In: Recent Advances in Anesthetic Management of Large Domestic Animals, Steffey E.P. (Ed.).

International Veterinary Information Service, Ithaca NY (www.ivis.org), Last updated: 12-Nov-2007;

A0317.1107
Panacur Granules (22.2% Fenbendazole) - A Time-Tested Broad-Spectrum
Antiparasitic
A. Lucio-Forster
1
, D. D. Bowman
2
and S. C. Barr
3

1,2
Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853,
USA.
3
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
Introduction
Fenbendazole was first patented in the United States in the 1970s for the treatment of helminth infections in various
animals. Since then, the granular formulation of fenbendazole in the Panacur product also received its own patents. The
benzimidazoles, of which fenbendazole is a member, interact with invertebrate tubulin, lead to the depletion of energy
reserves and inhibit the excretion of waste products from the cells of parasites. Due to its poor solubility, this class of
compounds is not easily formulated to be given parenterally, and thus, most benzimidazoles are formulated for oral
administration. The granular formulation developed for dogs has been one of the most successful benzimidazoles and one
of the few that persists in the world of small animal pharmaceuticals. The only other benzimidazole used routinely in small
animal medicine is the pro-benzimidazole febantel in Drontal Plus. There are currently no other benzimidazoles
specifically registered in the United States for treating the parasites of small animals.
For dogs six weeks of age and older (including pregnant bitches), the Panacur Granules 22.2% product administered at a
dosage of 50 mg/kg PO for three consecutive days, is labeled for the control and removal of ascarids (Toxocara canis and
Toxascaris leonina), hookworms (Ancylostoma caninum and Uncinaria stenocephala), whipworms (Trichuris vulpis), and
tapeworms (Taenia pisiformis). This same formulation is labeled for the treatment of helminths in various zoo animals as
well (lions, tigers, cheetahs, pumas, jaguars, leopards, panthers, grizzly bears, polar bears, and black bears), but it is not
labeled for use in the domestic cat in the United States. Other formulations showing a wide range of safety in many
different animals have been developed for many species including: horses, ruminants, swine, and turkeys.
To date there are few reports of fenbendazole sensitivity in dogs. One such report involved a 1.5 year old Doberman
pinscher undergoing fenbendazole treatment for suspected lungworm infection. The dog developed a bone marrow
hypoplasia after 11 days of a 14 day treatment with fenbendazole (50 mg/kg PO, q 12 hrs, with food) [34]. Discontinuation
of fenbendazole treatment and addition of bactericidal antibiotics and fluid therapy led to complete resolution of clinical
and hematological abnormalities. In addition, an unusual case of thrombo-ischaemic pinnal necrosis associated with
fenbendazole treatment was reported in 2005 by Nuttall et al., [55]: an 11-week old West Highland female terrier receiving
three consecutive 100 mg daily doses of fenbendazole at three weeks of age developed inflammation, exudation and
crusting of both ear tips. The dog developed complete coagulative necrosis of the distal third of both pinnae; the necrotic
tips required surgical removal. The diagnosis of fenbendazole-induced thrombo-ischemic necrosis was based on the dog's
clinical history, clinical findings and histopathology.
The granular product has been approved for Over the Counter (OTC) sales in the form of packets containing measured
volumes of granules (tradename: Panacur-C). The Center for Veterinary Medicine of the FDA approved this usage because
prior use of the product as a prescription-only treatment had not disclosed any concerns relative to hepatotoxicity at the
labeled dosage of 50 mg/kg. Although the product has routinely been used at higher dosages and for longer periods in the
treatment of some of the infections discussed below, it must be emphasized that these are off-label uses of the product
which warrant careful monitoring of animals.
The main focus of this paper is to summarize information available on the use of Panacur granules for the treatment of
canine parasitic infections not listed on the label. As mentioned above, some of these treatment regimens require that the
product be administered at higher dosages or for longer periods of time than those specified on the canine product label for
the control of ascarids, hookworms, whipworms and tapeworms. Also, in some cases, e.g., in the treatment of infections in
puppies, the product has been administered as a suspension rather than as granules, typically using one of the equine or
ruminant formulations. Finally, the authors would like to acknowledge that alternate drug treatments may also exist, and
may have been used, for some of the infections discussed below; a full review and discussion of such treatments is outside
the scope of this paper.
Fenbendazole Efficacy
Nematodes
Fenbendazole has efficacy against a number of nematodes and nematode stages in addition to those that appear on the
label, some of which are discussed below. Prior to the use of injectable ivermectin, fenbendazole was the typical mainstay
in the United States for treating parasitic infections that were out of the ordinary. This is not to say that ivermectin is a
better therapeutic agent than fenbendazole in many of these situations; only that ivermectin is now often chosen as a means
of treating these more unusual parasites or conditions.
Trematodes
Fenbendazole is a deworming agent that has activity against all the major groups of parasitic helminths, while avermectins
have activity only against nematodes and arthropods. Thus, besides nematode infections, fenbendazole has activity against
trematodes and some cestodes. More recently, praziquantel has been employed for treating trematode and cestode
infections, but although this compound has excellent efficacy against most flatworms, it has no activity against nematodes
or arthropods.
Cestodes
Fenbendazole is also cestocidal and a recent survey of intestinal parasites of stray dogs in Madrid, Spain, found it to have
the greatest effect (90 - 100%) against Taenia tapeworm infections (Panacur at a dose of 50 mg/kg q 24 h for 3 days)
when compared to mebendazole (Telmn, Esteve; 22 mg/kg q 24 h for 3 days), and the mixture of febantel-pyrantel-
praziquantel at a dose of 15 - 5 - 5 mg/kg once (Drontal Plus, Bayer) [54]. The Panacur product is labeled specifically
for the treatment of Taenia pisiformis in dogs, because at the labeled use rate of 50 mg/kg, this product does not clear all
dogs of their Dipylidium caninum infections. Fenbendazole is also known to be relatively ineffective against the adults of
Echinococcus granulosus.
