Ovex Suspension

For the treatment of gastrointestinal infestations of Enterobius vermicularis (threadworm).

There is no evidence that Ovex is effective in the treatment of cysticercosis.

Official guidelines should be taken into consideration.

For the indication Taeniasis:

Paediatric population / Children and adolescents (≥ 2 to 16 years)

Data on efficacy and safety in children and adolescents ≥ 2 years to 16 years are limited.

Mebendazole should be used only, if there is no therapeutic alternative.

Posology

Adults and children over 2 years: 1 x 5ml (1 dosing cup).

Care should be taken to avoid re-infection and it is strongly recommended that all members of the family are treated at the same time.

It is highly recommended that a second dose is taken after two weeks, if re-infection is suspected.

Children under 2 years of age:

This medicine has not been extensively studied in children below the age of 2 years. Currently available data are described in section 4.4, 4.8 and 5.2, but no recommendations on a posology can be made. Because of the lack of sufficient safety data, this medicine should not be used in children below the age of 1 year (see section 4.4, 4.8 and 5.2).

Method of administration

Oral

Ovex is contraindicated in pregnancy and in patients who have shown hypersensitivity to the active substance or any of the excipients listed in Section 6.1.

Ovex is not recommended in the treatment of children aged under 2 years.

If symptoms do not disappear within a few days, consult your doctor.

A case-control study of a single outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) suggested a possible association with the concomitant use of metronidazole with mebendazole. Although there are no additional data on this potential interaction, concomitant use mebendazole and metronidazole should be avoided.

Convulsions in children, including in infants below one year of age, have been reported very rarely during post-marketing experience with Ovex (see section 4.8). Ovex Suspension has not been extensively studied in children below the age of 2 years. Ovex Suspension should only be given to very young children if their worm infestation interferes significantly with their nutritional status and physical development. Therefore, Ovex Suspension should be used in children aged 1-2 years only if the potential benefit justifies the potential risk. Because of the lack of sufficient safety data, Ovex Suspension should not be used in children below the age of 1 year.

Glomerulonephritis and agranulocytosis have been very rarely reported with dosages substantially above those recommended and with treatment for prolonged periods of time.

As higher doses and longer treatment is recommended in patients with Echinococcosis, careful consideration should be given when treating patients with severe chronic hepatic diseases and/or bone marrow depression. These patients should be closely monitored with hematological, liver and renal function tests.

Consider discontinuing Ovex Suspension if clinically significant laboratory abnormalities are found. Official guidelines should be taken into consideration.

Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltase insufficiency should not take this medicine.

Methyl (E218) and propyl (E216) parahydroxybenzoate may cause allergic reactions which could possibly be delayed.

This medicine contains less than 1 mmol sodium (23 mg) per 5 mL dose, that is to say essentially 'sodium-free'.

This medicine contains 0.819 mg propylene glycol (E1520) in each 5ml dose, which is equivalent to 0.1638 mg/ml.

Concomitant treatment with cimetidine may inhibit the metabolism of mebendazole in the liver, resulting in increased plasma concentrations of the drug.

Concomitant use of mebendazole and metronidazole should be avoided (see Section 4.4).

Pregnancy

Since Ovex is contra-indicated in pregnancy, patients who think they are or may be pregnant should not take this preparation.

Lactation

Limited data from case reports demonstrate that a small amount of mebendazole is present in human milk following oral administration. Therefore, caution should be exercised when Ovex is administered to breast-feeding women.

Fertility

The effect on human fertility has not been evaluated.

Ovex does not affect mental alertness or driving ability.

Throughout this section adverse reactions are reported. Adverse reactions are adverse events that were considered to be reasonably associated with the use of mebendazole based on the comprehensive assessment of the available adverse event information. A causal relationship with mebendazole cannot be reliably established in individual cases. Further, because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

At the recommended dose, Ovex is generally well tolerated. However, patients with high parasitic burdens when treated with Ovex have manifested diarrhoea and abdominal pain.

The safety of mebendazole was evaluated in 6276 subjects who participated in 39 clinical trials for the treatment of single or mixed parasitic infestations of the gastrointestinal tract. In these 39 clinical trials, no adverse drug reactions (ADRs) occurred in ≥ 1% of mebendazole-treated subjects.

ADRs identified from clinical trials and post-marketing experience with mebendazole are included in Table 1. The displayed frequency categories use the following convention:

Very common (≥ 1/10); Common (≥ 1/100 and < 1/10); Uncommon (≥ 1/1000 and < 1/100); Rare (≥ 1/10,000 and < 1/1000); Very rare (< 1/10,000); Not known (cannot be estimated from the available data).

