c. Piperazine Citrate (Antepar) Syrup/Tablets. Piperazine citrate is used in
the treatment of Ascaris lumbricoides (roundworm) and Enterobius vermicularis
(pinworm). The drug produces a paralysis of the ascaris muscle with the resultant
expulsion of the worm (while alive) through intestinal peristalsis one to three days after
the initial treatment. The drug is relatively nontoxic to humans and usually produces no
side effects if administered in anthelmintic doses. The ingestion of unusually large
amounts of the drug may result in nausea, vomiting, diarrhea, abdominal pain,
headaches, tumors, and blurring of vision. Excessively prolonged or repeated treatment
should be avoided. The drug acts to paralyze the worms, and they are expelled (while
alive) one to three days after the initial treatment. The safety of this drug, in regard to
use during pregnancy, has not been established.
d. Thiabendazole (Mintezol). Thiabendazole is a wide spectrum anthelmintic.
It is the drug of choice in the treatment of Strongyloides stercoralis, (threadworm),
Ascaris lumbricoides (roundworm), Necator americanus (New World hookworm),
Ancylostoma duodenale (Old World hookworm), and Trichuris trichiura (whipworm)
infestations. The mode of action of this drug is not fully understood at this time, but
experimental studies have shown that the presence of this drug inhibits the normal
development of eggs. As in the case of other drugs, the use of this agent may cause
some adverse reactions such as nausea, vomiting, dizziness, and anorexia. In some
cases, the use of thiabendazole has caused erythema multiform, which can be fatal to
children. Thiabendazole should be used with caution in patients with hepatic or renal
dysfunction. Patients should be advised against performing tasks requiring mental
and/or physical alertness on days when the drug is taken. Also, there is some
indication that prolonged use of this drug may stimulate the migration of roundworms.
The tablets should be chewed before they are swallowed. The safety of thiabendazole
has not been established for pregnant women and women who are breast-feeding.
e. Pyrvinium Pamoate (Povan) Tablets/Oral Suspension. Pyrvinium
pamoate is the salt of a dye. Pyrvinium pamoate is used as an alternative drug in the
treatment of Enterobius vermicularis (pinworm) infestations. This drug is not
appreciably absorbed from the gastrointestinal tract.
(1) Pinworm infection can easily pass from person to person by the transfer
of eggs through direct contact, the handling of contaminated objects, and the breathing
in of airborne eggs. Therefore, if an infection is detected in a family member or
institutionalized group, treatment of all members should be considered for complete
(2) To avoid undue concern and to help avoid accidental staining, patients
and parents should be advised of the staining properties of pyrvinium. Tablets should
be swallowed whole to avoid staining of teeth. If the suspension is spilled, it will stain
most materials. The agent will also color the stool a bright red, which is not harmful to
the patient. If emesis (vomiting) occurs, the vomitus will probably be colored red and
will stain most materials.