Protozoa
Fenbendazole is unique amongst the anthelmintics in that it has activity against protozoa. Benzimidazoles have some of
their effects through the binding of tubulin [41], and since tubulin is a major component of some protozoa, it is not
surprising that benzimidazoles have been shown to be highly active against these pathogens [43]. In fact, tubulin is a major
component of the attachment disk of Giardia, and thus, this protozoan appears to be one of the most susceptible to
treatment with benzimidazoles.
Use of Fenbendazole for the Treatment of Nematode Infections in Dogs
Ascaridida
Treatment for Prevention of Prenatal Infection of Puppies with in utero Acquired Larvae of Toxocara canis
This large common roundworm of the small intestine of dogs and foxes is generally asymptomatic in older dogs with low
worm burdens, but can be characterized unthriftiness, diarrhea and abdominal distension in young pups. Intrauterine
infection of puppies is one way through which dogs become infected with this parasite, and while treatment of adult stages
of this parasite is specified on the label, the treatment of infective-stage larvae is not. The ability of fenbendazole to prevent
intrauterine infection of puppies, however, has been evaluated through the treatment of the bitch before, during, or right
after pregnancy. Studies show that although worm burdens in pups born to treated bitches may be reduced, in some cases
quite significantly, it is probably unwise to use this product for extended periods of time and in high doses in such
situations due to concerns over direct effects of the chemical on puppies.
The use of fenbendazole at 25 mg/kg PO, q 24 h from the 40th day of gestation through 2 days after whelping, was shown
to reduce overall worm burdens in puppies born to treated bitches by 98.4% [26]. Fifteen of the 28 puppies born under such
treatment in this study were found to be completely free of intestinal worms. In a similar study, puppies born to bitches
treated with fenbendazole only during pregnancy (at 50 mg/kg PO, q 24 h from day 40 until parturition), showed only a
64% reduction in the number of Toxocara canis recovered [16]. However, when such treatment was extended for 2 weeks
after parturition, the reduction in the number of worms recovered from the puppies could be increased to 89% [16].
Elevated dosages of fenbendazole for prevention of intrauterine transmission of toxocariasis have also been examined [68].
When high doses of fenbendazole are used (100 mg/kg PO, q 24 h from day 20 to 38 of gestation), the overall reduction of
worm burdens in pups was 92%. Yet, if still a higher dose is used (150 mg/kg), some puppies will die as a result of central
nervous system degeneration attributed to the high dose of the drug [68]. Thus, this product is probably not appropriate for
trying to obtain worm-free puppies by treating them in utero; it is likely wiser to treat puppies after birth as described
below.
Treatment of Neonatal Puppies for the Prevention of Patent Toxocara canis Infections and to Decrease of Worm Burdens
Treating puppies with fenbendazole early in life can have a marked effect on the number of ascarid eggs shed in the feces
of, and the number of adult worms present in, treated dogs. In fact, the treatment of newborn puppies with fenbendazole
(100 mg/kg PO, q 12 h, for 2 - 3 days) was shown to reduce the development of worms acquired from the mother by 91%
to 99% [50]. In a study by Fisher et al., [31], greyhound pups treated on days 5, 6 and 7 of life showed a 94% reduction in
worm burdens. Pups treated with two 3-day fenbendazole treatments with a 3-week interval using a fenbendazole
suspension (50 mg/kg PO) beginning 14 days after whelping were found not to excrete eggs in their feces for two months
after birth [1]. Furthermore, the same study determined that pups (along with bitches) treated at 2 weeks and 5 weeks of age
(50 mg/kg, PO, q 24 h for 3 days) did not shed eggs during the first two months of life [1]. Lloyd and Soulsby [50], were
also able to reduce worm burdens by about 90% by administering a single dose of fenbendazole (40 mg/kg PO) to 4- to 5-
week-old puppies.
Treatment of Neonatal Toxascariasis
The developmental stages of Toxascaris leonina all occur within the mucosa of the canine host and there is neither in utero
nor lactational transmission of larvae of this parasite from the bitch to her puppies. While the Panacur granules product is
labeled only for the treatment of adult Toxascaris leonina in dogs, and has been shown to be 100% efficacious in this
regard, it has also been shown to have high efficacy against the larval stages developing in the mucosae of dogs that have
ingested infective eggs [31]. In this report, treatment of puppies with 50 mg/kg of fenbendazole for 3 consecutive days after
exposure to such eggs led to an 82% reduction in the number of larvae present in the mucosae. Thus, fenbendazole in
addition to being an effective adulticide also seems to have marked activity against newly hatched and developing
Toxascaris leonina larvae.
Enoplida
Treatment of Eucoleus aerophilus
The capillarid of the bronchi of dogs is Eucoleus aerophilus. Infections with this parasite have been treated with a number
of compounds that are benzimidazoles related to fenbendazole for which there are no canine approved formulations in the
United States. Infections have been treated with flubendazole, tetramisole, and albendazole [20,51,58,75]. Although there
have apparently not been any reported attempts to treat these infections with either fenbendazole or with ivermectin, based
on the success of these other benzimidazoles in treating these infections, fenbendazole may be a good candidate for treating
infected animals.
Treatment of Eucoleus boehmi
Nasal capillariosis in dogs is caused by Eucoleus boehmi. This parasite lives in mucosa of the nasal sinuses of dogs and has
been the cause of chronic nasal discharge. Infections have been successfully treated with fenbendazole (50 mg/kg PO, 24 h
for 10 days), so that there were no eggs detected in the feces a month after treatment (King et al., 1990). However, the
infection did recur on examination four months later, and at this time the dog, a female blue tick hound, was treated with
ivermectin (0.2 mg/kg SQ once). Ultimately with these treatments and the concomitant treatments for a bacterial sinusitis,
the animal's condition cleared, but it continued to shed E. boehmi eggs in its feces. Treatment has also been performed
using only ivermectin (0.2 mg/kg SQ once) with good results [29]. With regards to this infection, there does not seem to be
sufficient information to choose one therapy over another at this time.