^a ADR frequency data derived from Clinical Trials or Epidemiological Studies

^b Adverse reactions reported during post-marketing surveillance

^c Observed in higher and prolonged doses

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

In patients treated at dosages substantially higher than recommended or for prolonged periods of time, the following adverse reactions have been reported rarely: alopecia, reversible liver function disturbances, hepatitis, agranulocytosis, neutropenia and glomerulonephritis. With the exception of agranulocytosis and glomerulonephritis, these also have been reported in patients who were treated with mebendazole at standard dosages (see Section 4.8).

Symptoms

In the event of accidental overdosage, abdominal cramps, nausea, vomiting and diarrhoea may occur.

Management

There is no specific antidote. Activated charcoal may be given if considered appropriate.

Pharmacotherapeutic classification: Anthelmintic for oral administration, benzimidazole derivatives

ATC code: P02CA01

In vitro and in vivo work suggests that mebendazole blocks the uptake of glucose by adult and larval forms of helminths, in a selective and irreversible manner. Inhibition of glucose uptake appears to lead to endogenous depletion of glycogen stores within the helminth. Lack of glycogen leads to decreased formation of ATP and ultrastructural changes in the cells.

There is no evidence that Ovex is effective in the treatment of cysticercosis.

Paediatric population:

Limited data of the mebendazole concentrations in plasma are available in children and adolescents 1 to 16 years of age. These data do not indicate substantially higher systemic exposure to mebendazole in subjects 3 to 16 years of age compared to adults.

In subjects 1 to <3 years of age, systemic exposure is higher than in adults due to higher mg/kg dose relative to adults.

Absorption

Following oral administration, approximately 20% of the dose reaches the systemic circulation, due to incomplete absorption and to extensive pre-systemic metabolism (first-pass effect). Maximum plasma concentrations are generally seen 2 to 4 hours after administration. Dosing with a high fat meal leads to a modest increase in the bioavailability of mebendazole.

Distribution

The plasma protein binding of mebendazole is 90 to 95%. The volume of distribution is 1 to 2 L/kg, indicating that mebendazole penetrates areas outside the vascular space. This is supported by data in patients on chronic mebendazole therapy (e.g., 40 mg/kg/day for 3-21 months) that show drug levels in tissue.

Biotransformation

Orally administered mebendazole is extensively metabolized primarily by the liver. Plasma concentrations of its major metabolites (amino and hydroxylated amino forms of mebendazole) are substantially higher than those of mebendazole. Impaired hepatic function, impaired metabolism, or impaired biliary elimination may lead to higher plasma levels of mebendazole.

Elimination

Mebendazole, the conjugated forms of mebendazole, and its metabolites likely undergo some degree of enterohepatic recirculation and are excreted in the urine and bile. The apparent elimination half-life after an oral dose ranges from 3 to 6 hours in most patients.

Steady-state Pharmacokinetics

During chronic dosing (e.g., 40 mg/kg/day for 3-21 months), plasma concentrations of mebendazole and its major metabolites increase, resulting in approximately 3-fold higher exposure at steady-state compared to single dosing.

Acute oral toxicity of mebendazole in a number of species is low with a large margin of safety. Chronic oral toxicity studies in rats at 40 mg/kg/day and above, showed altered liver weights with some slight centrilobular swelling and hepatocellular vacuolation, and altered testicular weights with some tubular degeneration, desquamation and marked inhibition of spermatogenic activity.

In genotoxicity studies mebendazole was aneugenic in mammalian somatic cells above a threshold plasma concentration of 115 ng/mL, but had no mutagenic or clastogenic activity. In limited long term studies in mice and rats no carcinogenic effects were seen.

Mebendazole has shown embryotoxic and teratogenic activity in pregnant rats and mice at oral doses of 10 mg/kg/day and above and in rats at a single dose of 10 mg/kg, approximately equivalent to the human dose of 100 mg on a body surface area (mg/m²) basis.

Sucrose

Microcrystalline cellulose and carmellose sodium

Methylcellulose 15 mPa.s

Methylparahydroxybenzoate (E218)

Propylparahydroxybenzoate (E216)

Sodium laurilsulfate

Banana flavour (containing propylene glycol (E1520))

Citric acid, monohydrate

Purified water

Not applicable.

3 years.

This medicinal product does not require any special storage conditions.

Amber glass flask containing 30 ml suspension, with either:

• Pilfer-proof screw cap. Cork insert in cap is coated on both sides with polyvinylchloride

or

• Child-resistant polypropylene screw cap, lined inside with a LDPE insert.

A 5ml natural polypropylene (food-grade) dosing cup is also provided, graduated for 2.5 ml and 5 ml.

Shake well before use.

No special requirements for disposal.

Any unused product or waste material should be disposed of in accordance with local requirements.