.
Emverm: Tablets may be chewed, swallowed whole, or crushed and mixed with food.
Vermox (available through donation program): Chew tablets completely prior to swallowing; do not swallow whole. Tablet may also be added to 2 to 3 mL of water on a spoon; within 2 minutes a soft mass with semi-solid consistency will form and can be swallowed.
Intestinal nematode infection: Treatment of patients ≥2 years of age with GI infections caused by Ancylostoma duodenale or Necator americanus (hookworms), Ascaris lumbricoides (roundworms), Enterobius vermicularis (pinworms), and Trichuris trichiura (whipworms).
Capillariasis; Echinococcosis, cystic (Echinococcus granulosus); Toxocariasis; Trichinellosis (Trichinella spiralis); Trichostrongyliasis
Mebendazole may be confused with metroNIDAZOLE
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
CarBAMazepine: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
Fosphenytoin-Phenytoin: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
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 X: Avoid combination
Nirmatrelvir and Ritonavir: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
Ritonavir: May decrease the serum concentration of Mebendazole. Risk C: Monitor therapy
Mebendazole serum levels may be increased if taken with food. Management: Administer without regard to meals.
The World Health Organization recommends preventative therapy with a benzimidazole, such as mebendazole, in females of reproductive potential who live in areas where the baseline prevalence of soil-transmitted helminth infections is ≥20% (WHO 2017).
Information following first trimester exposure to mebendazole is limited; however, an increased risk of birth defects has not been observed in the available studies (Gyorkos 2019). Most pregnancy outcome information is available from studies using mebendazole during the second or third trimester (Akpan 2018; Gyorkos 2019).
Untreated soil-transmitted helminth infections during pregnancy are associated with adverse maternal outcomes (eg, maternal iron deficiency anemia, low birth weight, neonatal and maternal death).
The World Health Organization (WHO) recommends preventive therapy with a benzimidazole, such as mebendazole, in pregnant women after the first trimester who live in areas where the baseline prevalence of soil-transmitted helminth infections is ≥20% (WHO 2017). The WHO also recommends treatment of soil-transmitted helminthiases (such as hookworm) in pregnant patients after the first trimester (WHO 1996).
Mebendazole is present in breast milk.
Systemic absorption of mebendazole is limited, which also limits potential transfer to breast milk. In one patient, milk concentrations were no longer measurable ~13 hours after a single maternal dose of mebendazole 100 mg orally (Stoukides 1994). Inhibition of lactation was observed following the initiation of mebendazole therapy in one woman ~3 months' postpartum who was exclusively breastfeeding her child (Rao 1983). A transient decrease in milk production was observed in one of 45 women (postpartum age not specified) who participated in a prospective study that evaluated mebendazole and breastfeeding (Karra 2016). Available reports have not noted adverse events in breastfed infants (Karra 2016; Kurzel 1994; Stoukides 1994).
According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. However, mebendazole is generally considered compatible with breastfeeding (WHO 2002).
Periodic hematologic, hepatic, and renal function; check for helminth ova in feces within 3-4 weeks following the initial therapy
Inhibits the formation of helminth microtubules; selectively and irreversibly blocks glucose uptake and other nutrients in susceptible adult intestine-dwelling helminths
Absorption: Oral: Poor; 5% to 10%; increased with food (Dayan 2003)
Distribution: Vd: 1 to 2 L/kg
Protein binding: 90% to 95%
Metabolism: Extensively hepatic
Half-life elimination: 3 to 6 hours
Excretion: Primarily feces (as unchanged drug and primary metabolite); urine (<2%)
Hepatic function impairment: Plasma levels may be increased.
Pediatric: Systemic exposure was higher in children ≤3 years of age as compared to adults after a single oral dose of 500 mg.
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