Treatment of Pearsonema plica
Pearsonema plica is the nematode responsible for urinary capillariosis in dogs. Treatment has commonly utilized
fenbendazole (50 mg/kg PO, q 24 h) from 3 [35] to 10 days [72]. In some cases, fenbendazole does not appear to clear the
infection, and ivermectin (0.2 mg/kg SQ) has been utilized, resulting in the clearance of the parasite based on the
disappearance of eggs from the urine and improvement of clinical signs [46,66]. Based on work with elevated doses of
ivermectin (0.1 to 0.2 mg/kg SQ once) against Trichuris vulpis [2], it is possible that the increased levels of this avermectin
may indeed have efficacy against this urinary canine capillarid, however, it would seem prudent to initiate therapy with a
course of fenbendazole at the approved dose of 50 mg/kg for several days before choosing the alternative.
Treatment of Trichinella spiralis
There have been very few cases where dogs have been identified with acute trichinosis infection, and no reliable
information is available on the current prevalence of this infection in dogs. In the treatment of humans with trichinosis, the
Medical Letter recommends that the person be given steroids for severe symptoms and then be treated with a long course of
mebendazole (200 - 400 mg PO q 8 h for 3 days, then 400 - 500 mg PO q 8 h for 10 days) with the alternative therapy
being albendazole (400 mg PO q 12 h for 8 - 14 days). Experimentally infected dogs have been treated relatively
successfully with albendazole (50 mg/kg PO, q 12 h for a week) starting about a month after the dogs had been infected
[13]. The benzimidazoles all seem to have some activity against Trichinella spiralis, and the choice of one product over
another would be difficult to judge. There are no commercial formulations of mebendazole available for veterinary use in
the United States and albendazole is only available in large-animal formulations. Thus, it would probably be prudent to
begin a dog with a newly discovered trichinosis infection on fenbendazole, and then switch to other products depending on
how well clinical signs are ameliorated.
Spirurida
Treatment of Canine Infections caused by Members of the Genus Physaloptera
Nematodes of the genus Physaloptera, Physaloptera rara and Physaloptera caninum, which persist in various canid, felid
and mustelid reservoir hosts, embed their heads into the stomach and duodenal mucosa of infected dogs. The associated
clinical sign is most typically vomiting. Panacur at 50 mg/kg is often used to treat this infection, but there is only a single
report in the literature of the success of such treatment. Jergens and Greve [40] treated a dog with a Physaloptera infection,
initially revealed by gastrointestinal endoscopy, with fenbendazole (50 mg/kg PO, q 24 h for 3 days). The treatment proved
successful in clearing the infection.
Strongylida
Treating to Prevent the Transmammary Transmission of Ancylostoma caninum Larvae
Infection with this hookworm is usually asymptomatic in adult dogs, but may be associated with severe anemia, bloody
feces and sudden death in pups. Puppies primarily become infected via transmammary transmission of infective larvae. As
in the case of Toxocara canis, fenbendazole treatment of bitches during pregnancy will have an effect on the presence of
hookworms in the pups. It is unclear, however, how safe the product is when used for this purpose. Duwell and Strasser,
1978 [27] showed that daily treatment of the bitch with fenbendazole (50 mg/kg PO, q 24 h from day 45 of pregnancy
through 2 to 2 weeks post-gestation) resulted in 100% clearing of Ancylostoma caninum in the pups. Higher doses (100
mg/kg PO, q 24 h from the 30th day of pregnancy until birth) have also proven capable of clearing the gastrointestinal tract
and tissue stages of this parasite in both pups and bitches, but at these doses, some pups may develop anatomical defects
such as cleft palates [9,67].
Since in the case of Ancylostoma caninum, almost all larval transmission to the puppies occurs through the milk, it is
unclear why there should be a need to initiate treatment at such early stages prior to whelping. It is possible, that treatment
of the bitch just a few days prior to whelping could prevent the larvae from making their way into the puppies in the milk.
It seems there have been no studies that have examined beginning fenbendazole treatment only 1 or 2 days prior to
parturition. It would be interesting to explore the effect of treating the bitch about 2 days before parturition and continuing
treatment for a few to several days after the puppies are born to assess the transmission of larval stages to the pups. This
treatment regimen might be an adequate means of preventing the puppies from being infected without putting them at risk
for any teratological effects of the drug.
Treatment of Angiostrongylus vasorum Infections
Angiostrongylus vasorum is rarely seen in North America, only being reported in dogs from the far-eastern coastal regions
of Canada. The adult worms live in the vasculature of the lung of infected dogs. Although the worms themselves cause
damage to the lung vasculature, the eggs deposited by the female and the hatched larvae cause the majority of the lung
pathology (similar to what occurs with Aelurostrongylus abstrusus infections in cats).
A review of canine angiostrongylosis by Bolt et al., [7] suggests the best treatment for this infection may be levamisole.
However, the authors noted the drug's palatability is poor, the therapeutic safety level in dogs low, and some dogs may
show neurological signs after treatment. Thus, the best alternative therapy, they suggest, is fenbendazole at 20 mg/kg PO
for 2 to 3 weeks or ivermectin at 0.2 mg/kg, though neither treatment may assure complete removal of adult worms and
may only stop larval shedding in the feces for some period of time. Furthermore, they note that post-treatment
complications such as, severe dyspnea and ascites may arise.
