PINWORM INFECTION
IS EXTREMELY CONTAGIOUS1,2

Eggs can survive on toys, doorknobs, faucets, and furniture for up to 3 weeks1,3

Pinworm eggs are sticky and resilient. They cling to fomites such as toys, doorknobs, faucets, furniture, towels, and bedding for up to 3 weeks. Since pinworm eggs can survive indoors for up to 3 weeks and are easily transmitted to other household members, pinworm infections tend to spread within infected families.1,3

According to the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) Red Book, prevalence can reach up to 50% in families with an infected child.1,3

Household objects that act as fomites for pinworm eggs include1,3:

Pinworm is easily spread to shared surfaces like door knobs.

Highly infective pinworm eggs can survive on fomites for 3 weeks and are easily transmitted through contact with shared objects.1,3


Pinworm transmission to the entire household

Transmission to other members of a household occurs easily when contact is made with contaminated household objects such as bed linens, clothing, carpeting, toys, towels, and toilet seats. Following contact, the sticky eggs are unknowingly ingested via hand to mouth, spreading the infection to another household member. Self-infection or reinfection usually results from perianal scratching and transporting of infective pinworm eggs on the fingertips or under the fingernails to the mouth.1,3


Why breaking the cycle can be difficult

  • One female pinworm can lay up to 10,000 highly infective eggs on the perianal folds of the infected person1
  • While important, personal hygiene and housecleaning alone are unlikely to stop an outbreak4; likewise, drug therapy should accompany appropriate household sterilization
  • Eggs can become airborne, inhaled, and swallowed by other household members5

Advice to caregivers1

  • Infected people should shower in the morning to remove infective pinworm eggs
  • Frequently changing the underclothes, bedclothes, and bedding of an infected person may decrease egg contamination
  • Parents and caregivers should be cautioned not to shake out bed linens, blankets, and towels during an outbreak
  • Specific hygiene measures such as avoiding scratching of the perianal area, practicing good hygiene, and keeping fingernails short may decrease the risk of continued transmission

IMPORTANT SAFETY INFORMATION

Contraindications:

Mebendazole is contraindicated in persons who have shown hypersensitivity to the drug.

Warnings:

There is no evidence that mebendazole, even at high doses, is effective for hydatid disease. There have been rare reports of neutropenia and agranulocytosis when mebendazole was taken for prolonged periods and at dosages substantially above those recommended.

Precautions:

Periodic assessment of organ system functions, including hematopoietic and hepatic, is advisable during prolonged therapy.

Adverse Reactions Include:

Transient symptoms of abdominal pain and diarrhea with expulsion of worms in cases of massive infection; liver function test elevations [AST (SGOT), ALT (SGPT), and GGT]; and on rare occasions hypersensitivity (rash, urticaria and angioedema); rare reports of neutropenia, agranulocytosis (see Warnings above) and hepatitis when mebendazole was taken for prolonged periods and at dosages substantially above those recommended; and very rare cases of convulsions.

Drug Interactions:

Preliminary evidence suggests that cimetidine inhibits mebendazole metabolism and may result in an increase in plasma concentrations of mebendazole.

Pregnancy Category C:

Mebendazole has shown embryotoxic and teratogenic activity in pregnant rats at single oral doses as low as 10 mg/kg (approximately equal to the human dose, based on mg/m2). In view of these findings the use of mebendazole is not recommended in pregnant women.

Nursing Mothers:

It is not known whether mebendazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when mebendazole is administered to a nursing woman.

Pediatric Use:

EMVERM has not been extensively studied in children under two years; therefore, in the treatment of children under two years, the relative benefit/risk should be considered.

Overdosage:

In the event of accidental overdosage, gastrointestinal complaints lasting up to a few hours may occur. Vomiting and purging should be induced. Activated charcoal may be given.

Information for Patients:

  • Patients should be informed of the potential risk to the fetus in women taking mebendazole during pregnancy, especially during the first trimester (see Pregnancy Category C above).

  • Patients should also be informed that cleanliness is important to prevent reinfection and transmission of the infection.

INDICATION

EMVERM (mebendazole) 100 mg chewable tablet is indicated in adults and children over 2 years of age for the treatment of Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (common roundworm), Ancylostoma duodenale (common hookworm), and Necator americanus (American hookworm) in single or mixed infections.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. To report SUSPECTED ADVERSE REACTIONS contact Impax Laboratories, Inc. at 1-877-994-6729.

Please see full Prescribing Information for EMVERM.

References:
1. Committee on Infectious Diseases, American Academy of Pediatrics. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:621-622, 934. 2. Kucik CJ, Martin GL, Sortor, BV. Common intestinal parasites. Am Fam Physician. 2004;69(5):1161-1168. 3. Epidemiology & risk factors. Centers for Disease Control and Prevention website. http://www.cdc.gov/parasites/pinworm/epi.html. Updated January 10, 2013. Accessed March 30, 2017. 4. Maguire JH. Intestinal nematodes (roundworms). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:3199-3207.e2. 5. Biology. Centers for Disease Control and Prevention website. http://www.cdc.gov/parasites/pinworm/biology.html. Reviewed January 10, 2013. Accessed March 30, 2017.

IMPORTANT SAFETY INFORMATION

IMPORTANT SAFETY INFORMATION

Contraindications:

Mebendazole is contraindicated in persons who have shown hypersensitivity to the drug.

Warnings:

There is no evidence that mebendazole, even at high doses, is effective for hydatid disease. There have been rare reports of neutropenia and agranulocytosis when mebendazole was taken for prolonged periods and at dosages substantially above those recommended.

Precautions:

Periodic assessment of organ system functions, including hematopoietic and hepatic, is advisable during prolonged therapy.

Adverse Reactions Include:

Transient symptoms of abdominal pain and diarrhea with expulsion of worms in cases of massive infection; liver function test elevations [AST (SGOT), ALT (SGPT), and GGT]; and on rare occasions hypersensitivity (rash, urticaria and angioedema); rare reports of neutropenia, agranulocytosis (see Warnings above) and hepatitis when mebendazole was taken for prolonged periods and at dosages substantially above those recommended; and very rare cases of convulsions.

Drug Interactions:

Preliminary evidence suggests that cimetidine inhibits mebendazole metabolism and may result in an increase in plasma concentrations of mebendazole.

Pregnancy Category C:

Mebendazole has shown embryotoxic and teratogenic activity in pregnant rats at single oral doses as low as 10 mg/kg (approximately equal to the human dose, based on mg/m2). In view of these findings the use of mebendazole is not recommended in pregnant women.

Nursing Mothers:

It is not known whether mebendazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when mebendazole is administered to a nursing woman.

Pediatric Use:

EMVERM has not been extensively studied in children under two years; therefore, in the treatment of children under two years, the relative benefit/risk should be considered.

Overdosage:

In the event of accidental overdosage, gastrointestinal complaints lasting up to a few hours may occur. Vomiting and purging should be induced. Activated charcoal may be given.

Information for Patients:

  • Patients should be informed of the potential risk to the fetus in women taking mebendazole during pregnancy, especially during the first trimester (See Pregnancy Category C above).

  • Patients should also be informed that cleanliness is important to prevent reinfection and transmission of the infection.

INDICATION

EMVERM (mebendazole) 100 mg chewable tablet is indicated in adults and children over 2 years of age for the treatment of Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (common roundworm), Ancylostoma duodenale (common hookworm), and Necator americanus (American hookworm) in single or mixed infections.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. To report SUSPECTED ADVERSE REACTIONS contact Impax Laboratories, Inc. at 1-877-994-6729.

Please see full Prescribing Information for EMVERM.