Emverm (mebendazole)

No dosing information is available for this tab.

Mebendazole is administered orally and may be taken without regard to meals.

Mebendazole 100-mg chewable tablets may be chewed, swallowed whole, or crushed and mixed with food.

Mebendazole 500-mg chewable tablets must be chewed completely before swallowing and should not be swallowed whole. In individuals who have difficulty chewing, the 500-mg tablet should be placed on a spoon and about 2-3 mL of drinking water added onto the tablet using a dosing syringe; within 2 minutes, the tablet should absorb the water and change into a soft, semi-solid mass that can be swallowed.

No dosing information is available for this tab.

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Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

Mebendazole/Metronidazole

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: The exact mechanism is unknown. Both mebendazole and metronidazole have been documented to cause Stevens-Johnson syndrome/toxic epidermal necrolysis. Concurrent use may result in additive or synergistic risk.(1)

CLINICAL EFFECTS: Concurrent use of mebendazole and metronidazole may increase the risk of Stevens-Johnson syndrome/toxic epidermal necrolysis.(1,2)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The Canadian manufacturer of mebendazole states that concurrent use of metronidazole should be avoided.(2) If concurrent use is warranted, monitor patients closely for signs and symptoms of Stevens-Johnson syndrome/toxic epidermal necrolysis. Instruct patients to discontinue therapy and seek medical attention for any peeling skin rash or blisters.

DISCUSSION: In a retrospective review, 46 cases of Stevens-Johnson syndrome/toxic epidermal necrolysis that were reported to the Taiwan Department of Health for the period between February, 1996 and February, 1997 were matched to 2 case controls each. The odds ratio for developing Stevens-Johnson syndrome/toxic epidermal necrolysis was 9.5 among subjects who had used both metronidazole and mebendazole in the preceding 6 weeks. All 46 workers were Filipino. Following a change in practice in the Philippines that stopped routine prescription of anthelmintic drugs to workers going abroad, no new cases were reported.(1)

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

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There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

• Disease of liver

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Rare or Very Rare

• Abnormal hepatic function tests
• Agranulocytosis
• Allergic dermatitis
• Anaphylaxis
• Angioedema
• Drug-induced hepatitis
• Glomerulonephritis
• Hypersensitivity drug reaction
• Neutropenic disorder
• Seizure disorder
• Skin rash
• Stevens-johnson syndrome
• Toxic epidermal necrolysis

More Frequent

• Acute abdominal pain

Less Frequent

• Diarrhea
• Flatulence
• Nausea
• Vomiting

Rare or Very Rare

• Alopecia
• Anorexia
• Dizziness
• Urticaria

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In rat reproduction studies, adverse developmental effects (i.e., skeletal malformations, soft tissue malformations, decreased pup weight, embryolethality) were observed when a single oral dose of mebendazole as low as 10 mg/kg (about 0.2 times the total maximum daily human dosage) was administered during the period of organogenesis. Maternal toxicity was reported at higher dosages.

Published data to date regarding use of mebendazole in pregnant women (e.g., prospective pregnancy registries, case-control retrospective cohort studies, randomized controlled studies) have not indicated a clear association between mebendazole and a potential risk of major birth defects or miscarriage. Overall, these studies did not identify a specific pattern or frequency of major birth defects with mebendazole use. However, these studies cannot definitely establish the absence of any mebendazole-associated risk because of methodological limitations, including recall bias, confounding factors, and, in some cases, small sample size or exclusion of first-trimester mebendazole exposures.

Clinicians should consider that untreated soil-transmitted helminth infections in pregnancy can be associated with adverse outcomes, including maternal iron deficiency anemia, low birthweight, and neonatal and maternal death.

Limited data indicate that mebendazole is distributed into milk in low concentrations following oral administration. Effects of the drug on human milk production and effects on the breast-fed infant are unknown.

The benefits of breast-feeding and the importance of mebendazole to the woman should be considered along with potential adverse effects on the breast-fed child from the drug or from the underlying maternal condition.

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