There have been several recent case reports in which fenbendazole was the chosen treatment. Brennan et al., [15] reported
on two cases that were successfully treated with fenbendazole (at doses ranging from 20 mg/kg q 24 h up to 100 mg/kg q
24 h for 7 to 21 days) [15] have been reported to be effective in the treatment of Angiostrongylus vasorum. A 17-month-old
female greyhound with right-sided cardiac enlargement and verminous pneumonia was successfully treated with 50 mg/kg
q 24 h for five days. A 23-month-old male Jack Russell terrier with cardiac enlargement and pulmonary changes was
treated with the same dose of fenbendazole PO for 7 days. Baermann fecal examinations two months after treatment were
negative for A. vasorum larvae. Estves et al., [28] reported on treatment of a one-year-old neutered female beagle with
widespread pneumonitis evidenced by radiographic imaging. The animal was shedding numerous A. vasorum larvae in its
feces and was placed on fenbendazole for 15 days (20 mg/kg q 24 h). After two weeks of treatment the dog's condition was
markedly improved. Chapman et al., [18] treated 23 dogs presenting with A. vasorum infections to the Queen Mother
Hospital for Animals North Mymms, Hertfordshire, UK. Three dogs died shortly after admission; these three dogs were
severely dyspneic and two had experienced syncopal episodes. Fortunately, the remaining 20 dogs were successfully
treated using fenbendazole at 50 mg/kg PO, q 24 h, for 5 to 21 days. Four of the dogs had positive fecal samples after the
treatment had resolved clinical signs. In dogs treated with fenbendazole, follow-up radiographs have demonstrated
resolution of the alveolar pattern and development of a mild, hazy interstitial pattern [5]. Whitley et al., [73] published a
report on the treatment of a 14-month-old female golden retriever with a history of conjunctival hemorrhage and
neurological signs determined to be infected with A. vasorum. The dog was placed on fenbendazole (50 mg/kg PO q 24 h)
for 21 days, and two weeks later was reported to be clinically normal. Boag et al., [6] reported on three cases of
hypercalcaemia associated with angiostrongylosis. Hypercalcaemia and respiratory signs both resolved with treatment of
the parasite with fenbendazole at 50 mg/kg q 24h for 15 - 22 days. In 2006, Nicolle et al., [56] reported on a case of
angiostrongylosis in a Yorkshire terrier presenting with dyspnea, coughing, abdominal distension, and mild exercise
intolerance. The case resolved after treatment with fenbendazole (30 mg/kg PO, q 24 h) for 3 weeks. And finally, most
recently, Tebb et al., [69] successfully treated a 2 year old male neutered Cocker Spaniel with a history of soft cough for its
angiostrongylosis with a 10 day course of fenbendazole at 50 mg/kg q 24 h. Two weeks after treatment the dog showed
much clinical improvement, and eight weeks after initial presentation was assessed to be clinically normal. Thus, these
reports provide good evidence that fenbendazole is effective alleviating the symptoms of angiostrongylosis and
discontinuing larval shedding in the feces of treated dogs.
A report on three dogs with intracranial hemorrhage secondary to severe coagulation defects associated with infection with
A. vasorum infection was published by Garosi et al., [33]. The first case was diagnosed postmortem, but the other two dogs
(a four year old male, neutered, cocker spaniel, and a 14 month old, neutered female Staffordshire bull terrier) were treated
with a seven day course of 50 mg/kg fenbendazole PO q 24 h. Both dogs had normal coagulation profiles a week after
treatment; repeat fecal analyses two weeks after treatment were negative for larvae in both cases.
Treatment of Crenosoma vulpis
Crenosoma vulpis is considered mainly a parasite of foxes that on occasion finds its way into dogs through ingestion of
infective-stage larvae in slugs or snails. Infections of the lower respiratory tract with this parasite, [along with
Angiostrongylus vasorum, Oslerus osleri, Filaroides hirthi, Eucoleus aerophila, and Paragonimus kellicotti (and other
species of Paragonimus outside of North America)], are known to cause eosinophilic bronchitis in dogs. Dogs will
typically present with either a productive or a non-productive cough, and if infections is severe, respiratory distress.
Radiographs of the lungs may show bronchial patterns with some interstitial components throughout the parenchyma. As
with Oslerus, Filaroides, and Angiostrongylus, diagnosis can be made through the finding of larvae in the feces.
Crenosoma vulpis infection in dogs has been effectively treated with fenbendazole (50 mg/kg PO, q 24 h) for 3 days [60], 5
days [39], or 14 days [49]. It has been suggested, however, that extending the treatment beyond the 3-day standard
recommendation for fenbendazole offers no benefit [4], yet lower doses of fenbendazole for longer periods of time (20
mg/kg PO, q 24 h, 14 days) have been reported to be effective [52]. In addition, febantel (with praziquantel and pyrantel) in
Drontal Plus given for 7 consecutive days has been used to treat this infection in a dog [19]. It would appear that the most
direct course of therapy would be to treat dogs with the approved intestinal dose of fenbendazole (50 mg/kg PO, q 24 h for
three days) and several weeks later ascertain if further treatment is warranted.
Treatment of Filaroides hirthi Infections
Filaroides hirthi lives in the parenchyma of the lung of infected dogs and may be asymptomatic or lead to pneumonia in
immunosuppressed animals. Fenbendazole has proven to be very effective in treating this infection. Pinckney et al., [61]
treated a 1-year-old Yorkshire terrier with a single oral dose of 0.068 mg of ivermectin followed with fenbendazole (50
mg/kg PO, q 24 h for two weeks). After treatment this dog's feces became negative for the larvae of this parasite, and the
dog improved without any recurrence of signs. Caro-Vadillo et al., [17] recently reported that treatment of a Scottish terrier
with 50 mg/kg of fenbendazole, q 24 h PO for three weeks eliminated the parasite and improved the clinical condition of
the dog.
Rubash [64] reported on the treatment of a Chihuahua presenting with sudden weakness and rapid breathing, found to be
infected with Filaroides hirthi. The dog was treated with fenbendazole (50 mg/kg PO, q 24 h) for 14 days. On Day 1 of
treatment, the dog developed signs of facial swelling and urticaria, so prednisolone was also given during the course of
treatment. On Day 3 of treatment, the coughing worsened and the dog became dyspneic, but treatment with furosemide and
hydrocodone led to improvement over the next 24 hours. Forty days after the initiation of therapy, the dog appeared
healthy, and larvae were not detected in the feces. The dog was last examined 4 months after discharge and found to be
normal. In one other report, Bourdeau and Ehm [10] found that fenbendazole (50 mg/kg PO, q 24 h for 14 days) did not
clear a dog of its infection, but that ivermectin (0.050 mg/kg SQ once) reduced the number of larvae in the feces. This dog
apparently recovered 2 weeks after the ivermectin treatment.
