Meben - Clinical Pharmacology
Following administration of 100 mg twice daily for three consecutive days, plasma levels of Meben and its primary metabolite, the 2-amine, do not exceed 0.03 mcg/mL and 0.09 mcg/mL, respectively. All metabolites are devoid of anthelmintic activity. In man, approximately 2% of administered Meben is excreted in urine and the remainder in the feces as unchanged drug or a primary metabolite.
The following adverse reactions have been identified in adult and pediatric patients postmarketing with Meben formulations and dosages other than the VERMOX ™ 100 mg chewable tablet. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Table 3: Adverse Reactions Identified During Postmarketing Experience with Meben*
Read the entire FDA prescribing information for Vermox (Meben)
How much should I take?
A doctor or pharmacist will tell you how much you should take depending on the type of worms you have.
Always follow the instructions that come with your medicine.
If you have threadworms (also called pinworms) you will usually take a single dose. If you live with anyone else, they will need to be treated at the same time because threadworms can spread easily.
A doctor or pharmacist may suggest you repeat the dose after 2 weeks to prevent you from getting them again. This is because the medicine kills the worms but not their eggs.
For other worms such as whipworm, roundworm and hookworm, follow a doctors’ instructions on how to take Meben. Usually you need to take a dose 2 times a day for 3 days.
Case 1. Acute liver injury due to Meben.
A 52 year old Belgian man was treated with Meben (100 mg twice daily) for 3 days for suspected ascariasis. Fourteen days later the course was repeated, but within 2 days of restarting Meben he developed fever (39 o C), diarrhea, poor appetite and fatigue. Because of the fever, he was given a 5 day course of cefuroxime, but remained febrile and symptomatic and was then found to have elevations in serum aminotransferase levels, with normal serum bilirubin and alkaline phosphatase (Table). He had eosinophilia (18%: absolute count 2,286/μL). Tests for hepatitis A, B and C were negative. He had low levels of antinuclear antibody (ANA: 1:40) and smooth muscle antibody (SMA: 1:160), but total globulin levels were normal. Ultrasound of the abdomen was negative. Stools were negative for ova and parasites. A liver biopsy showed multiple granulomas with multinucleate cells and active inflammation. There were no ova or helminths visualized and special stains for mycobacteria were negative. He improved rapidly without further therapy and 3 months later serum enzymes were normal.
There have been liver function test elevations and rare reports of hepatitis when Meben was taken for prolonged periods and at dosages substantially above those recommended.
Toxocariasis (Visceral Larva Migrans)
For the treatment of toxocariasis (visceral larva migrans) caused by dog and cat roundworms, some clinicians recommend that adults and pediatric patients receive Meben in a dosage of 100-200 mg twice daily for 5 days. However, optimum duration of therapy is not known and some clinicians recommend that treatment be continued for up to 20 days. A dosage of 1 g 3 times daily (50 mg/kg daily) for 21 days reportedly was curative in a least one patient with this infection.
8. Cautions with other medicines
Some medicines and Meben interfere with each other.
Check with a pharmacist or doctor if you're taking:
- metronidazole – a medicine usually used for bacterial or protozoan infections
- cimetidine – usually used for excess stomach acid
All benzimidazoles can cause mild and reversible rises in transaminases, but even in high doses withdrawal is justified in only a few patients.
Granulomatous hepatitis with eosinophilia has been attributed with Meben.
A 52-year-old man with ascariasis took two 3-day cycles of Meben 100 mg bd with a 2-week interval. Within 48 hours of the second course he developed fever (39°C), diarrhea, anorexia, and prostration. Ten days later he had tender hepatomegaly. His liver function tests were abnormal (aspartate transaminase 466 IU/1, alanine transaminase 458 IU/1). The serum alkaline phosphatase and bilirubin were normal and the gamma-glutamyl transferase mildly raised. The white blood cell count was 12.7 x 109/1 with 18% eosi-nophils.
Coagulation was normal. Tests for Hepatitis A, B, and C, cytomegalovirus, and Epstein-Barr virus were all negative. Serum ACE was not raised. Antimitochondrial antibodies were negative but anti-nuclear antibodies and antibodies against smooth muscle were positive. Extensive tests to exclude other causes of granulomatous hepatitis were all negative. A liver biopsy showed multiple granulomata consisting of epithelioid cells, multinucleated giant cells, plasma cells, and lymphocytes.
