FENBENDAZOLE First Draft Prepared by Dr. William C. Keller, Food and Drug Administration, Rockville, Maryland USA 1. EXPLANATION Fenbendazole is a light brownish-gray odourless, tasteless crystalline powder which is insoluble in water, but highly soluble in DMSO. It is a broad spectrum veterinary anthelmintic used in canines, equines, ruminants and swine. Fenbendazole has not been previously evaluated by the Joint FAO/WHO Expert Committee on Food Additives. 2. BIOLOGICAL DATA 2.1 Biochemical aspects 2.1.1 Absorption, distribution, and excretion Studies were performed to obtain basic information on the pharmacokinetics of 14C-fenbendazole after single oral doses in dogs, rats, rabbits, and sheep. The doses used were 5 mg/kg b.w. for sheep and 10 mg/kg b.w. for the other species. The material tested was administered as an aqueous suspension in 2% starch mucilage. All data are based on radioactivity, with metabolism not taken into account. Absorption was slow, but more rapid in monogastrics. The highest concentrations measured in blood were 0.9 µg/ml in rats 5 to 7 hours post-administration, 0.9 µg/ml in rabbits 8 hours post-administration, 0.4 µg/ml in dogs 24 hours post-administration and 0.32 µg/ml in sheep 2-3 days post-administration. Elimination t´ from blood was 6 hours in rats, 13 hours in rabbits, 15 hours in dogs, and one day in sheep. In all animals except rabbits, elimination occurred >90% in faeces, with <7% in urine. In rabbits, excretion was 75% in faeces and 21% urine. At three days post-administration 98% elimination in dogs, 92% elimination in rabbits, and 99% elimination in rats had occurred. Hepatic distribution at 7 days was highest (2.7 ppm) in sheep and lowest (0.06 ppm) in rats (Kellner & Christ, 1973). Investigations into the pharmacokinetics of 14C-fenbendazole after intravenous and oral administration were carried out in the rat, rabbit, dog, sheep, and pig (oral only). All species received 5 mg/kg b.w. fenbendazole as a 2.5% aqueous suspension in 2% starch mucilage. All data are based on radioactivity, with metabolism not taken into account. The decrease in blood levels after i.v. administration occurred with a t´ of 10 and 13 hours in the dog, >7 hours in the rat, 12 and 18 hours in the rabbit, and 13 hours in sheep. The decrease in blood levels after oral administration occurred with a t´ of 15 ± 3 hours in the dog, 6 ± 1 hours in the rat, 13 ± 4 hours in the rabbit, 9.4 ± 1.1 hours in the pig and 28 ± 4 hours in sheep. The t´ for monogastrics was similar for oral and i.v. administration, but for sheep the post-iv elimination was much faster due to lack of a rumen effect on absorption. Elimination occurred mainly in the faeces and was nearly complete after one week. Intestinal absorption was about 70% in the rabbit, 25-50% in the rat, >33% in the pig, 25% in sheep and >20% in the dog. Elimination via the urine during 7 days following i.v. administration was significant: rabbit 38 - 40%, rat 23 ± 5.7%, dog 29 - 38% and sheep 34%. Of this about 90% in the rat, 69-77% in the dog, 55% in the rabbit, and 45% in the sheep was eliminated within 24 hours. Urinary elimination in the pig and sheep following oral administration was 31-36% and 8-11%, respectively. The largest component of the dose was eliminated in the faeces by all species. The distribution pattern for fenbendazole 6 - 8 hours after an oral dose in the rabbit, dog, and rat showed the highest levels in the liver (Villner et al., 1974). 2.1.2 Biotransformation Sheep and rabbits received 10 mg/kg b.w. 14C-fenbendazole orally, and faeces and urine were evaluated. About 10-20% of excretion occurred in urine with the remainder being in faeces. About 50-75% of the urinary extract occurred as the p-OH metabolite (Klöpffer, 1973). A single dose of fenbendazole was administered orally to rats, rabbits, and dogs, and serum levels of parent compound and of three metabolites (oxfendazole, oxfendazole sulfone, and p-OH oxfendazole) were determined post-administration at various times. Rats received 500 mg/kg b.w., while rabbits and dogs received 25 mg/kg b.w. The detection limit was 0.05 ppm for parent drug and the NH2 metabolite (which was not distinguishable from parent), and 0.01 ppm for the other metabolites. Blood levels of parent drug were detectable after 24 hours in all species and in the dog and rat at 48 hours (rabbit blood levels were not evaluated at 48 hours). Levels of SO and SO2 metabolites were also found, while practically no traces of the p-OH metabolite were found (Düwel & Uihlein, 1980). The disposition and metabolism of fenbendazole were studied in vivo in cattle, chickens, sheep, goats, rabbits, and in vitro in hepatic preparations from cattle, sheep, goats, rabbits, rats, chickens, ducks, turkeys, and catfish. The major urinary metabolite when fenbendazole was administered either i.v. or orally (5 mg/kg b.w.) was p-OH fenbendazole. The sulfoxide and sulfone appeared in plasma but were recovered in only trace amounts in urine or faeces, and the amine was a minor metabolite appearing only occasionally in plasma (Short et al., 1988). A general metabolism scheme may be found on page 23. The ready interconversion of oxfendazole and fenbendazole is notable. Also important, in considering the benzimidazoles as a group, is the entry of febantel to the oxfendazole-fenbendazole pool through either conversion of febantel to fenbendazole directly or the conversion of febantel through the sulfoxide to oxfendazole. 