Treatment of Oslerus (Filaroides) osleri Infections
This worm causes nodules in the mucosa of the trachea of dogs, and is usually associated with cough and respiratory
distress in affected animals. Numerous authors have reported on the treatment of Oslerus osleri infections with either
fenbendazole or ivermectin with mixed results [11,37,42,47,48,53,57,65]. Thus, it seems at this time, the physical removal
of the nodules followed by treatment with oxfendazole (10 mg/kg PO, q 24 h, for 4 weeks) may be a better treatment
option. Oxfendazole is available in several preparations from Fort Dodge Animal Health as Benzelmin Equine Paste in a 12
gram syringe, Bovine Dewormer Suspension 22.5%, and Synantic Bovine Dewormer 18.5%. Typically, treatment with the
Synantic Bovine Dewormer at 90 mg/ml is used (approximately 1 ml per 10 kg).
Use of Fenbendazole for Treatment of Trematode Infections in Dogs
Digenea
Treatment of Heterobilharzia americana
Dogs in the southeastern United States that come in contact with water containing cercariae can become infected with the
blood fluke Heterobilharzia americana. The infection can cause chronic hepatitis and thickened bowel walls due to the
host's reaction to eggs shed by the female into the blood stream that become lodged in the tissues. The preferred treatment
for this infection is most likely praziquantel at dosages similar to those used in human schistosomiasis, i.e., around 20
mg/kg q 8 h for 1 day. However, fenbendazole treatment (40 mg/kg PO q 24 h for 10 days) of a dog with a 2-year-old
experimental infection resulted in the dog having no worms present when euthanatized 17 days after treatment [63]. Troy et
al., [71] also reported that fenbendazole will cause clinical improvement in treated animals.
Treatment of Paragonimus kellicotti
The lung fluke, Paragonimus kellicotti, is an uncommon but occasional parasite of dogs in the Eastern and Central United
States. Dogs with Paragonimus kellicotti infections have been successfully treated with fenbendazole (50 mg/kg PO, 24 h
for 14 days; or at 100 mg/kg PO q 24 h for 10 days) [25]. Dogs have also been treated using albendazole (30 mg PO, q 24 h
for 12 days) with good success [70]. Praziquantel (23 mg/kg, q 8 h, for three days) also clears dogs of their infections [14].
It would appear that either therapy is efficacious in clearing dogs of their lung fluke infections. Thus, the choice of either
Panacur or Droncit for therapy may depend on factors such as which product is available at the time of diagnosis.
Treatment of Opisthorchis caninus
Dogs experimentally infected with an intestinal fluke (Opisthorchis caninus) after being fed infected fish were cleared of
their infections by fenbendazole treatment (200 mg/kg PO, q 24 h for three days) [62]. Although treating intestinal flukes
with praziquantel (6 to 40 mg/kg PO once), such as is done with Nanophyetus salmincola [32], would probably be the
preferred method today, fenbendazole would be an alternative therapy.
Use of Fenbendazole for the Treatment of Cestode Infections in Dogs
Cyclophyllidea
Treating Larval Mesocestoides Infections
It is not known how dogs become infected with the larval stage of Mesocestoides. It is thought that a cysticercoid stage
must precede the tetrathyridium stage infectious to the final host, and that perhaps this cysticercoid develops in a
coprophilic insect [12] which may then be ingested by the dog and lead to infection. The larval stage, the tetrathyridium,
which develops in the abdominal cavities of infected dogs, causes severe and significant disease. Treatment often requires a
laparotomy and the washing of the abdominal cavity. The liver and other organs can also become involved. In fact, the
washing of the abdomen may have to be repeated several times. It has been found in these cases the infections with the
larval forms do not respond to praziquantel or albendazole, but repeated treatment with fenbendazole, (100 mg/kg, PO, q
12 h for 28 days), may clear infections [23].
In a case report from Italy, a mixed-breed dog presenting with anorexia, depression, and pain upon abdominal palpation,
was found to have a peritoneal infection caused by an unidentified Mesocestoides species [8]. The dog was initially treated
with fenbendazole at a dose of 50 mg/kg PO, q 24 h for 10 days, and with a single dose of praziquantel at 5 mg/kg. There
was initial improvement, but almost a week after the end of treatment the dog developed abdominal distension and fever.
Bacterial contamination in addition to a few calcarious corpuscles were evident in recovered peritoneal fluid. Antibiotics
were given and a laparotomy and peritoneal lavage was performed with further evidence of peritoneal cestodiasis. During
the following 8 months the dog experienced recurring episodes of bacterial peritonitis and peritoneal cestodiasis that were
treated with fenbendazole at 100 mg/kg q 24 h continuously along with antibiotics. The dog was reportedly alive a year
after presentation and still on continuous fenbendazole. Thus, it is evident that although fenbendazole is the treatment of
choice for peritoneal cestodiasis caused by the larval forms of this parasite, treatment may ameliorate clinical signs and
bring a marked reduction to their number, but it may not clear the infection or prevent recurrence [8].
Use of Fenbendazole for the Treatment of Protozoal Infections in Dogs
Diplomonadida
Treating Canine Giardia Infections
Giardia spp. are flagellates of the small intestine of many animals including dogs. The infection may be asymptomatic or
may lead to chronic diarrhea (especially in young animals). Fenbendazole has been shown to be one of the benzimidazoles
that functions very well as an agent against intestinal giardiasis. It has been shown have high potency in vitro against G.
duodenalis [54]. Furthermore, the treatment of dogs with 50 mg/kg PO, q 24 h fenbendazole for 3 days has been shown to
be highly efficacious in clearing dogs of their Giardia infections both in experimental and clinical cases [3,38,74].
Fenbendazole at 50 mg/kg PO, sid, 7 days, was also able to eliminate cyst shedding in treated dogs [44]. Dryden et al., [24]
recommend the use of fenbendazole (50 mg/kg) or the combination of praziquantel, pyrantel pamoate, and febantel (5, 5,
and 25 mg/kg, respectively) for 3 to 5 days [59] for the treatment of giardiasis in dogs.
