UNCOVERING PINWORM
IN YOUR PRACTICE

Perianal pruritus is the hallmark symptom of pinworm infection1

  • Perianal and perineal itching are the most common symptoms of pinworm infections. Severe irritation of the anal area can lead to intense scratching and excoriation1
    • The itching is often worse at night when female pinworms are migrating out of the anus to lay eggs
    • Sleep disturbance, restlessness, and irritability are other symptoms attributed to pinworm
  • Pinworm should be suspected in young children with perianal pruritus and restless sleep2

Other, less common symptoms are1,3:

Abdominal pain Dysuria Teeth grinding
Anorexia Enuresis Weight loss


According to the Centers for Disease Control and Prevention (CDC), occasional complications in females include4:

Vulvovaginitis Pelvic granulomas Peritoneal granulomas

Diagnostic approaches

Symptoms of intense anal itching and sleep disturbance are generally strong indications of pinworm infection.

Visual identification of pinworms in the perianal region after the infected person is asleep is one possible way of diagnosing pinworm. The most common diagnostic method is called the “tape test.”3

A tape test diagnosis is made by applying clear adhesive tape to the perianal area, then examining the tape under a microscope for the presence of pinworm eggs. For the highest level of accuracy, this test should be conducted on 3 consecutive mornings.3

Pinworms infest the colon video

Courtesy of Bioresonance Therapy.

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. Meinking TL, Burkhart CN, Burkhart CG. Changing paradigms in parasitic infections: common dermatological helminthic infections and cutaneous myiasis. Clin Dermatol. 2003;21(5):407-416. 2. Kucik CJ, Martin GL, Sortor BV. Common intestinal parasites. Am Fam Physician. 2004;69(5):1161-1168. 3. 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. 4. Enterobiasis. Centers for Disease Control and Prevention website. http://www.cdc.gov/dpdx/enterobiasis/. Updated May 3, 2016. 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.