2.2 Toxicological studies 2.2.1 Table 1: Acute toxicity studies Species Sex Route LD50 Reference (mg/kg b.w.) Mouse M&F oral > 10 000 Scholz & Schultes, 1973a Mouse M&F s.c. > 3 200 Scholz & Schultes, 1973a Mouse M&F i.p. > 3 200 Scholz & Schultes, 1973a Rat M&F oral > 10 000 Scholz & Schultes, 1973b Rat M&F s.c. > 2 000 Kramer & Schultes, 1973a Rat M&F i.p. > 1 250 Kramer & Schultes, 1973b Rabbit M&F oral > 5 000 Scholz & Schultes, 1973c Dog M&F oral > 500 Scholz & Schultes, 1973d Swine M&F oral > 5 000 Duwel, 1974 Sheep F oral > 500 Wilkins, 1973 The oral LD50 of p-OH fenbendazole was >10 000 mg/kg b.w. in mice and rats (Kramer & Schultes, 1974c,d) 2.2.2 Short-term studies 2.2.2.1 Mice Fenbendazole was submitted to a general pharmacologic screening procedure in mice over a dose range of 100 to 300 mg/kg b.w. The following observations were reported: Increased motor activity induced by administering the CNS stimulant methamphetamine was not changed by pretreatment with fenbendazole, pretreatment of mice with fenbendazole had no influence on hexobarbitone anaesthesia as measured by sleep time, fenbendazole treatment was found to have no effect on pain perception using the radiant heat method test, maximal electroshock convulsions in mice were not affected by fenbendazole, and fenbendazole had no apparent anticonvulsant activity against pentamethyletetrazole (Vogel & Alpermann, 1973). 2.2.2.2 Rats Fenbendazole was submitted to a general pharmacologic screening procedure in rats over a dose range of 100 to 300 mg/kg b.w. The following observations were reported: Fenbendazole was determined not to have anti-inflammatory activity in the rat paw oedema test using carrageenan as an irritant, there was no change in body temperature when fenbendazole was administered to yeast-fevered rats, and fenbendazole was negative for diuretic activity (Vogel & Alpermann, 1973). Fenbendazole was administered via stomach tube to groups of 10 male and 10 female immature Wistar rats at the rate of 0, 25, 250, and 2500 mg/kg b.w./day for 30 days. Food consumption was determined continuously and body weight twice weekly. Rats were observed daily and clinically examined weekly. Haematology, clinical chemistry and urinalysis were determined prior to treatment initiation and at sacrifice. Half the animals were sacrificed one day after treatment ceased and the remainder were sacrificed 8 days after treatment ceased. The rats received a complete gross necropsy, organ weights were determined, and a standard array of tissues was examined histopathologically following sacrifice. No treatment-related findings were reported (Kramer & Schultes, 1973c). Fenbendazole was administered via stomach tube to groups of 15 male and 15 female immature Wistar rats at the rate of 0, 25, 200, and 1600 mg/kg b.w./day for 90 days. At treatment day 61 doses for five male and female rats were increased to 2500 mg/kg b.w./day. Food intake was determined continuously and body weight twice weekly. Rats were observed daily and clinically examined weekly. Haematology, clinical chemistry and urinalysis were determined prior to treatment initiation, at the sixth week of treatment and at sacrifice. Ten animals were sacrificed 1 day after treatment ceased and the remainder were sacrificed 7 days after treatment ceased. The rats received a complete gross necropsy, organ weights were determined, and a standard array of tissues was examined histopathologically following sacrifice. Two rats from the 1600 and 5 rats from the 2500 mg/kg b.w./day groups were observed to have tremors after the 84th treatment. No other treatment-related findings were reported (Kramer & Schultes, 1974a). A 15-week oral toxicity study in Charles River CD rats was performed to evaluate the toxicity of fenbendazole in rats. Fenbendazole was provided in the feed to groups of 50 rats/sex derived from the F1a generation of a 3-generation reproductive toxicology study at levels to yield a dose of 160, 400, or 1000 mg/kg b.w./day. Animals were observed daily and weights and food consumption recorded weekly. At 12 weeks clinical chemistry, haematology, urinalysis, and ophthalmic examinations were conducted. Rats which died during the study and rats from the 1000 mg/kg b.w./day and control groups were necropsied. The treated male groups all gained less weight than controls but there was a reverse relationship to dose. The treated groups also weighed less than controls at study initiation: the 1000 mg/kg b.w./day male mean weight was 75% of controls and the female mean weight was 73% of controls. No other treatment-related observations were reported. It should be noted [see Goldenthal 1979b] that this study was initiated as a 2-year chronic study that was apparently terminated due to toxicity (Goldenthal, 1979a). 2.2.2.3 Dogs Fenbendazole was administered to 6-week old puppies to determine the safety of the 22.2% granules or 10% suspension formulations. Groups of 3 beagle pups/sex received doses of 0, 50, or 250 mg/kg b.w./day granules or 250 mg/kg b.w./day suspension provided in gelatin capsules for 6 days. Clinical signs, haematology, and clinical chemistry were evaluated. No treatment-related effects were reported (Mehring, 1982). Fenbendazole was administered in gelatin capsules to groups of 2 male and 2 female beagles for 30 consecutive days at the rate of 0, 25, 80, or 250 mg/kg/day. The dogs were 7 to 34 months old at initiation of the experiment. Food consumption was determined daily and weights were determined weekly. Dogs were observed daily and examined weekly for treatment-related signs. Haematology, clinical chemistry, and urinalysis were performed prior to treatment initiation and at sacrifice. Following sacrifice, dogs received a gross necropsy and organ weights were determined. A standard selection of organs was evaluated histopathologically. Treatment-related lesions reported include lymph follicle proliferation in the region of the stomach pyloric glands at 250 mg/kg b.w./day and low-grade diffuse cellular centrilobular fatty degeneration of the liver in males at 80 and 250 mg/kg b.w./day. The NOEL was 25 mg/kg b.w./day (Kramer & Schultes, 1973d). Fenbendazole was administered in gelatin capsules to 4 groups of 3 male and 3 female beagle dogs for 90 consecutive days at the rate of 0, 20, 50, or 125 mg/kg b.w./day. The dogs were 8 to 48 months old at initiation of the experiment. Food consumption was determined daily and weights were determined weekly. Dogs were observed daily and examined weekly for treatment-related signs. Haematology, clinical chemistry, and urinalysis were performed prior to treatment initiation, after 30 days of treatment, and at sacrifice. Following sacrifice, dogs received a gross necropsy and organ weights were determined. A standard selection of organs was evaluated