Concluding Remarks
Fenbendazole is a broad-spectrum anti-parasiticide that provides significant ability to control various helminth parasites in
dogs and also has the ability to clear dogs of their Giardia infections. This is a product that has been time-tested and found
to be very safe for dogs even when given to sick animals daily at double the usual therapeutic dosage for periods of up to a
month. Few reports of adverse reactions have been published, but careful monitoring of animals is warranted. Out of all the
dogs given fenbendazole since it entered the market, there have been only 230 Adverse Drug Experiences (ADEs) reported
to the FDA. Of these, the top two are vomiting and depression/lethargy (Table 1). It is noteworthy that death is reported in
some 24 dogs (10%), however, it is important to bear in mind FDA cautions relative to ADEs. Most importantly (Table 1):
"For any given (ADE) report, there is no certainty that the reported drug caused the adverse event. The adverse event may
have been related to an underlying disease, using other drugs at the same time, or other non-drug related causes." and
"Accumulated ADE reports should not be used to calculate incidence rates or estimates of drug risk, because there is no
accurate way to determine how many animals were given the drug."
Thus, this product in its granular form (Panacur) still seems to have a place in the veterinarian's pharmacopoeia even
though for specific parasites better therapies may be currently available.
From http://www.fda.gov/cvm/ade_description.htm
1. For any given Adverse Drug Experiences (ADE) report, there is no certainty that the reported drug caused the
adverse event. The adverse event may have been related to an underlying disease, using other drugs at the same time,
or other non-drug related causes. And, this listing does not include information about underlying diseases, other
drugs used at the same time, other non-drug related causes, or the final outcome of the reaction.
2. The accuracy of information regarding the ADE is dependent on the quality of information received from the
veterinarian or animal owner.
3. Accumulated ADE reports should not be used to calculate incidence rates or estimates of drug risk, because there is
no accurate way to determine how many animals were given the drug. For example, if a drug is widely used to treat
Table 1. Top 15 adverse drug experiences in dogs reported to the FDA from 1987 to 2007 using oral
fenbendazole; a total of 230 canine reports were evaluated by the agency [30].
Sign Reacted
Vomiting 122
Depression/lethargy 116
Anorexia 84
Diarrhea, mild 58
Diarrhea 30
Death 24
Dehydration 24
Pain, abdomen 19
Ineffect, ascarids 15
Hyperactivity 12
Weight loss 11
Fever, body 10
Birth defect(s) 9
Convulsion(s) 9
Trembling 8
certain conditions, there may be more ADEs for that drug than another product that is not used as often. This would
not mean that the first drug was more unsafe than the second. The number of reports simply represents the numbers
of ADEs received for a particular drug, by species, and route of administration.
References
1. Abbott EM, Dent CN. Comparison of two different treatment regimens for the control of Toxocara canis infections in
commercial breeding kennels. Canine Pract 1998; 23:6-7.
2. Anderson DL, Roberson EL. Actvity of ivermectin against canine intestinal helminths. Am J Vet Res 1982; 43:1681-
1683.
3. Barr SC, Bowman DD, Heller RL. Efficacy of fenbendazole against giardiasis in dogs. Am J Vet Res 1994; 55:988-990.
4. Bihr T, Conboy GA. . Lungworm (Crenosoma vulpis) infection in dogs on Prince Edward Island. Can Vet J 1999;
40:555-559.
5. Boag AK, Lamb CR, Chapman PS, Boswood A. Radiographic findings in 16 dogs infected with Angiostrongylus
vasorum. Vet Rec 2004; 154:426-430.
6. Boag AK, Murphy KF, Connolly DJ. Hypercalcaemia associated with Angiostrongylus vasorum in three dogs. J Small
Anim Pract 2005; 46:79-84.
7. Bolt G, Monrad J, Koch J, et al., Canine angiostrongylosis: a review. Vet Rec 1994; 135:447-452.
8. Bonfanti U, Bertazzolo W, Pagliaro L, et al., Clinical, cytological and molecular evidence of Mesocestoides sp. infection
in a dog from Italy. J Vet Med A Physiol Pathol Clin Med 2004; 51:435-438.
9. Bosse M, Stoye M. Effect of various benzimidazoles carbamates on somatic larvae of Ancylostoma caninum and
Toxocara canis. II. Pregnant bitches. [Zur Wirkung verschiedener Benzimidazolcarbamate auf somatische Larven von
Ancylostoma caninum Ercolani 1859 (Ancylostomidae) und Toxocara canis Werner 1782 (Anisakidae). II. Untersuchungen
an der graviden Hundin]. Zentralbl Veterinarmed B 1981; 28:265-279.
10. Bourdeau P, Ehm JP. Filaroides sp. infection in dogs. A case report and an update on filaroidosis caused by Filaroides
hirthi Georgi and Anderson 1975 [Cas original de filaroidose due Fialroides sp. chez le chien. Donnes actuelles sur la
filaroidose Filaroides hirthi Georgi et Anderson 1975]. Recl Med Vet 1992; 168:315-321.
11. Bourdoiseau G, Cadore JL, Foumier C, et al., 1994. Canine oslerosis: update on diagnosis and treatment. [L'oslerose du
chien: actualites diagnostiques et therapeutiques]. Parasite 1:369-378.
12. Bowman DD. Georgis' Parasitology for veterinarians 8th edition. Philadelphia: Saunders, 2003.
13. Bowman DD, Darrigrand RA, Frongillo, et al., Treatment of experimentally induced trichinosis in dogs and cats. Am J
Vet Res 1993; 168:314-321.
14. Bowman DD, Frongillo MK, Johnson RC, et al., Evaluation of praziquantel for treatment of experimentally induced
paragonimiasis in dogs and cats. Am J Vet Res 1991; 52:68-71.
15. Brennan SF, McCarthy G, McAllister H, et al., Clinical signs, diagnosis and treatment of three dogs with
angiostrongylosis in Ireland. Irish Vet J 2004; 57:103-109.
