Vermox generic: mebendazole and the conditions on getting it

Whether a generic can be obtained, and what the price depends on

Getting mebendazole means following local regulations and consulting a pharmacist or a healthcare provider about what those regulations allow. The medicine is labeled mebendazole and marked Rx, a prescription. It is not a controlled medication.

Whether a generic can be obtained depends on two supply conditions of that one path. In one, Vermox is an available brand, generics are available, and the legal status is prescription only. In many countries it is available only by prescription. In some places, low-dose mebendazole may be available over the counter. That over-the-counter low dose stays inside the same condition as the prescription-only status, and it does not become the rule for every place. “Generics available” does not name a maker, a pack, or a separate tablet. The prescriber and the licensed pharmacy are who confirm what can be dispensed.

The same path also carries this supply condition: no lower-cost generic is available, availability has been discontinued, and the brand name Vermox is no longer available. It is a prescription medication in the United States and in many other countries. Under that condition there is no lower-cost generic to price, and the Vermox brand is not a current product to ask for.

The price follows whichever supply condition is the local one. Where a generic is sold, the price depends on that local sale. Where no lower-cost generic is sold and the brand is no longer available, there is no generic price under the Vermox name. Neither condition includes a dollar amount, a fee, or a day the medicine arrives.

Both conditions sit on one obtain path. A healthcare provider diagnoses the infection, and a licensed pharmacy dispenses the prescription.

A doctor can prescribe other medications in place of Vermox. If a substitute is needed, ask that doctor.

Which worm infections it is used for

Roundworm and whipworm are the two infections named either way. Roundworm is Ascaris lumbricoides. Whipworm is Trichuris trichiura. The everyday name and the Latin name are the same worm, so a lab line that uses the Latin name is not a second infection. That pair is the shared use.

A wider list and a narrower list both belong to that use. The wider list is intestinal worm infections. It includes pinworm, Enterobius vermicularis, together with roundworm and whipworm, and it adds hookworm. Hookworm on this wider list is either Ancylostoma duodenale or Necator americanus, so a result that names either species is still hookworm. Pinworm and hookworm belong to this wider use of the same medicine.

The narrower list is stomach infections due to roundworm and whipworm. The medicine is only used for infections in the stomach due to those worms. It can work well for stomach infections caused by certain worms. That is not a promise that every worm infection clears. Pinworm and hookworm are outside this narrower list. The boundary is the stomach, and the worms inside it are roundworm and whipworm.

How it acts on the worms and what the body does with it

It kills adult helminths that live in the intestine. Helminth means worm. How those adult worms die is one part of the fact. What the body does with the drug after a dose is the other part.

How it kills the adult worms

The medicine keeps the worms from absorbing sugar, also called glucose, so they lose energy and die, then pass out of the body in the stool. It blocks glucose uptake and inhibits the formation of microtubules, the fine inner supports in the cells of susceptible adult worms that live in the intestine.

It begins working immediately after the first dose. It may take up to three days to kill all the adult worms. Itching should start to improve within a few days of completing the full course.

It kills adult worms and may not kill all worm eggs. Dead worms may be seen in the stool, especially during a heavy infection. In many cases the worms are broken down and may not be visible. Seeing them is described as a sign the medication is working.

Where the drug goes and how it leaves

About 2 to 10 percent of a swallowed dose reaches the blood. The peak in blood serum comes at about 2 to 4 hours. About 90 to 95 percent binds to proteins. It spreads at about 1 to 2 liters per kilogram of body weight.

It reaches serum, cyst fluid, the liver, omental fat (the fatty sheet inside the abdomen), and pelvic, pulmonary, and hepatic cysts. Levels are highest in the liver, and relatively high in muscle-encysted larvae of Trichinella spiralis. Those are places the drug goes, not extra infections it is used for. It crosses the placenta.

The liver breaks it down extensively. It leaves mainly in the feces, and about 2 percent leaves in the urine.

Elimination half-life is one fact, the time for the amount in the body to fall by half, with both ranges kept: about 2.5 to 5.5 hours, and 3 to 6 hours.

Who may take it, including children, pregnancy, and breastfeeding

A child, a pregnancy, and breastfeeding are three separate decisions, made before any dose number is treated as a plan. A pediatrician is the clinician before a child takes it. An obstetrician-gynecologist is the clinician before pregnancy or breastfeeding.

Whether a young child may take it

Consult a pediatrician before giving this medicine to a child. A doctor decides for a young child. Two lower ages are the condition of that decision, and they stay together.

One includes adults and children 1 year and older, people ages 1 year and older, and children as young as 1 year of age. The other says children younger than 2 years old should not use it unless a doctor determines otherwise. It is commonly used, and often prescribed, in children over the age of 2, with a healthcare provider guiding use under 2.

Whether it is used in pregnancy

It crosses the placenta. The pregnancy category is C, and safety in pregnancy is not clear. The first-trimester limit is one limit: avoid it, especially in the first trimester, unless clearly needed, and it is generally not recommended during the first trimester unless clearly needed. Use in pregnancy only if the doctor approves. Do not use it if pregnant without talking to an obstetrician-gynecologist first.