histopathologically. The gastric mucosa was reported to contain lymph follicles and lymphocytic infiltration in both treated and control dogs. No treatment-related findings were reported (Kramer & Schultes, 1974b). The toxicity of fenbendazole was evaluated in beagle dogs by administering fenbendazole in gelatin capsules to 4 groups of 4 male (5.5 to 9.7 kg) and 4 female (4.8 to 7.3 kg) dogs at levels of 0, 20, 50, and 125 mg/kg b.w./day for 6 months. Dogs were housed individually in metal metabolism cages. Food consumption and weights were determined weekly. Dogs were observed daily and examined weekly for treatment-related signs. Reflexes were examined prior to treatment and at 1, 3 and 6 months of treatment. Ophthalmoscopic examinations, haematology, clinical chemistry, and urinalysis were performed prior to treatment and at 3 and 6 months. Following sacrifice dogs received a gross necropsy and organ weights were determined. A standard selection of organs from the control and 125 mg/kg b.w./day treatment groups were evaluated histopathologically. In addition, tissues from dogs in the 20 and 50 mg/kg b.w./day groups in which gross lesions were observed or in which treatment-related lesions were observed in the 125 mg/kg group were also evaluated histopathologically. A treatment-related nodular appearance of the gastric mucosa was observed at gross necropsy in all treated groups but not controls. Formation of lymphoid nodules in the gastric mucosa corresponding to this gross lesion was observed on histopathologic evaluation in all treatment groups. Focal encephalomalacia, satellitosis and neuronophagia were observed in the cerebra of two dogs at the 125 mg/kg b.w./day level and slight perivascular inflammation and gliosis were reported in the cerebrum of another animal at the 125 mg/kg b.w./day level. Since effects were observed at the lowest dose of 20 mg/kg b.w./day, there was no NOEL (Wazeter & Goldenthal, 1977). The toxicity of fenbendazole was evaluated in beagle dogs by administering fenbendazole in gelatin capsules to 5 groups of 6 male (5.9 to 14.1 kg) and 6 female (5.4 to 11.6 kg) dogs at levels of 0, 4, 8, 12, and 20 mg/kg b.w. daily for 6 months. Dogs were housed individually in metal metabolism cages. Food consumption and weights were determined weekly. Dogs were observed daily and examined weekly for treatment-related signs. Reflexes were examined prior to treatment and at 1, 3 and 6 months of treatment. Ophthalmoscopic examinations, haematology, clinical chemistry, and urinalysis were performed prior to treatment and at 3, and 6 months. After 6 months of treatment 4 dogs of each sex/group were sacrificed while the remaining 2 dogs of each sex/group were sacrificed 3 weeks after treatment had ceased. At sacrifice, each dog received a complete gross necropsy and adrenals, brain, heart, kidneys, liver, spleen, pituitary, testes, ovaries, and thyroid were weighed. A standard selection of organs from the control and 20 mg/kg b.w./day treatment groups were evaluated histopathologically. In addition, tissues from dogs in the 4, 8, and 12 mg/kg b.w./day groups in which gross lesions were observed, and mesenteric lymph nodes, stomach, colon, and testes were also evaluated histopathologically. An increased number of treated dogs had lymphocytic foci in the lamina propria of the gastric mucosa compared to control dogs. The extent of this effect appeared to be dose-related. Very slight to moderate hyperplasia of mesenteric lymph nodes was also increased in treated groups. The investigators believed the increased incidence in treated groups may indicate a treatment-related local irritant effect. Mesenteric lymph nodes from dogs sacrificed 3 weeks after cessation of treatment were deemed to have hyperplasia and congestion (Goldenthal, 1978). An independent histopathologic review of stomach mucosal tissue and mesenteric lymph nodes from this and the previous study was performed. This review concluded that lymphoid hyperplasia of the gastric mucosa was associated with fenbendazole treatment. The reviewers were not convinced that this effect was a direct irritant effect or that the gastric effect was associated with lymph node hyperplasia. They further stated that any nonspecific irritant could produce the lymph node changes (Dua, 1981). Histopathologic changes reported in the two previous studies occurred in the control as well as the treated dogs. The incidence occurring at the high doses suggests a treatment-related effect, however, the incidence of changes occurring in the low-dose group appears to be within the range of biological variation. Interpretation of these changes would have been facilitated by availability of historical control data. Results from this study are consistent with a NOEL of 4 mg/kg/day. This conclusion is supported by the following study. A further 14-week study using 3 beagles/sex/dose was done to assess the oral toxicity of fenbendazole, particularly effects on stomach mucosal lymphoid follicles and mesenteric lymph nodes. Dogs received doses of 0, 1, 2, 5, or 10 mg/kg b.w./day provided in gelatin capsules. Food consumption was determined daily and weights were determined weekly. Dogs were observed daily and examined weekly for treatment-related signs. Haematology, clinical chemistry, and urinalysis were performed prior to treatment initiation, and at week 13. Following sacrifice, dogs received a gross necropsy and liver, kidney, and spleen weights were determined. Organs evaluated histopathologically included liver, kidney, spleen, mesenteric lymph nodes, samples of the stomach regions and tissues with gross lesions. No treatment-related findings were reported (Doerr & Carmines, 1983). 