16. Burke TM, Roberson EL. Fenbendazole treatment of pregnant bitches to reduce prenatal and lactogenic infections of
Toxocara canis and Ancylostoma caninum in pups. JAVMA 1983; 183:987-990.
17. Caro-Vadillo A, Martinez-Merlo E, Garcia-Real I, et al., Verminous pneumonia due to Filaroides hirthi in a Scottish
terrier in Spain. Vet Rec 2005; 157:586-589.
18. Chapman PS, Boag AK, Guitian J, et al., Angiostrongylus vasorum infection in 23 dogs (1999-2002). J Small Anim
Pract 2004; 45:435-440.
19. Cobb MA, Fisher MA. Crenosoma vulpis infection in a dog. Vet Rec 1992; 130:452.
20. Coman S, Doana V, Milu A. Aspects of the prevalence and treatment of endoparasitic infections in dogs. [Aspecte
privind prevelenta si tratamentul infestatiilor cu endoparaziti la caine]. Rev Romana Med Vet 2000; 10:407-412.
21. Conboy GA. Natural infections with Crenosoma vulpis and Angiostrongylus vasorum in Atlantic Canada and their
treatment with milbemycin oxime. Vet Rec 2004; 155:16-18.
22. Conboy GA, Adams C. Treatment of Crenosoma vulpis infection in two silver foxes (Vulpes vulpes) with ivermectin. J
Zoo Wildlife Med 1995; 26:597-600.
23. Crosbie PR, Boyce WM, Platzer EG, et al., Diagnostic procedures and treatment of eleven dogs with peritoneal
infections caused by Mesocestoides spp. JAVMA 1998; 213:1578-1583.
24. Dryden MW, Payne PA, Ridley RK, et al., Gastrointestinal parasites: The Practice Guide to Accurate Diagnosis and
Treatment. Suppl. Comp: Cont Educ Vet 2006; 28(8A).
25. Dubey JP, Miller TB, Sharma SP. Fenbendazole for treatment of Paragonimus kellicotti infection in dogs. JAVMA
1979; 174:835-837.
26. Duwel D. Toxocariasis in human and veterinary medicine - and how to prevent it. Helminthologica 1983; 20:277-286.
27. Duwel D, Strasser H. Investigatons on the birth of helminth-free pups following treatment of bitches with fenbendazole
[Versuch zur Geburt heminthen-freier Hundwelpen durch Fenbendazol-Behandlung]. Deut Tierarztl Woch 1978; 85:239-
241.
28. Estves I, Tessier D, Dandrieux J, et al., Reversible pulmonary hypertension presenting simultaneously with an atrial
septal defect and angiostrongylosis in a dog. J Small Anim Pract 2004; 45(4):206-209.
29. Evinger JV, Kazacos KR, Cantwell HD. Ivermectin for treatment of nasal capillarisis in a dog. JAVMA 1985; 186:174-
175.
30. FDA 2007. Cumulative Adverse Drug Experience Report - 1987 to 2007 [online]. Available from:
http://www.fda.gov/cvm/Documents/ade_web_rpts_DF.pdf.
31. Fisher MA, Jacobs DE, Hutchinson MJ, et al., Efficacy of fenbendazole and piperazine against developing stages of
Toxocara and Toxascaris in dogs. Vet Rec 1993; 132:473-475.
32. Foreyt WJ, Gorham JR. Evaluation of praziquantel against induced Nanophyetus salmincola infections in coyotes and
dogs. Am J Vet Res 1988; 49:563-565.
33. Garosi LS, Platt SR, McConnell JF, et al., Intracranial haemorrhage associated with Angiostrongylus vasorum infection
in three dogs. J Small Anim Pract 2005; 46:93-99.
34. Gary AT, Kerl ME, Wiedmeyer CE, et al., Bone marrow hypoplasia associated with fenbendazole administration in a
dog. J Am Anim Hosp Assoc 2004; 40:224-229.
35. Gillispie D. Successful treatment of canine Capillaria plica cystitis. Vet Med Small Anim Clin 1983; 78:681-682.
36. Greenlee PG, Noone KE. Pulmonary capillariasis in a dog. JAVMA 1984; 20:983-985.
37. Hamann F, Schuster R. Invasion of the trachea with the nematode Oslerus osleri in a dog. [Befall der Trachea mit dem
Nematoden Oslerus osleri bei einen Hund]. Kleintierpraxis 1995; 40:533-535.
38. Itoh N, Muraoka N, Aoki M, et al., Treatment of canine giardiasis with benzimidazoles. J Japan Vet Med Assoc. 2002;
55:739-743.
39. Jaeger GT, Skancke EM, Hamnes IS, et al., Crenosoma vulpis as a cause of chronic cough in dogs in Norway. [Revens
lungeorm (Crenosoma vulpis) som arsak til hoste hos hund I Norge] Nor Veterinaertidsskr 2005; 117:605-611.
40. Jergens AE, Greve JH. Endoscopy case of the month: chronic vomiting in a dog. Vet Med 1992; 87:872-876.
41. Jimenez-Gonzalez A, Armas-Serra C de, Criado-Fornelio A, et al., Preliminary characterization and interaction of
tubulin from Trichinella spiralis larvae with benzimidazole derivatives. Vet Parasitol 1991; 39:89-99.
42. Jones BR, Clark WT, Collins GH, et al., Filaroides osleri in a dog. N Z Vet J 1977; 25:103-104.
43. Katiyar SK, Gordon VR, McLaughlin GL, et al., Antiprotozoal activities of benzimidazoles and correlations with beta-
tubulin sequence. Antimicrob Agents Chemother 1994; 38:2086-2090.
44. Kim-NamSoo, Chon-SeungKi. The efficacy of albendazole, fenbendazole and metronidazole for treatment of canine
Giardia. J Vet Clinics 2005; 22:239-243.
45. King RR, Greiner EC, Ackerman N, et al., Nasal capillariasis in a dog. JAAHA 1990; 26:381-385.
46. Kirkpatrick CE, Nelson GR. Ivermectin treatment of urinary capillariasis in a dog. JAVMA 1987; 191:701-702.
47. Lamb CR. What is your diagnosis. J Small Anim Pract 1992; 33:358-366.
48. Lappin MR, Prestwood AK. Oslerus osleri: clinical case, attempted transmission, and epidemiology. J Am Anim Hosp
Assoc 1988; 24:153-158.
