Two chewables, two calendar days
Advena issues pinworm as a two-tablet card. Day 0 is one Emverm 100 mg chewable. Day 14 is the same chewable again. CDC writes that second dose because the first tablet kills worms, not eggs. Eggs already on skin or linen can hatch after the adults are gone. The later chewable catches that next generation.
- Day 0Emverm 100 mg chewable, one tablet
- Day 14Second 100 mg chewable if the pinworm course repeats
Emverm 100 mg chewable, two tablets, the Advena pinworm two-dose lock, marked September 2026. US mebendazole is brand-only; Vermox is gone and there is no approved generic. Medfinder, citing GoodRx in 2026, lists about $5,258 average retail and about $4,287 with a GoodRx coupon for two 100 mg tablets. Amneal's Emverm Savings Program may drop a commercially insured fill to $5, subject to that program's rules. Coupon sites stay in this caption. Each href is that pharmacy only. Advena does not dispense. Prescription required.
Emverm's own table is thinner than that card. The prescribing information lists one 100 mg tablet once for enterobiasis. A second course is advised only if the patient is not cured three weeks later. No fasting. No purge. The tablet may be chewed, swallowed, or crushed into food. Adults and children two years and older share that schedule.
Amneal's HCP page still tells clinics to prescribe two tablets, because a second course is often needed after the first hatch. CDC, Merck Manual, and most US household plans put that second swallow at two weeks, not twenty-one days. This lock follows the two-week clock so a family can mark a calendar. If a prescriber keeps the PI's three-week 'if not cured' line, the chewable itself does not change.
A US counter will not hand you a 6 mg or 12 mg mebendazole tablet. Those strengths are not on the Emverm NDC. The blister Amneal ships is one 100 mg chewable, NDC 64896-669-30, peach, unscored, 'ap' over '107'. Ordering 'pinworm pills' online still means a prescription. Advena does not fill. Mail [email protected] about the sheet, not about a bottle.
Most of the tablet never becomes a blood level
After 100 mg twice daily for three days, plasma mebendazole stays at or below 0.03 mcg/mL. The primary 2-amine metabolite stays at or below 0.09 mcg/mL. Those are Emverm numbers. They explain why a short gut course feels uneventful and why high-dose tissue work is a different monitoring job.
Impaired liver function, slow metabolism, or blocked biliary flow can raise plasma mebendazole. That is a bench note for anyone already in liver clinic, not a reason to skip a labelled pinworm pair in a healthy child.
Patient counseling on the PI is simple. Take it with or without food. Do not pair it with metronidazole. Chew, swallow, or crush. Store at 68 to 77 F. The blister is one tablet. A pinworm house needs two dates, so the clinic has to write a quantity that matches the card, not a single souvenir chewable.
Emverm is the US product. Vermox is a history line
Medfinder's 2026 prescriber note is blunt. The only commercial mebendazole in the United States is Emverm 100 mg chewable, made by Amneal. Vermox was discontinued around 2011. No FDA-approved generic sits behind it. Niche demand plus a single brand is why a two-tablet pinworm fill can price like a specialty drug.
GoodRx still lists Emverm as brand-only. That is the SERP fact people hit when they type 'order mebendazole chewable'. The dollar pair for two tablets lives in the dose rail on this page, cited from Medfinder's reading of GoodRx in 2026. Do not paste a foreign 100 mg strip into a US cart and call it the same fill. Import packs are not this NDC.
Amneal's Emverm Savings Program can drop a commercially insured fill to a small copay when the patient and the pharmacy qualify. Medicare, Medicaid, and cash patients are usually outside that card. Those people need a prescriber to talk through pyrantel pamoate over the counter, or generic albendazole, before anyone pays brand cash. This sheet does not invent a cheap US mebendazole generic that does not exist.
If the infection is bacterial, not a worm, this chewable is the wrong lock. A fluoroquinolone such as ciprofloxacin is a different labelled problem with a boxed warning of its own.
Metronidazole is a hard avoid. Marrow sits on long courses
Lines Dr. Hofer benches before the card is issued
- Hypersensitivity to mebendazole or an excipient - the only listed contraindication
- Metronidazole together with Emverm - SJS and TEN reported; do not combine
- Convulsions in infants under one year - postmarketing, including with Emverm
- Agranulocytosis and neutropenia - higher dose or longer duration than STH labelling
- Trials (6276 subjects, 39 studies, mixed formulations): anorexia, abdominal pain, diarrhea, flatulence, nausea, vomiting, rash
Postmarketing lists also name anaphylaxis, dizziness, hepatitis, abnormal liver tests, glomerulonephritis, angioedema, urticaria, alopecia, and the severe skin reactions already tied to metronidazole. Those reports mix formulations and durations other than the 100 mg chewable. They still belong on the bench.
Overdose of the high, long kind has produced alopecia, reversible transaminase rises, hepatitis, agranulocytosis, neutropenia, and glomerulonephritis. Accidental extra chewables tend to show gut signs. There is no specific antidote. Blood counts belong on any off-table high-dose plan. They do not belong as theatre around a two-tablet pinworm card in a well child.
Initial US approval for mebendazole was 1974. The chewable you can buy now is Amneal's ANDA product, not a new molecule. Inactive ingredients include microcrystalline cellulose, corn starch, anhydrous lactose, sodium starch glycolate, magnesium stearate, stearic acid, sodium lauryl sulfate, sodium saccharin, and FD&C Yellow No. 6. Flag a dye allergy before the first chew.