There was slight fibrosis around the granulomata. There was no evidence of cholestasis. No helminthic ova were found. Ziehl-Nielsen and periodic acid Schiff stains were both negative. After 2 days the fever had subsided without treatment and he felt better. The serum transaminases returned to normal over the next 10 weeks and the eosinophilia disappeared.
At usual recommended dosages (i.e., 100-200 mg daily), Meben appears to cause minimal adverse effects. Adverse effects appear to occur more frequently when higher dosages (e.g., those used in the treatment of extraintestinal infections such as hydatid disease) are used, and may be related to effects resulting from drug-induced killing of the parasites in some cases. Transient diarrhea and abdominal pain have occurred occasionally during Meben treatment, but usually have been associated with massive infections and expulsion of the helminths. Nausea, vomiting, headache, tinnitus, numbness, and dizziness also have been reported occasionally during Meben therapy. Fever has occurred in some patients, particularly in those receiving high-dose therapy for extraintestinal infections. Myelosuppression manifested as neutropenia (including agranulocytosis) and/or thrombocytopenia also has been reported in patients receiving high-dose (e.g., 30-50 mg/kg daily) Meben therapy for extraintestinal infections; while the myelosuppression usually was reversible following discontinuance of the drug, death has occurred rarely. Other adverse effects reported rarely in patients receiving Meben include alopecia, rash, pruritus, urticaria, angioedema, flushing, hiccups, cough, weakness,drowsiness, chills, hypotension, seizures, transient abnormalities in liver function tests (e.g., increased serum concentrations of aminotransferases, alkaline phosphatase, and/or bilirubin), increased BUN, decreased hemoglobin concentration and/or hematocrit, leukopenia, thrombocytopenia, eosinophilia, hematuria, and cylindruria.Migration of roundworms through the mouth and nose also has been reported.
Some side effects can be serious. If you experience any of these symptoms call your doctor immediately or get emergency medical treatment:
- shortness of breath
- difficulty breathing or swallowing
- fever, sore throat, chills, or other signs of infection
Meben may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What if I take too much?
Taking an extra dose of Meben by accident is unlikely to cause any harm.
However, you may get side effects such as:
- stomach cramps
- feeling or being sick (nausea or vomiting)
Speak to a doctor if you’re worried, have side effects or you take more than 1 dose.
Meben Oral Tablets, chewable 100 mg Meben Tablets, Copley Vermox®, Janssen AHFS DRUG INFORMATION® (2004)
Meben interferes with cellular tubulin formation in the helminth and causes ultrastructural degenerative changes in its intestine. As a result, its glucose uptake and the digestive and reproductive functions are disrupted, leading to immobilization, inhibition of egg production and death of the helminth.
Meben, a benzimidazole, is poorly absorbed from the gut, although it dependably enters cyst fluid; it is therefore most useful for treating intestinal infections and cyst-forming infestations. It is essentially an antihelminthic drug, being effective against hookworm, ascariasis, enterobiasis, and trichuriasis. Meben is effective against enteric Strongyloides but since it is not absorbed it is ineffective against tissue forms. However, it is also effective against Giardia lamblia, while Trichomonas vaginalis is susceptible in vitro. Meben does not interfere with the normal intestinal flora.
Meben has been assessed in a range of doses and durations of treatment. The most usual dose is 100 mg bd for 3 days; absorption is minimal, but there is considerable variation in plasma concentrations; the half-life is 2-9 hours. Much higher doses, up to 60 mg/ kg/day, have been used in inoperable cases of cystic echinococcosis infestation, and then unwanted effects are more common.
Flubendazole is an analogue of Meben used in intestinal helminthiasis and hydatid disease. In trials of two-dose oral treatment for intestinal helminthiasis, reactions were mild and uncommon. They consisted of nausea, abdominal pain, dyspepsia, and sleepiness. Subsequent field experience has not suggested that flubendazole differs appreciably from other members of the class as regards adverse effects.
How can i get Meben online over the counter?
You can buy Meben OTC in online drugstore with low cost.
What if I forget to take it?
If you are taking Meben 2 times a day and you have missed a dose, take it as soon as you remember. However, if you remember more than 4 hours after your dose was due, skip the missed dose and just take your next dose as normal.
