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| Clinical data | |
|---|---|
| Trade names | Vermox,[1] Ovex, others |
| Other names | MBZ |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a682315 |
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| Pregnancy category | |
| Routes of administration | By mouth |
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| Pharmacokinetic data | |
| Bioavailability | 2–10% |
| Protein binding | 95% |
| Metabolism | Extensiveliver |
| Eliminationhalf-life | 3–6 hours |
| Excretion | Feces, urine (5–10%) |
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| CompTox Dashboard(EPA) | |
| ECHA InfoCard | 100.046.017 |
| Chemical and physical data | |
| Formula | C16H13N3O3 |
| Molar mass | 295.298 g·mol−1 |
| 3D model (JSmol) | |
| Melting point | 288.5 °C (551.3 °F) |
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Mebendazole (MBZ), sold under the brand nameVermox among others, is amedication used to treat a number ofparasitic worm infestations.[5] This includesascariasis,pinworm infection,hookworm infections,guinea worm infections andhydatid disease, among others.[5] It has been used for treatment ofgiardiasis but is not a preferred agent.[6][7] It is takenby mouth.[5]
Mebendazole is usually well tolerated.[5] Common side effects includeheadache, vomiting, andringing in the ears.[5] If used at large doses it may causebone marrow suppression.[5] It is unclear if it is safe in pregnancy.[5][2] Mebendazole is a broad-spectrumantihelminthic agent of thebenzimidazole type.[5]
Mebendazole came into use in 1971, after it was developed byJanssen Pharmaceutica inBelgium.[8] It is on theWorld Health Organization's List of Essential Medicines.[9] Mebendazole is available as ageneric medication.[10]
Mebendazole is a highly effective, broad-spectrumantihelmintic indicated for the treatment ofnematode infestations, including roundworm, hookworm, whipworm, threadworm (pinworm), and the intestinal form oftrichinosis prior to its spread into the tissues beyond the digestive tract. Other drugs are used to treat worm infections outside the digestive tract, as mebendazole is poorly absorbed into the bloodstream.[11] Mebendazole is used alone in those with mild to moderate infestations. It kills parasites relatively slowly, and in those with very heavy infestations, it can cause some parasites to migrate out of the digestive system, leading to appendicitis, bile duct problems, or intestinal perforation. To avoid this, heavily infested patients may be treated withpiperazine, either before or instead of mebendazole. Piperazine paralyses the parasites, causing them to pass in the feces.[12] It is also used rarely in the treatment ofcystic echinococcosis, also known as hydatid disease. Evidence for effectiveness for this disease, however, is poor.[13]
Mebendazole and other benzimidazole antithelmetics are active against both larval and adult stages of nematodes, and in the cases of roundworm and whipworm, kill the eggs, as well. Paralysis and death of the parasites occurs slowly, and elimination in the feces may require several days.[11]
Mebendazole has been shown to cause ill effects in pregnancy in animal models, and no adequate studies of its effects in human pregnancy have been conducted.[2] Whether it can be passed by breastfeeding is unknown.[14][2]
Mebendazole sometimes causes diarrhea, abdominal pain, and elevated liver enzymes. In rare cases, it has been associated with a dangerously low white blood cell count,low platelet count, and hair loss,[14][15] with a risk ofagranulocytosis in rare cases.
Carbamazepine andphenytoin lower serum levels of mebendazole.Cimetidine does not appreciably raise serum mebendazole (in contrast to the similar drugalbendazole), consistent with its poor systemic absorption.[16][17]
Stevens–Johnson syndrome and the more severetoxic epidermal necrolysis can occur when mebendazole is combined with high doses ofmetronidazole.[18]
Mebendazole works by selectively inhibiting the synthesis ofmicrotubules via binding to thecolchicine binding site ofβ-tubulin, thereby blocking polymerisation oftubulin dimers in intestinal cells of parasites.[19] Disruption of cytoplasmic microtubules leads to blocking the uptake ofglucose and other nutrients, resulting in the gradual immobilization and eventual death of thehelminths.[11]
Poor absorption in the digestive tract makes mebendazole an efficient drug for treating intestinal parasitic infections with limited adverse effects. However mebendazole has an impact on mammalian cells, mostly by inhibiting polymeration oftubulin dimers, thereby disrupting essential microtubule structures such asmitotic spindle.[20] Disassembly of the mitotic spindle then leads toapoptosis mediated via dephosphorylation ofBcl-2 which allows pro-apoptotic proteinBax to dimerize and initiate programmed cell death.[21]
Mebendazole is available as ageneric medication.[10] Mebendazole is distributed in international markets byJohnson and Johnson and a number of generic manufacturers.[22]
In the United States, mebendazole is sometimes sold at about 200 times the price of the same medication in other countries.[23][24][25]