Laundry and nails do work the chewable cannot
Viable eggs can leave the gut for about a week after treatment. Eggs already in the room can last about three weeks. That is why one tablet for one child is a classic way a family stays itchy. CDC asks that infected people, caretakers, and the rest of the household take the same two-dose plan together.
Morning shower or stand-up bath beats a long soak that floats eggs onto the waterline. Short nails. Hands washed after toilet and before food. Underwear and night clothes changed daily. Hot wash for bedding after each dose date. CDC does not ask schools to exclude a treated child. The loop lives at home.
Pyrantel pamoate 11 mg/kg once, repeat in two weeks, is the OTC cousin CDC lists beside mebendazole and albendazole 400 mg. It is often the honest cash answer when Emverm is unaffordable and the diagnosis is pinworm. It is weaker on whipworm. Do not swap it in for a mixed soil-transmitted stool without a clinician looking at the species.
The parent-facing walk-through of dates, laundry, and who swallows what is the pinworm briefing. This monograph keeps the labelled lock and the cash problem. Dr. Lena Hofer answers the mailbox below.
Age two is the floor. Pregnancy is a conversation, not a cart click
Safety and effectiveness of the 100 mg chewable are not established under two years. Convulsions have been reported under one year. CDC still tells clinicians to weigh risk and benefit under two. This lock does not invent a toddler dose.
Published human data have not shown a clear link between mebendazole and major birth defects or miscarriage. The studies cannot prove a first-trimester absence of risk. Rat and mouse work at and above about 10 mg/kg produced resorptions and malformations, with maternal toxicity at the high end. Hamsters and rabbits did not show embryotoxicity up to 40 mg/kg in the cited studies.
Untreated soil-transmitted infection in pregnancy can mean iron-deficiency anemia, low birth weight, and, in heavy endemic settings, maternal or neonatal death. WHO has long supported later-pregnancy deworming where the worm burden is the threat. A light US pinworm itch in week eight is not that setting. Hold the chewable and call obstetric care. Hygiene can run while that call happens.
A small amount of mebendazole appears in human milk. Infant effects are not clearly reported. Milk-supply notes are inconsistent. The PI says weigh the benefit of feeding against the mother's need and any theoretical infant risk. Geriatric trials were too thin to split old from young. Issue the same 100 mg tablet if the indication is labelled and the swallow is safe.
Pinworm is the lock. The other four worms still sit on the PI
Emverm is indicated for patients two years and older with gut infection from Enterobius vermicularis, Trichuris trichiura, Ascaris lumbricoides, Ancylostoma duodenale, and Necator americanus. The pinworm lock on this page is two 100 mg chewables. The soil-transmitted trio uses a different count.
| Infection | Labelled Emverm schedule | What the mean trial table showed |
|---|---|---|
| Pinworm (enterobiasis) | 1 tablet once; Advena card repeats day 14 | Mean cure 95% |
| Whipworm (trichuriasis) | 1 tablet morning and evening, 3 days | Mean cure 68%; egg cut 93% |
| Roundworm (ascariasis) | 1 tablet morning and evening, 3 days | Mean cure 98%; egg cut 99% |
| Hookworm (Ancylostoma or Necator) | 1 tablet morning and evening, 3 days | Mean cure 96%; egg cut 99% |
Whipworm is the stubborn line. A 68% mean cure is why nobody should shrink that infection to one casual chewable. Heavy hookworm is also an iron problem. Killing the worm does not refill a ferritin on its own.
Mixed luminal infection can ride the three-day morning-and-evening card. Tissue larvae, hydatid disease, and neurocysticercosis are outside this chewable. Those need a better-absorbed benzimidazole under a specialist, not a bigger Emverm pile. Albendazole is the usual next name, and it is a different prescription.
Tubulin first, then the glucose line fails
Mebendazole is methyl 5-benzoylbenzimidazole-2-carbamate. Formula C16H13N3O3. Molecular weight 295.29. DailyMed calls it a white to slightly yellow powder, less than 0.05% soluble in water. The chewable exists because that powder is meant to sit against the worm in the gut, not to dissolve into a neat plasma peak.
The microbiology section is short. The drug interferes with cellular tubulin formation in the helminth and leaves degenerative changes in the parasite gut. Glucose uptake fails. Digestive and reproductive work stall. The worm stops moving, egg output drops, and it dies. That is starvation on the worm's clock, not a chemical blast in the first hour.
Selectivity is the reason a short luminal course is quiet in the host. Parasite beta-tubulin binds the drug more tightly than mammalian tubulin. Almost none of a standard swallow reaches host marrow or liver. Push the milligram and the days far past the soil-transmitted table, and that margin shrinks. Neutropenia and agranulocytosis in the warnings sit on those longer, higher exposures.
Resistance, if it appears, is expected to come from beta-tubulin changes that weaken binding. Clinical meaning in a US pinworm house is still unclear on the label. A failed household is usually a missed second dose or a dirty linen loop, not a documented tubulin mutant.
Issue the card only after the species and the household are named
A finished Emverm card names the worm, the two dates, and who else in the house swallows on those dates. It also names metronidazole as a drug that stays off the list for those days. If the stool or the tape test still shows eggs after a completed pair, the next move is another look at the diagnosis, not a third chewable invented on a webpage.
Foreign 'mebendazole 500 mg once' packs and veterinary benzimidazoles are not this lock. Neither is a tapeworm. GoodRx and other coupon boards stay in the rail caption. Advena Med does not dispense. A prescriber who can see the child, the pregnancy test, and the other medicines still has to sign the script.