2.2.2.4 Swine The toxicity of fenbendazole was evaluated by dosing 8 growing pigs via gavage with 2000 mg fenbendazole/kg b.w./day for 14 days. The animals were observed daily, and blood and urine samples were collected on alternate days including baseline values. The pigs were sacrificed 10 days after the last dose and subjected to complete gross and histopathologic examination. Four pigs developed pneumonia during the treatment. Treatment-related leukopenia developed on day 6 of dosing but returned to normal on day 18, 4 days after treatment ceased. Both the segmented neutrophils and lymphocytes were affected. Sorbitol dehydrogenase values were significantly increased from treatment day 4, but returned to baseline on day 20, 6 days after treatment ceased. No treatment-related gross or histopathologic lesions were reported (Hayes et al., 1983a). The toxicity of fenbendazole was evaluated in groups of 5 female pigs in which fenbendazole was provided in feed at the rate of 0, 25, 75, or 125 mg/kg b.w./day for 5 days. They were observed daily. Blood and urine samples were collected on days -5, -2, 0, 3, 7, 10 and 15. The pigs were sacrificed 10 days after the last dose and subjected to complete gross and histopathologic examination. Leukopenia developed on day 3 for the 75 and 125 mg/kg b.w./day groups and after treatment ceased, on day 7 in the 25 mg/kg b.w./day group, but all groups had returned to normal on day 15, 10 days after treatment ceased. The segmented neutrophils and lymphocytes were affected. In groups receiving 75 and 125 mg/kg b.w./day, sorbitol dehydrogenase values were significantly increased from treatment day 3, but returned to baseline on day 10, 5 days after treatment ceased. No treatment-related gross or histopathologic lesions were reported (Hayes et al., 1983b). Thirty sows were divided into groups receiving 0, 3, 9, 15 and 25 mg fenbendazole/kg b.w./day in feed for 3 days. The animals were maintained for an additional 10 days after treatment ceased. Blood and urine were collected on alternate days including during a 10-day pretreatment phase. Clinical chemistry, haematology, urinalysis and gross and histopathologic observations revealed no treatment-related effects. The NOEL was 25 mg/kg b.w./day (Booze & Oehme, 1983). 2.2.3 Long-term/carcinogenicity studies 2.2.3.1 Mice The carcinogenicity of fenbendazole was evaluated in Charles River CD-1 mice. In a 2-year study, 480 six-week old mice were divided into 4 groups of 60 male and 60 female mice which received fenbendazole in the diet at levels targeted to provide doses of 0, 45, 135, and 405 mg/kg b.w./day. The test material was mixed with the diet by adding it to 500 g of food and blending, then mixing this premix with the mouse diet in a blender. The fenbendazole concentration was based on the most recent body weight and food consumption data, and fresh diets were prepared weekly. Samples of the diet containing the test substance were taken at periodic intervals during the study. Mice were observed daily for general physical appearance, behaviour, and toxic signs, and observations recorded weekly except moribundity/mortality which were recorded daily. Individual body weights and food consumption were recorded weekly. After 24 months of fenbendazole administration the surviving mice were sacrificed and complete necropsies performed. All animals that died during the course of the study were also necropsied. Histopathologic evaluation was performed on a standard array of tissues from the control and high-dose group and all tissues where lesions were observed at necropsy in all dose groups. Survival in treated groups was somewhat reduced when compared with controls: Control: - 55% M and 60% F; 45 mg/kg b.w./day - 43% M and 37% F; 135 mg/kg b.w./day - 47% M and 42% F; and 405 mg/kg b.w./day - 37% M and 43% F. Sporadic body weight gain differences between treatment groups and controls occurred at various times during the study, but no apparent treatment-related alteration was observed. Food consumption was comparable for all groups. The incidence of inflammatory lesions and proliferative lesions was unrelated to fenbendazole treatment. Total numbers of benign and malignant neoplasms for the treated group and control were similar. No compound effect was evident histopathologically. Based on these results the investigators concluded that no fenbendazole-related effects were observed in any treatment group during the study (Goldenthal, 1980b). 2.2.3.2 Rats The chronic toxicity, including carcinogenicity, of fenbendazole was evaluated in Charles River CD rats. In a lifetime study including an in utero phase fenbendazole was provided in the diet at dose levels of 0, 5, 15, 45, and 135 mg/kg b.w./day. Groups of 50 male and 50 female rats, derived from a three-generation reproduction study performed using the same dose-levels (as the F1a rats) were used in the study. Surviving male rats were terminated at week 123 and surviving females were terminated at week 125. Febendazole was mixed with the diet. The fenbendazole concentration was based on the most recent body weight and food consumption data and fresh diets were prepared weekly. On day 0 and on day 7 of weeks 1, 14, 52, 104, and 122 samples of the diet containing the test substance were taken. Rats were observed daily for general physical appearance, behaviour, and toxic signs and observations recorded weekly except moribundity/mortality which were recorded daily. Individual body weights and food consumption were recorded weekly. Opthalmoscopic examination was performed at 3, 6, 12, 18, and 24 months and at termination. Haematology, clinical chemistry, and urinalysis were performed on samples obtained at 3, 6, 12, 18, and 24 months from 10 rats/sex/dose (selected randomly). The surviving rats were sacrificed and complete necropsies performed. The following organs were weighed: adrenals, brain, heart, kidneys, liver, spleen, testes, and ovaries. All animals that died during the course of the study were necropsied but no organ weights were taken. Histopathologic evaluation of a standard array of tissues from the control and high-dose group, and liver and mesenteric lymph nodes, and all tissues in which lesions were observed at necropsy in the other dose groups was performed. Treatment-related physical signs reported included diarrhoea and red material in faeces (45 mg/kg b.w./day and 135 mg/kg b.w./day) and reddish-brown urine (15, 45, and 135 mg/kg b.w./day). Mortality was not statistically different from controls for any treatment group. At 80 weeks, survival for all