Whether it is used while breastfeeding

Do not use it while breastfeeding without talking to an obstetrician-gynecologist first. That clinician assesses the risks and benefits before it is started during nursing. Excretion in breast milk is unknown, safety during breastfeeding has not been fully established, and caution applies. A small amount may pass into breast milk, while significant adverse effects on infants are not expected. Those milk details stay one caution.

What to tell a provider before starting, and what it is not for

Hypersensitivity, a serious allergy to this medicine, is a contraindication. A known allergy means it is not started.

Before Vermox 100 mg, tell the doctor about any history of anemia, a low blood count, liver disease, or intestinal conditions such as Crohn’s disease or ulcerative colitis. When the liver is impaired, systemic exposure may increase, so more of the drug may circulate in the body.

Tell the healthcare provider about all medicines in use, including prescription and over-the-counter medicines, vitamins, and dietary or herbal supplements.

Neutropenia and agranulocytosis are reported with high doses. Neutropenia means too few neutrophils, white cells that respond to infection. Agranulocytosis is a severe lack of those cells. Those high-dose blood effects are part of what is told to the provider before the start.

The medicine is not effective for hydatid disease. Giardiasis, Mansonella perstans filariasis, and visceral larva migrans are outside the infections this medicine is being used for.

How the dose is chosen and how each dose is taken

The provider sets the dose, and it depends on the parasite. The forms that carry amounts are 100 mg tablets and 500 mg chewable tablets. A liquid suspension is also named for children, beside the chewable tablet. Choosing the dose is one decision. It is typically based on the type of infection rather than the child’s weight, and it is also typically adjusted for the child’s age and the type of infection.

The course for roundworm, whipworm, and hookworm

The provider sets the course. Neither schedule is the generic product’s own, and the two are not folded into one.

For whipworm, roundworm, and hookworm together, the schedule is 100 mg twice daily, morning and evening, for 3 consecutive days. Hookworm is only in this schedule.

Where use is limited to roundworm and whipworm, and Vermox is called a single dose, the schedule is 500 mg chewed and swallowed as a single dose, also stated as Vermox 500 mg by mouth as a single dose. That 500 mg dose is for age 1 year and older. Under 1 year, safety and efficacy of that Vermox dose are not established.

The pinworm dose and a later dose

Where pinworm is included, the dose is a single 100 mg dose. A later dose is one further action, because the drug may not kill all the eggs. It may be repeated after 2 and 4 weeks if the infection persists. A second dose is often recommended after two to four weeks so worms that hatch from eggs after the first dose are killed. If cure is not achieved 3 weeks after treatment, a second course is advised.

Whether the tablet is chewed, crushed, or swallowed whole

The 500 mg chewable tablet, including the one for roundworm or whipworm, is chewed completely before swallowing. Tablets are also described as able to be chewed, swallowed whole, or crushed and mixed with food, including a small amount of soft food such as yogurt or applesauce. The Vermox tablet is also described as chewed completely, and not swallowed whole. If chewing is difficult, put about 2 mL to 3 mL of water, about half a teaspoon, on a spoon, place the 500 mg tablet in the water, and within 2 minutes it absorbs the water and becomes a soft mass that can be swallowed.

Food with the dose

No special diet is required, and fasting is not required. The dose can be taken with or without food. A meal that contains some fat can sometimes help absorption. Taking the dose with food might help prevent stomach upset.

Alcohol during the course

Alcohol is not known to have a significant interaction, and it does not interact directly. It can irritate the stomach in a way similar to some side effects. Limit it, and use it in moderation, during treatment. A pharmacist can advise.

A missed dose

If you miss a dose, take it as soon as you remember, unless it is almost time for the next dose. Then skip the missed dose. Do not take two doses at the same time, and do not double up.

Taking too much

Taking too much may increase abdominal discomfort or liver issues. If you suspect an overdose and the symptoms are severe, seek medical attention at the nearest emergency care. Do not drive there. Bring the medicine so the clinicians can see what was taken.

Which medicines must not be combined with it

These medicines are not covered by one rule. A contraindicated pair, a pair to avoid, and a pair to monitor lead to different actions, so each drug is handled on its own terms.

Metronidazole (Flagyl)

Mebendazole increases the toxicity of metronidazole. The risk is serious skin reactions, Stevens-Johnson syndrome or toxic epidermal necrolysis. Do not start the pair on your own. Not taking Vermox and metronidazole together, and avoiding them or using an alternate drug, stays beside the other condition: use together is usually not recommended but may be required in some cases. If both are prescribed, the doctor may change the dose or how often one or both medicines are used.

Phenytoin and fosphenytoin

Phenytoin is contraindicated. It decreases mebendazole levels by increasing metabolism, the liver’s breakdown of the drug, so less mebendazole remains. Fosphenytoin does the same and is also contraindicated. Neither drug is combined with mebendazole.

