OTC medications for threadworms are highly effective and well tolerated. Mebendazole and piperazine cure around 90% of infestations. Both drugs can cause a number of adverse events including gastrointestinal side effects and hypersensitivity reactions, although these are rare.
Mebendazole inhibits the formation of microtubules, the intracellular cylinders that maintain the cell’s shape, aid mitosis and contribute to organelle function. Mebendazole binds to the threadworm’s beta-tubulin, a protein in microtubules, at much lower concentrations than to the mammalian version of the polypeptide. Mebendazole also inhibits mitochondrial function and glucose uptake, both of which contribute to its efficacy.
Piperazine acts through a different mechanism. Piperazine, a GABA (gamma-amino-butyric acid) agonist, relaxes the threadworm’s muscles, thereby paralysing the worm. The paralysed worms are too flaccid to reproduce and patients pass the limp worms in their faeces. To aid expulsion, OTC formulations of piperazine include sennosides. Once again, a marked dose difference separates the concentration that paralyses worms and that producing side effects in the host. Piperazine is available as a sachet that parents stir into milk or water, which often makes dosing children easier. Pripsen Powders are the only drug treatment for threadworms which can be given to children under the age of two years old (from 3 months of age).
Five key points are worth remembering when advising on threadworm treatments:
- Many children don’t develop the intense itch that is threadworm’s hallmark, but they can still pass on the infection. Therefore, the entire family might need treatment with either piperazine or mebendazole, whether or not they suffer symptoms.
- Some customers should see their GP before using piperazine or mebendazole. Those with liver or kidney disease, have a history of epilepsy or are breast-feeding, should not take piperazine. Mebendazole is not suitable for children under the age of two years.
- Pregnant women should not take either drug. Rather they should use hygiene measures, which will usually eradicate the infestation in six weeks. You can reassure pregnant women they will not pass the worms to their baby and their baby is unlikely catch the infection during birth.
- Remind customers and their families to take a second dose 14 days after the first. This clears any un-hatched worms. If symptoms don’t resolve after the second dose, the GP should be consulted.
- Recommend a set of hygiene measures
Complete, effective treatment for threadworm
A double-dose treatment
Pripsen Powder (Piperazine Phosphate) is raspberry flavoured and is suitable for children from the age of three months. It can be mixed with water or milk.
Pripsen Mebendazole Tablets are chewable with a pleasant orange taste and can be taken by children over the age of two. The first dose of Pripsen treats the adult threadworms, but some eggs may be left behind, so a second dose is taken two weeks later which breaks the threadworm life cycle.