groups exceeded 80%, except high dose males with 72% survival. At terminal sacrifice, survival was: Controls: - 34% M and 36% F; 5 mg/kg b.w./day - 42% M and 28% F; 15 mg/kg b.w./day - 46% M and 38% F; 45 mg/kg b.w./day - 44% M and 36% F; and 135 mg/kg b.w./day - 24% M and 24% F. Body weights at terminal sacrifice were significantly lower for the 45 and 135 mg/kg b.w./day groups compared with controls. This is reflective of the weight differences at the beginning of the study. However, weight gains were also reduced for the 45 and 135 mg/kg b.w./day groups versus controls. Food consumption was comparable for all groups. Sporadic significant differences occurred in the haematologic, clinical chemistry and urinalysis parameters. Of these, only the alkaline phosphatase in the 15, 45 and 135 mg/kg b.w./day groups and SGOT in the 135 mg/kg b.w./day group were consistently elevated in a manner suggesting biological significance. The following were noted at gross necropsy: enlargement or cyst formation in lymph nodes of rats from the 45 and 135 mg/kg b.w./day groups, liver mass and/or nodule formation in rats of the 135 mg/kg b.w./day group, cyst formation in the liver of females in the 135 mg/kg b.w./day group, and testicular masses among males at the 135 mg/kg b.w./day dose-level. Treatment-related histopathologic findings reported included: sinus ectasia and reactive hyperplasia of the mesenteric lymph nodes in all but the low dose level; centrilobular hepatocellular hypertrophy, focal hepatocellular hyperplasia, hepatocellular cytoplasmic vacuolation, focal bile duct proliferation, and biliary cyst formation in the 45 and 135 mg/kg b.w./day dose levels, nodular hepatocellular hyperplasia in female rats of the 45 and 135 mg/kg b.w./day dose levels, and testicular interstitial cell adenomas in the 135 mg/kg b.w./day male rats. Based on these findings the authors concluded the no effect level for this study was 5 mg/kg b.w./day (Goldenthal, 1980c). Subsequent to the above report the liver histopathology slides from the study were evaluated by an independent pathologist. Slides from all study animals were evaluated. The following fenbendazole-related changes were reported for the treatment groups: hepatocellular hypertrophy, vacuolation and bile duct proliferation in the 15, 45, and 135 mg/kg b.w./day groups, hepatocellular hyperplasia and biliary cysts in the 45 and 135 mg/kg b.w./day groups, and hepatocellular adenomas and carcinomas in the 135 mg/kg b.w./day group. A low incidence of hepatic tumours was noted in this study including in controls. No treatment-related changes were reported for the 5 mg/kg b.w./day group (Brown, 1982). Some differences in criteria and terminology were noted between the original and review pathologists. Additionally the review pathologist reviewed only the liver slides. Therefore a consensus report of hepatic lesions was generated as shown in Table 2: Table 2: Results of consensus report on hepatic lesions Dose (mg/kg b.w./d Fenbendazole) Liver lesions 0 5 15 45 135 Historical (%) control Periportal M 0 2 12* 22* 28* hypertrophy F 1 1 8* 25* 21* Centrilobular M 0 0 1 2 13* hypertrophy F 0 0 1 0 5 Diffuse M 0 0 1 6* 6* hypertrophy F 0 0 0 3 4 Focal vacuolation M 1 2 1 8* 8* F 4 1 3 0 2 Periportal M 5 7 12 9 6 vacuolation F 4 8 9 14* 14* Bile duct M 8 7 12 11 7 3-52 proliferation F 7 8 7 21* 26* 1.6-27 Biliary cysts M 1 1 0 6 8* F 1 3 1 12* 29* Cholangiosclerosis M 3 2 3 0 0 F 1 3 1 12* 29* Nodular/focal M 4 6 7 11 13* 0-15 hyperplasia F 11 8 3 14 19 0-18 Neoplastic nodule M 0 2 1 1 3 0-5.7 F 2 0 2 0 3 0-5.7 Adenomas M 0 0 0 1 1 0-3.3 F 1 0 0 0 0 0-2.9 Carcinomas M 1 1 3 0 2 0-5 F 0 0 0 1 3 0-0.8 * Statistically significant compared to concurrent controls. Note: Group sizes were 50 apart from 49 in high dose male group. Historical controls from 10 studies were provided, which had a combined incidence of 1 hepatic carcinoma in 980 female rats while the present study contained 1 hepatic carcinoma in the 45 mg/kg b.w./day group and 3 hepatic carcinomas in the 135 mg/kg b.w./day group females (Muser & McClain, 1982). Subsequent to this a pathology working group (PWG) was convened to evaluate the liver histopathology slides from the fenbendazole chronic rat study. The PWG comprised a chair and 5 additional independent pathologists. Prior to the PWG the chair reviewed all liver slides in a blind fashion and issued a report. For the PWG review the original pathologist's (OP) and the consensus diagnoses between the original pathologist and review pathologist (RP) when appropriate had to be matched with the PWG chair's diagnoses. All hepatocellular neoplasms, all slides showing nodular hyperplasia, nodular hypertrophy, or neoplastic nodule diagnosed by the OP or RP and focal hyperplasia diagnosed by the chair, and all slides showing biliary cyst/cholangioma were reviewed by the PWG and reported as shown in Table 3: Table 3. Results of PWG report Treatment Group (male/female) Cont 5 15 45 135 Nonneoplastic changes Focal hyperplasia 3/6 4/4 1/3 1/9 5/16 Foci of cellular 22/24 28/26 29/23 43/29 43/44 alteration Neoplastic changes Hepatocellular adenoma 0/1 0/0 0/0 1/1 2/2 Hepatocellular carcinoma 1/0 1/0 3/0 0/1 3/2 Combined neoplasms 1/0 1/0 3/0 1/1 5/4 Hepatocellular hypertrophy 0/2 2/6 17/20 38/40 42/48 Cholangioma 1/0 0/1 0/0 1/3 2/10 Biliary cysts 0/0 1/1 1/0 2/6 3/12 Note: Group sizes as in previous table. The conclusions of the PWG were: 1. Lifetime treatment of CD rats with fenbendazole in the diet did not result in a significant compound-related increase in hepatocellular neoplasms. Differences in incidences among groups were considered to reflect normal biological variation. 2. Lifetime treatment of CD rats with fenbendazole in the diet was associated with a significant increase in hepatocellular foci of cellular alteration at dose levels of 45 and 135 mg/kg b.w./day in males and 135 mg/kg b.w./day in females. There was also an increase in hepatocellular focal hyperplasia in females at 135 mg/kg b.w./day. Foci of cellular alteration and focal hyperplasia were considered to be toxic lesions that were not associated with induction of hepatocellular neoplasms in this study. 