Deferiprone

Each drug increases the other’s toxicity by pharmacodynamic synergism, their effects adding together. Avoid deferiprone with this medicine, or use an alternate drug. Also avoid other drugs tied to neutropenia or agranulocytosis. If an alternative is not possible, the absolute neutrophil count is monitored more frequently.

Ropeginterferon alfa-2b

Ropeginterferon alfa-2b and this medicine each increase the other’s toxicity. Myelosuppressive drugs can add together, so the bone marrow may make even fewer blood cells. Avoid the combination. If it is still given, monitor for excessive myelosuppression.

Acalabrutinib

With acalabrutinib, either drug increases the other’s toxicity by pharmacodynamic synergism, effects that add. Use caution and monitor. Taking them together may increase the risk of myelosuppressive effects, a heavier load on the marrow’s blood-cell production.

Cimetidine and carbamazepine

Cimetidine and carbamazepine move mebendazole levels in opposite directions. Cimetidine increases those levels by decreasing metabolism. Use caution and monitor. Carbamazepine decreases the levels by increasing metabolism. That effect is minor, and its significance is unknown.

Which effects are named, and which cannot wait

Call a doctor for medical advice about side effects. Side effects may be reported to the FDA at 1-800-FDA-1088.

Effects that are commonly named

Commonly named effects are loss of appetite (anorexia), stomach or abdominal pain, diarrhea, gas, nausea, vomiting, and rash. Stomach pain, nausea, gas, and diarrhea are called usually mild and temporary, and common effects may get better as the body gets used to the medication. Tell the healthcare provider if they continue or worsen. If effects are seen, stop and speak to the doctor again about other intestinal-worm medicines.

Effects that cannot wait

Check with a doctor immediately for black, tarry stools; chills; convulsions; cough or hoarseness; dark urine; fever with or without chills; a general feeling of tiredness or weakness; hives or welts, itching, or skin rash; large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs; light-colored stools; lower back or side pain; nausea and vomiting; painful or difficult urination; pale skin; redness of the skin; sore throat; sores, ulcers, or white spots on the lips or in the mouth; unusual bleeding or bruising; unusual tiredness or weakness; upper right abdominal or stomach pain; and yellow eyes and skin.

Where the incidence is not known, and medical attention may be needed, the signs are blistering, peeling, or loosening of the skin; difficulty with swallowing; a fast heartbeat; joint or muscle pain; red skin lesions, often with a purple center; red, irritated eyes; and tightness in the chest. Stevens-Johnson syndrome and toxic epidermal necrolysis are skin reactions that need a doctor immediately.

Rare but serious effects are also named as allergic reactions or liver enzyme changes, especially with prolonged use.

Other effects whose frequency is not one class

With incidence not known, and among effects that may not need medical attention, are a bloated feeling, a full feeling, hair loss or thinning of the hair, and weight loss. Also named, with frequency not defined, are headache, hematuria (blood in the urine), leukopenia (too few white cells), drowsiness, decreased hemoglobin, agranulocytosis, alopecia with high doses, toxic epidermal necrolysis, Stevens-Johnson syndrome, a rise in AST, ALT, and GGT (hepatitis), neutropenia (sore throat, unusual fatigue), and glomerulonephritis (inflammation of the kidney’s filters).

Dizziness, headache, drowsiness, hair loss, and swelling do not have one frequency. They are named with stomach pain, vomiting, and diarrhea and given no frequency. Dizziness, severe skin reactions, hair loss, and swelling are called less common. Headache, dizziness, drowsiness, rash, and hair loss also appear with frequency not defined.

Which household and hygiene steps go with pinworm

These steps apply when the infection is pinworm, and only for that infection. They cover who else in the home is treated, and the habits that continue with treatment.

Who else in the household is treated

For pinworm, all household members may need treatment at the same time, even with no symptoms of their own. Someone who feels well can still pass the infection back to a person just treated. Treating the household together is how that reinfection is prevented.

Which hygiene steps continue during and after treatment

Wash your hands thoroughly and scrub under the fingernails, especially before eating and after using the toilet. Shower daily, and change underwear and bed linens regularly. Keep the hand, shower, and linen steps going during treatment and after it ends.

What identifies mebendazole besides the Vermox name

The chemical name is Methyl (5-benzoyl-1H-benzimidazol-2-yl)carbamate, and the formula is C16H13N3O3. Those identifiers name the substance when a brand is not the line being read. It is also called an antiparasitic, a medicine used against parasites, and the class code is ATC P02CA01. The FDA approved it in 1974, and the European Medicines Agency has approved it as well. Emverm is another brand name listed beside Vermox for mebendazole, and it is not the generic of Vermox.

How the tablets are stored

Store the tablets in a cool, dry place at room temperature, below 86°F (30°C). Vermox stored below 30°C uses that same ceiling. Keep the original container tightly closed, away from direct sunlight, heat, and moisture, and out of the reach of children and pets. Do not use the tablets after the expiration date.

When unused tablets are discarded after opening

Discard unused Vermox tablets 1 month after the bottle is first opened. When the bottle is first opened, write that Discard After date on the bottle label in the place provided, so the month-later day shows on the bottle.