49. Lalonde R, Carioto L, Villeneuve A. Crenosoma vulpis lung infestation in a dog. [Infestation pulmonaire par
Crenosoma vulpis chez le chien]. Med Vet Que 2005; 35:11-, 42-43.
50. Lloyd S, Soulsby EJL. Prenatal and transmammary infections of Toxocara canis in dogs: effect of benzimidazoles-
carbamate anthelmintics on various developmental stages of the parasite. J Small Anim Pract 1983; 24:763-768.
51. Massou C, Franc M. Vermifugation of domestic carnivores by tetramisole and levamisole: a review. [La vermifugation
des carnivores domestiques avec le tetramisole et le levamisole: donnees bibliographiques.] Rev Med Vet-Toulouse 1995;
146:181-188.
52. McGarry JW, Martin M, Cheeseman MT, et al., Crenosoma vulpis, the fox lungworm, in dogs. Vet Rec 137:217-272.
53. Metcalfe SS. Filaroides osleri in a dog. Austral Vet Practit 1997; 27:65-67.
54. Mir G, Mateo M, Montoya A, et al., Survey of intestinal parasites in stray dogs in the Madrid area and comparison of
the efficacy of three anthelmentics in naturally infected dogs. Parasitol Res 2007; 100:317-320.
55. Nuttall TJ, Burrow R, Fraser I, et al., Thrombo-ischaemic pinnal necrosis associated with fenbendazole treatment in a
dog. J Sm Anim Pract 2005; 46:243-246.
56. Nicolle AP, Chetboul V, Tessier-Vetzel D, et al., Severe pulmonary arterial hypertension due to Angiostrongylus
vasorum in a dog. Can Vet J 2006; 47:792-795.
57. Outerbridge CA, Taylor SM. Oslerus osleri tracheobronchitis: treatment with ivermectin in 4 dogs. Can Vet J 1998;
39:238-240.
58. Packova I. Case reports: diagnosis, therapy. A chronic cough outbreak in a breeding kennel - pulmonary Capillaria
infection. [Kasuistika - diagnostika, terapie. Pripad chronickeho kasle v chovne stanici - capillariosis pulmonum].
Veterinarstvi 1998; 48:516.
59. Payne PA, Ridley RK, Dryden MW, et al., Efficacy of a combination febantel-praziquantel-pyrantel product, with or
without vaccination with a commercial Giardia vaccine, for treatment of dogs with naturally occurring giardiasis. JAVMA
2002; 220:330-333.
60. Peterson EN, Barr SC, Gould WJ, et al., Use of fenbendazole for treatment of Crenosoma vulpis infection in a dog.
JAVMA 1993; 202:1483-1484.
61. Pinckney RD, Studer AD, Genta RM. Filaroides hirthi infection in two related dogs. JAVMA 1988; 93:1287-1288.
62. Promod-Kumar, Srivastava AK, Pandey BB, et al., Therapeutic trial of some drugs against opisthorchiasis in
experimental pups. Ind J Vet Med 1992; 12:89.
63. Ronald NC, Craig TM. Fenbendazole for the treatment of Heterobilharzia americana infection in dogs. JAVMA 1983;
182:172.
64. Rubash JM. Filaroides hirthi infection in a dog. JAVMA 1986; 189:213.
65. Saari S, Syrjala P, Lappalainen A, et al., Tracheobronchitis in dogs caused by Filaroides osleri. Literature review and
two case reports. [Filaroides (Oslerus) osleri-madon aiheuttam trakeobronkiitti koiralla - kirjallisuuskatsaus ja kaksi
tapausselostusta.] Suom Elainlaakariklehti 1997; 103:647-653.
66. Spillman SK, Glardon OJ. What is your diagnosis? What therapeutic measures do you propose? Capillaria plica
infection in a dog. Schweiz Arch Tierheilkd 1989; 131:213-214.
67. Stoye M, Von Ahn O. Effect of fenbendazole on inhibited somatic larvae of Ancylostoma caninum in the pregnant
bitch. J Vet Med Ser B 1987; 34:13-21.
68. Stoye M, Vorbohle HJ. Effect of fenbendazole on inhibited somatic larvae of Toxocara canis in the pregnant bitch.
{Sur Wirkung von Fenbendazol auf ruhende somatische Larven von Toxocara canis Werner 1782 (Anisakidae) in der
graviden Hundin}. Zbl Vet Med 1985; 32:637-651.
69. Tebb AI Johnson VS, Irwin PJ. Angiostrongylus vasorum (French heartworm) in a dog imported into Australia. Aust
Vet J 2007; 85:23-28.
70. Todd KS, Howland TP, Macy DW. Treatment of canine paragonimiasis with albendazole. Canine Pract 1978; 5:6,11-
12,14.
71. Troy GC, Forrester D, Cockburn C, et al., Heterobilharzia americana infection and hypercalcemia in a dog: a case
report. JAAHA 1987; 23:35-40.
72. Veen L. Capillaria plica infection of the bladder of a Shetland sheepdog. [Blaasinfectie met Capillaria plica bij een
sheltie reu]. Tidschr Diergeneesk 2002; 127:393-394.
73. Whitley NT, Corzo-Menendez N, Carmichael NG, et al., Cerebral and conjunctival haemorrhages associated with von
Willebrand factor deficiency and canine angiostrongylosis. J Sm Anim Pract 2005; 46(2):75-78.
74. Zajac AM, LaBranche TP, Donoghue AR, et al., Efficacy of fenbendazole in the treatment of experimental Giardia
infections in dogs. Am J Vet Res 1998; 59:61-63.
75. Zurliskii P. Report of Thominx (Capillaria) infection in dogs and its treatment. Veterinarna Sbirka 1981; (11):18-19.
All rights reserved. This document is available on-line at www.ivis.org. Document No. A0317.1107