3. Lifetime treatment of CD rats with fenbendazole in the diet was associated with a compound-related increase in hepatocellular hypertrophy at dose levels of 15, 45, and 135 mg/kg b.w./day. It is interpreted as a common adaptive response to toxicity unrelated to the formation of hepatic neoplasms. 4. Lifetime treatment of CD rats with fenbendazole in the diet was associated with a compound-related increase in "cholangiomas" in females at the 135 mg/kg b.w./day dose level. The incidence of biliary cysts was also increased in females at both 45 and 135 mg/kg b.w./day. Biliary cysts and "cholangiomas" were slightly increased in males at 135 mg/kg b.w./day. The weight of all of the evidence permitted the consensus opinion of the PWG that the "cholangioma"/biliary cysts observed in this study represent a toxic proliferative lesion probably initiated in utero by administration of excessively high doses of fenbendazole. There was a reduction in the incidence of hepatocellular carcinoma in female rats in the 135 mg/kg b.w./day group (2 vs 3) reported by the PWG compared with the previous consensus report, although this incidence is still high when compared to historical controls (Sauer, 1986). 2.2.4 Reproduction studies 2.2.4.1 Rats The potential reproductive effects of fenbendazole were studied in a 3-generation reproduction study in Charles River CD rats in which fenbendazole was administered in the diet to provide doses of 0, 160, 400, and 1000 mg/kg b.w./day. Eighty male and 160 female rats (weighing 63 to 114 g) were evenly distributed among the treatment groups. Except during mating the rats were individually housed in wire-mesh cages. After 70 days of treatment, at approximately 100 days of age, the F0 parental rats were housed 2 females/male within the same treatment group for 15 days to produce the F1 generation. The females were examined daily and presence of sperm or vaginal plug was designated day 0 of pregnancy. Females were separated and allowed to deliver, with this date designated day 0 of lactation. The pups were counted, sexed and weighed at designated intervals during lactation. At 21 days pups from the F1a litters were selected to comprise a 2-year oral toxicity study in rats. After weaning, the F0 parental rats were reduced to 10 males and 20 females per group and after a 10-day rest period, the surviving F0 parental rats were mated a second time to produce the F1b litters. The F1b litters were raised and evaluated in the same manner as the F1a litters. After weaning the F1b litters were allowed to remain together for 1 week and then 10 males and 20 females were selected to comprise the F1 generation. After weaning, any F1b pups not selected for the next generation were discarded. Five male and 5 female F0 rats per group were sacrificed and necropsied and the remainder discarded. Due to signs of toxicity observed at 15 weeks in the F1a generation rats being used in a 2-year study, the reproductive toxicology study was terminated after 30 weeks. The F1 rats were examined externally, sacrificed and discarded. A reduction in weight gains was consistently seen in treated groups. In general this effect was more severe in the higher dose groups. Other parameters were less consistently affected (Goldenthal, 1979b). The potential reproductive effects of fenbendazole were studied in a second 3-generation reproduction study in Charles River CD rats. Fenbendazole was administered in the diet at levels designed to provide doses of 0, 5, 15, 45, and 135 mg/kg b.w./day. Fresh diets containing appropriate fenbendazole concentrations were prepared weekly throughout the study. Diet samples were collected at study initiation, 3 months, 1 year, and at study termination. Three-hundred rats were initially distributed among the five treatment groups to provide 20 males and 40 females per group. Rats were individually housed except during mating and lactation. Rats were maintained on their respective diets throughout the duration of each generation. After 70 days of treatment, at about 100 days of age, the F0 parental rats were mated (2 females/male) to produce the F1a litters. Rats were maintained together for 15 days and females were checked daily for sperm. This finding was designated day 0 of pregnancy and females were then placed in separate cages during gestation. The day of delivery was designated lactation day 0, and litter size, live and dead pups were determined. Dams and pups were observed daily and litters were evaluated on days 1, 4, 7, 14, and 21. Due to decreased body weights, pups were allowed to remain with dams for an additional week before weaning. The F1a pups were then utilized for a life-time carcinogenicity study. After weaning the F0 females and males were reduced to 20 and 10 animals per treatment group, rested for 10 days and then mated a second time to produce the F1b litters. An identical procedure to that used to produce the F1a litters was used for the F1b litters, except that females were housed with different males within the treatment group. After weaning the F1b pups were maintained together for 1 week, and then 10 males and 20 females were randomly selected from each group to become the F1 parents. The remaining F1b pups were examined and sacrificed. Following weaning 5 male and 5 female F0 parents were sacrificed and received a complete gross necropsy including determination of organ weights. The following organs from the control and 135 mg/kg groups were also evaluated histopathologically: thyroid, heart, lung, stomach, kidneys, spleen, adrenals, urinary bladder, and gonads. Livers from all dose groups were evaluated. At approximately 100 days of age, the F1 parental rats were mated to produce the F2a litters. The F2a litters were handled in the same manner as the F1a litters, except that at weaning they were examined for abnormalities, sacrificed and discarded rather than being used for a chronic study. The F2b litter and subsequent F2 parental rats and F3a and F3b litters were produced and evaluated in the same manner. The rats were observed daily and examined weekly and weights