Do not take a double dose to make up for a forgotten one.
The use of albendazole and Meben in patients with hydatidosis has been evaluated in 448 patients with Echinococcus granulosis hydatid cysts who received continuous treatment with albendazole 10-12 mg/kg/day for 3-6 months daily orally in a total dose of (323 patients) twice or Meben 50 mg/kg/day. At the end of treatment, 82% of the cysts treated with albendazole and 56% of the cysts treated with Meben showed degenerative changes. During long-term follow-up 25% of these cysts showed relapse, which took place within 2 years in 78% of cases. Further treatment with albendazole induced degenerative changes in over 90% of the relapsed cysts, without induction of more frequent or more severe adverse effects, as observed during the first treatment period. Adverse effects during the first treatment period consisted of raised transaminases with albendazole (67 of 323 patients) and Meben (16 of 125 patients), and abdominal pain in 12 and 11% respectively. With both drugs, occasional patients experienced headache, abdominal distension, vertigo, urticaria, jaundice, thrombocytopenia, fever, or dyspepsia, but most of these are known manifestations of echinococcus infection. Six of 323 patients taking albendazole withdrew because of adverse effects compared with eight of 125 patients taking Meben. It appears that albendazole is more effective than Meben in the treatment of hydatid cysts caused by E. granulosis and that both the intensity and the frequency of the usually mild adverse effects are comparable.
In 78 patients with hydatid disease there was a low recurrence rate of hydatid disease (below 3%) after a postoperative prophylactic course of Meben 20 mg/kg/day in three divided doses for 3 months. The only adverse effect of Meben was excessive loss of hair in two women. The unusual low recurrence rate of hydatid disease after treatment with Meben in this study was subsequently questioned and attributed to meticulously careful surgical procedures, with avoidance of spillage of hydatid fluid and complete removal of parasitic components.
Meben Tabs USP 100 mg 12 Chewable Tabs Box Text
NDC 0093- 9107 -29
Meben Tablets, USP 100 mg
Each tablet contains: Meben, USP 100 mg USUAL DOSAGE: See package insert for dosage information. Store at 20° to 25°C (68° to 77°F) . KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.
Meben is a benzimidazole carbamate with a broad range of anthelmintic activity. 1,2,64,65 It is active against the larvae and adults of E. vermicularis, A. lumbricoides, T. trichiura, N. americanus and A. duodenale. It is ovicidal for Ascaris and Trichuris spp. It is less effective than thiabendazole against S. stercoralis. Meben has been used at high doses and for long periods in the treatment of C. philippinensis. It can also be used for infections caused by Angiostrongylus cantonensis, Angiostrongylus costaricensis, Toxocara canis and Trichostrongylus spp. The drug has activity against adult Trichinella spiralis, with some activity against larval forms, and it is currently recommended in the treatment of trichinosis.
Meben is also effective in the treatment of certain types of filariasis; it is considered the drug of choice against Mansonella perstans (diethylcarbamazine is ineffective) and has been shown to have efficacy against L. loa, O. volvulus and Dracunculus medinensis infections. The drug has activity against T. saginata, T. solium and Hymenolepis nana, although praziquantel is more effective. Although Meben does not eradicate echinococcal infection, the drug prevents progression of existing cysts and the development of new cysts when administered in high dose for a prolonged period. Meben has largely been replaced by albendazole for echinococcosis.
Meben acts by binding parasite tubulin, thus blocking microtubule assembly and interfering with glucose absorption. Susceptible helminths become paralyzed and depleted of energy stores, but death and clearance of the worms from the gastrointestinal tract can take days. Meben, formulated as 100 mg tablets, has low water solubility and is poorly absorbed. It is 95% protein-bound in plasma and undergoes rapid and extensive first-pass metabolism in the liver. Thus, systemic bioavailability is low, accounting not only for its poor tissue levels and relative lack of usefulness in extraintestinal infections, but also for its low rate of side effects.
Abdominal pain and diarrhea may occur after Meben administration. The drug also has been reported to prompt the migration of adult Ascaris spp. into the mouth and nose. At high doses, reversible bone marrow suppression with neutropenia, alopecia, allergic skin reactions, hepatitis, vertigo and oligospermia occur rarely.