Version May 2024
Note: Dose is expressed as pyrantel base.
Ascariasis (Ascaris lumbricoides) (roundworm) (alternative agent) (off-label use): Oral: 11 mg/kg (maximum: 1 g/dose) as a single dose (Leder 2019a).
Enterobiasis (pinworm): Oral: 11 mg/kg (maximum: 1 g/dose) as a single dose (manufacturer's labeling); repeat dose in 2 weeks to prevent reinfection (CDC 2016; Drugs for Parasitic Infections 2013).
Hookworms (Ancylostoma duodenale and Necator americanus) (off-label use): Oral: 11 mg/kg (maximum: 1 g/dose) once daily for 3 days (Bethony 2006; Drugs for Parasitic Infections 2013; Kappagoda 2011).
Trichostrongylosis (Trichostrongylus spp) (off-label use): Oral: 11 mg/kg (maximum: 1 g/dose) as a single dose (Drugs for Parasitic Infections 2013).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Refer to adult dosing.
(For additional information see "Pyrantel pamoate: Pediatric drug information")
Note: Dose is expressed as pyrantel base.
Ascariasis (Ascaris lumbricoides) (roundworm): Limited data available: Children and Adolescents: Oral: 11 mg/kg once daily for 3 days; maximum dose: 1,000 mg/dose (Red Book [AAP 2018]).
Hookworms (Ancylostoma duodenale and Necator americanus ): Limited data available: Children and Adolescents: Oral: 11 mg/kg once daily for 3 days; maximum dose: 1,000 mg/dose (CDC 2019b; Red Book [AAP 2018]).
Moniliformis: Very limited data available: Children and Adolescents: Oral: 11 mg/kg/dose every 2 weeks for 3 doses (CDC 2013; Counselman 1989; Messina 2011).
Pinworm (Enterobius vermicularis ): Note: It is recommended to treat the entire household to prevent reinfection (Bradley 2019; Red Book [AAP 2018]).
Children and Adolescents: Limited data available in ages <2 years: (CDC 2019a; Red Book [AAP 2018]):
Weight-directed dosing: Oral: 11 mg/kg administered as a single dose; maximum dose: 1,000 mg/dose; repeat dose in 2 weeks to eliminate possible reinfection (CDC 2019a; Red Book [AAP 2018]).
Fixed dosing: Oral: Administer as a single dose; repeat dose in 2 weeks to eliminate possible reinfection (CDC 2019a).
11 to 16 kg: 125 mg.
17 to 28 kg: 250 mg.
29 to 39 kg: 375 mg.
40 to 50 kg: 500 mg.
51 to 62 kg: 625 mg.
63 to 73 kg: 750 mg.
74 to 84 kg: 875 mg.
>84 kg: 1,000 mg.
Trichostrongylosis (Trichostrongylus spp): Limited data available: Children and Adolescents: Oral: 11 mg/kg administered as a single dose; maximum dose: 1,000 mg/dose (Drugs for Parasitic Infections 2013).
Children and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling.
Children and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Central nervous system: Dizziness, headache
Gastrointestinal: Abdominal cramps, diarrhea, nausea, vomiting
Hypersensitivity to pyrantel or any component of the formulation
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Phenylalanine: Some products may contain phenylalanine.
Other warnings/precautions:
• Household contacts: Since pinworm infections are easily spread to others, treat all family members in close contact with the patient.
• Self-medication (OTC use): When used for self-medication, patients should be instructed to contact health care provider if symptoms or pinworm infection persists after treatment or if any worms other than pinworms are present before or after treatment. Patients should not repeat dose unless directed to do so by their health care provider.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suspension, Oral [strength expressed as base]:
Pin-Away: 50 mg/mL (60 mL) [sugar free; contains methylparaben, polysorbate 80, propylene glycol, propylparaben, sodium benzoate]
Reeses Pinworm Medicine: 50 mg/mL (30 mL) [contains saccharin sodium, sodium benzoate]
Yes
Chewable (Pin-X Oral)
720.5 mg (12): $13.44
Suspension (Pin-X Oral)
50 mg/mL (30 mL): $8.61
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral:
JAA Pyral 35: 35 mg [DSC]
Oral: May be administered without regard to meals; may be taken with water, milk, or fruit juice. The use of a laxative is not required prior to, during, or after use.
Suspension: Shake well before use.
Oral: May be taken alone or mixed with milk or juice. May be administered without regard to meals. The use of a laxative is not required prior to, during, or after use.
Suspension: Shake well before use.
Enterobiasis (pinworm): Treatment of pinworms caused by Enterobius vermicularis
Ascariasis (Ascaris lumbricoides) (roundworm); Hookworms (Ancylostoma duodenale and Necator americanus); Trichostrongylosis (Trichostrongylus spp.)
Substrate of CYP2D6 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
There are no known significant interactions.
Pyrantel pamoate has minimal systemic absorption. Systemic absorption would be required in order for pyrantel pamoate to cross the placenta and reach the fetus.
Some products may contain phenylalanine.
Stool for presence of eggs, worms, and occult blood
Causes the release of acetylcholine and inhibits cholinesterase; acts as a depolarizing neuromuscular blocker, paralyzing the helminths
Absorption: Oral: Poor
Metabolism: Partially hepatic
Time to peak, serum: 1 to 3 hours
Excretion: Feces (>50% as unchanged drug); urine (≤7% as unchanged drug and metabolites)
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