and feed consumption were recorded on a weekly basis. Observations for the reproductive aspects of this study included male and female fertility, length of gestation period, litter size and weight at various stages of lactation, and pup weight at weaning. All pups dying during lactation were examined by necropsy or skeletal staining. A summary of observations reported for the 45 and 135 mg/kg b.w./day parental rats at various times throughout the study includes: soft stool with diarrhoea and red discharge, reddening and yellowish staining of the anal-genital region and emaciation, reduced weight gains and food consumption, and slight to moderate histopathologic hepatic changes including hepatocellular hypertrophy, biliary hyperplasia, and lymphoid cell infiltration. These changes were more severe for the 135 mg/kg b.w./day group. Alterations in the 5 and 15 mg/kg b.w./day groups were marginal or inconsistent when compared to controls. A summary of observations on reproductive or pup effects of fenbendazole reported for the 135 and 45 mg/kg b.w./day groups at various times throughout the study includes: reduced fertility indices, survival indices, pup weight, and lactational growth, as well as diarrhoea, yellow color, reduced activity, bloated stomach, and alopecia. These effects were also more pronounced in the high-dose group. Alterations in the 5 and 15 mg/kg b.w./day groups were marginal or inconsistent when compared to controls. Based on these results the investigators concluded that the NOEL for this study was 15 mg/kg b.w./day for maternal and reproductive toxicity (Goldenthal, 1980a). 2.2.5 Special studies on embryotoxicity and/or teratogenicity 2.2.5.1 Rats The potential embryotoxicity of fenbendazole was evaluated in Wistar rats. Sexually mature virgin female Wistar rats were mated with fertile males, to provide 4 groups of 20 pregnant animals. Dams were evaluated for presence of sperm and the day on which sperm was detected was designated gestation day one. Dams in these groups received doses of 0, 25, 250, or 2500 mg/kg b.w./day fenbendazole via stomach tube in a 2% starch mucilage vehicle at the rate of 10 ml/kg b.w./day on gestation days 7-16. Rats were observed daily, and weighed weekly. Doses were based on the most recent body weight. Food intake was monitored continuously. All dams were sacrificed on gestation day 21 and fetuses were delivered by caesarean section. Each dam received a gross necropsy and organs were weighed. The uterus was opened and number and placement of live and dead fetuses and resorptions were determined. The fetuses were examined externally for abnormalities; about 50% were then processed for Alizarin red staining to evaluate skeletal abnormalities and the remainder were processed with Bouin's solution for evaluation of soft tissue abnormalities. No treatment-related effects were noted in any of the maternal or fetal parameters. One litter in the high-dose group was comprised entirely of abnormal pups. Abnormalities included shortened, twisted tails, fused vertebral centrae, diaphragmatic hernia, and hydrocephalus. The investigators judged this single litter to be an anomalous finding as no other treatment group or litter within the high-dose treatment group demonstrated any treatment-related effect. Based on results of this study the investigators concluded the NOEL to be 2500 mg/kg b.w./day (Kramer & Baeder, 1973). Fenbendazole was administered orally to Sprague-Dawley rats on days 8 to 15 of gestation. There was no evidence of embryotoxic or teratogenic effects at either of the doses used - 60 and 120 mg/kg b.w./day. Similar results were obtained with the 6-hydroxy derivative; and the sulfone metabolite was also without embryotoxic or teratogenic effect at the highest dose used (66 mg/kg b.w./day). The sulfoxide (i.e., oxfendazole) at a dose level of 16 mg/kg b.w./day caused nearly 80% embryolethality and an increase in the number of external malformations. At a dose of 2 mg/kg b.w./day there was 100% embryolethality (Delatour and Lapras, 1979). Febantel and several of its metabolites were tested for possible embryotoxicity. The compounds were given to rats, by gavage, during days 8 to 15 of pregnancy, up to the maximum tolerated dose. Fenbendazole showed no adverse effect at the highest dose used - 66 mg/kg b.w./day, but administration of febantel and its two sulfoxide metabolites (the second being oxfendazole) produced teratogenic effects (increased incidences of external and skeletal abnormalities) and embryolethality with no-observed-effect levels of 22, 23 and 10 mg/kg b.w./day respectively (Delatour et al., 1981a). 2.2.5.2 Rabbits The potential embryotoxicity of fenbendazole was studied by administering fenbendazole to pregnant 5-7 month old yellow silver rabbits. Eleven to 14 females were employed per dose. Rabbits were mated twice (at 6-hour intervals) with fertile males. After mating, rabbits were maintained in metal cages with metal gratings. The pregnant rabbits were divided into 4 groups of 10 and administered doses of 0, 10, 25, and 63 mg/kg b.w./day on gestation days 7-19. The test material was administered as suspension in 2% starch mucilage with a stomach tube at the rate of 5 ml/kg b.w. The rabbits were observed daily, and weighed weekly. Food intake was monitored continuously. Does were sacrificed on gestation day 29, received a complete gross necropsy, and fetuses were delivered by caesarean section. The uterus was evaluated for resorptions and fetuses were examined grossly for abnormalities. The fetuses were subsequently maintained in an incubator for 24 hours. About 50% of the fetuses were then processed in Bouin's solution for soft tissue examination, and 50% using Alizarin red stain for skeletal examination. One doe in the 63 mg/kg b.w./day group aborted on gestation day 27, while 2 does in this group and one in the 25 mg/kg b.w./day group were found to have resorbed their litters. An increase in skeletal anomalies (13th rib) and delayed ossification of cranial bones occurred in the 63 mg/kg b.w./day group. Based on these findings the investigators concluded the NOEL for this study was 25 mg/kg b.w./day (Scholz & Baeder, 1973). 