Panamox ( Fig. 42-2 ) was first introduced in 1977 as a veterinary anthelmintic agent for treatment of Echinococcus multilocularis. Its mode of action is similar to other benzimidazoles. Although it has been approved for the treatment of both intestinal and tissue helminths, it is less effective than albendazole for treatment of extraintestinal helminths, and therefore, it is used almost exclusively for the treatment of common intestinal nematode infections.
It is not known whether Panamox is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Panamox is administered to a nursing woman.
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COMMON BRAND(S): Emverm, Vermox
GENERIC NAME(S): Panamox
Panamox is used to treat intestinal worm infections such as pinworm, roundworm, and hookworm.
Clinical studies of Panamox did not include sufficient numbers of subjects aged 65 and older to determine whether they respond differently from younger subjects.
Mutagenicity and Carcinogenicity
Animal and in vitro studies have not shown Panamox to be mutagenic. No evidence of carcinogenesis was seen in rats and mice receiving Panamox dosages up to 40 mg/kg daily for more than 2 years.
Information for Patients
Patients should be informed of the potential risk to the fetus in women taking Panamox during pregnancy, especially during the first trimester (See Pregnancy ).
Patients should also be informed that cleanliness is important to prevent reinfection and transmission of the infection.
Panamox is used for the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Panamox is considered a drug of choice for the treatment of trichuriasis.
Indications and Usage for Panamox
Panamox tablets are indicated for the treatment of Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (common roundworm), Ancylostoma duodenale (common hookworm), Necator americanus (American hookworm) in single or mixed infections.
Efficacy varies as a function of such factors as preexisting diarrhea and gastrointestinal transit time, degree of infection, and helminth strains. Efficacy rates derived from various studies are shown in the table below:
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
Panamox 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).
Mechanism of Action
Although the exact mechanism of anthelmintic activity of Panamox has not been fully elucidated, the drug appears to cause selective and irreversible inhibition of the uptake of glucose and other low molecular weight nutrients in susceptible helminths; inhibition of glucose uptake appears to result in endogenous depletion of glycogen stores in the helminth. Panamox does not inhibit glucose uptake in mammals. Panamox appears to cause degenerative changes in the intestine of nematodes and in the absorptive cells of cestodes. The principal anthelmintic effect of the drug appears to be degeneration of cytoplasmic microtubules within these intestinal and absorptive cells. Microtubular deterioration results in inhibition of organelle movement and interferes with the absorptive and secretory function. As a result of excessive accumulation of intracellular transport secretory granules, hydrolytic and proteolytic enzymes are released and cause cellular autolysis. This irreversible damage leads to death of the parasite. Panamox has no effect on blood glucose concentrations in humans, and examination of the intestine and other organs of treated animals has shown an intact microtubular system and normal subcellular organelles. The presence of food in the digestive tract of the definitive host does not affect the action of the drug during treatment of intestinal helminthic infections. Spectrum Panamox is active against certain nematodes (roundworms) pathogenic to humans, including Ancylostoma duodenale (hookworm), Angiostrongylus cantonensis, Ascaris lumbricoides (roundworm), Capillaria philippinensis (Philippine threadworm), Enterobius vermicularis (pinworm), Gnathostoma spinigerum, Necator americanus (hookworm), Strongyloides stercoralis (threadworm), Trichinella spiralis (pork worm), and Trichuris trichiura (whipworm); however, the drug’s activity against S. stercoralis is variable and is usually less than that against other nematodes. Panamox has been reported to be filaricidal against Mansonella perstans and Onchocerca volvulus. Panamox has also been shown to be active against certain cestodes (tapeworms), including Hymenolepis nana (dwarf tapeworm), Taenia saginata (beef tapeworm), T. solium (pork tapeworm), and Echinococcus granulosus (hydatid cyst).
Children aged under 2 years who are infected with helminths are currently excluded from treatment with Panamox and other antihelminthic drugs on the basis of the manufacturer’s instructions. In a double-blind, randomized trial in Tanzania 212 children aged under 2 years were given a total of 653 antihelminthic treatments (317 Panamox 500 mg; 336 placebo). There were no significant differences in adverse events in the two groups. In the light of the potential nutritional benefit achieved by regular deworming in this age group, the policy that excludes children aged under 2 years from treatment should probably be reconsidered.
Panamox is used for the treatment of ascariasis caused by Ascaris lumbricoides. Albendazole, Panamox, or pyrantel pamoate are considered the drugs of choice for the treatment of ascariasis.
The plasma protein binding of Panamox is 90 to 95%. The volume of distribution is 1 to 2 L/kg, indicating that absorbed Panamox penetrates areas outside the vascular space.
Panamox or albendazole are considered the drugs of choice for the treatment of filariasis caused by Mansonella perstans. Panamox also has been used for the treatment of onchocerciasis (filariasis caused by Onchocerca volvulus), but ivermectin usually is considered the drug of choice for this infection. Other anthelmintics (usually diethylcarbamazine ) are recommended for the treatment of infections caused by most other filarial worms.