2.2.5.3 Dogs Two groups of 12 bitches received oral doses of 100 mg/kg b.w./day fenbendazole in capsules on gestation days 14-22 or 22-30. A similar control group received empty capsules. Each group contained approximately half nulliparous and half multiparous bitches. Bitches were observed daily through weaning of pups at 6 weeks. A necropsy was performed on all stillborn pups and pups dying prior to 42 days. About half the bitches in each group produced litters. No treatment-related findings were reported (Mehring, 1981). 2.2.5.4 Swine Eight groups of 10 sows received 3 mg fenbendazole/kg in feed daily for 3 days during week 1, 2, 3, 4, 7, 10, 13, or 14 of gestation. Ten sows were treated prior to breeding and an equal number of controls were used. Fenbendazole had no adverse effect on sows or litters (Evans, 1980). A total of 104 sows were treated orally with 500 mg/kg b.w./day (?) fenbendazole once or occasionally multiple times between gestation days 8 and 33. The sows were allowed to deliver their litters. The gestation period, live and dead piglets, and deformities were determined. Live pigs were radiographed for skeletal abnormalities. No maternal effects or fetal effects were reported (Tiefenbach, 1984; Baeder 1988). 2.2.5.5 Sheep In a series of studies pregnant ewes were treated with oral doses of fenbendazole in the following manner: a) A group of 15 ewes received 15 mg/kg b.w. four times during gestation. The exact days of gestation were variable. b) A group of 10 ewes were given a single dose of 50 mg/kg b.w. 96 hours following servicing. c) A group of 19 ewes received 15 mg/kg b.w. every 4 weeks during gestation for a total of 7 doses. Each experiment showed no effects on lambing and no apparent abnormalities in the offspring (Wilkins, 1973). 2.2.5.6 Cattle A group of 27 cows were given oral doses of 50 mg/kg b.w. fenbendazole on days 12 and 21 of gestation, then at 3 week intervals until the fifth month, and subsequently at 2-monthly intervals. Another group of 35 cattle was given 20 mg/kg b.w. fenbendazole on days 9, 10, 19, 30, 69, 99, 129, 159, and 189 of gestation. In both experiments calving progressed normally and there were no apparent abnormalities in the offspring (Muser & Lapras, 1979). 2.2.5.7 Horses Pregnant mares were given oral doses of fenbendazole at 10 or 25 mg/kg b.w./day in the last trimester of pregnancy. Other mares were given single oral doses of 5 mg/kg b.w. within 1 to 7 weeks of foaling. In neither case were there apparent effects on foals (Paul & Muser, 1981). 2.2.6 Special studies on testicular function 2.2.6.1 Sheep A group of 4 rams were given a single oral dose of 50 mg/kg b.w. fenbendazole. Another group of 5 rams were dosed orally with 15 mg/kg b.w. monthly for 4 months. Semen quality was unaffected either during or following treatment (Wilkins, 1973). 2.2.6.2 Horses Effects on testicular function in stallions were examined in a study using a single oral dose of 20 mg/kg b.w. fenbendazole. The animals were castrated 4, 12, 26, 60, or 72 h after dosing. No effects were seen on seminal volume, spermatozoa counts and morphology, testicular size and weight or serum testosterone levels (Squires et al., 1978). 2.2.7 Special studies on genotoxicity Table 4. Results of genotoxicity studies Test Test object Dose or Results Reference system Concentration Ames test1 S.typhimurium 1-2500 µg Negative Mourot, 1990 TA97, 98, 100, 102 Ames test1 S.typhimurium 1-5000 mg Negative Mazza et al., TA98, 100, 1981 1535, 1537, 1538 Ames test1 S.typhimurium 1-10000 Negative Rabenold & TA1435, 1537 µg/plate Brusick, 1982 Mitotic HeLa cells 1 mg/ml Positive Puenter, 1978 index Forward Mouse up to 62.25 Weakly Cifone & mutation1 lymphoma µg/ml positive2 Myrh, 1983a assay DNA Primary rat 0.5-100 Negative Myrh & repair1 hepatocytes µg/ml Brusick, 1982a Micronucleus Mouse RBCs 3000 mg/kg Negative Horstmann et test al., 1986 Cytogenetics Chinese 1000-4000 Negative Muller et al., assay hamster mg/kg 1986 marrow bone 1. Both with and without rat liver S9. 2. Positive in the presence, but not in the absence of metabolic activation. 2.3 Observations in humans Five healthy male subjects were given oral doses of 300 mg fenbendazole with breakfast, and 6 healthy male subjects were given 600 mg fenbendazole 12 hours after their last meals. Serum concentrations were monitored. The following parameters were evaluated: Blood pressure, pulse rate, symptom list and self-rating scale, and clinical chemistry values. Serum values were detected in 2/5 subjects receiving fenbendazole with a meal and 0/6 subjects receiving fenbendazole without food. No relevant changes were established in the subjects (Rupp & Hajdu, 1974). 3. COMMENTS Comprehensive toxicological data on fenbendazole were provided, including the results of studies on its kinetics, metabolism, short- and long-term toxicity, carcinogenicity, genotoxicity, reproductive toxicity, embryotoxicity, and teratogenicity. The rate of absorption following oral administration was slow, but more rapid in monogastric animals. The extent of absorption was 25-50% in rats, less than 20% in dogs, 70% in rabbits, 25% in sheep, and more than 33% in pigs. Elimination was greater than 90% within 3 days, with the majority in the faeces. Fenbendazole was metabolized to oxfendazole (the sulfoxide), oxfendazole sulfone, and amine metabolites, which were detectable in plasma. The major urinary metabolite was 4-hydroxy-fenbendazole, with traces of oxfendazole and oxfendazole sulfone. The metabolic pathway was similar in rats, rabbits, dogs, sheep, cattle, goats, and chickens. In a 24-month study in mice in which fenbendazole was given in the diet, there were sporadic body-weight differences between treated and control groups but no meaningful relationship with drug treatment. Survival was reduced in the treated groups, but only at the highest dose of 405 mg/kg b.w./day could it be attributed to fenbendazole administration. There were no increases in tumour incidence. The NOEL was 135 mg/kg b.w./day. Rats born during a multigeneration study received fenbendazole in the diet for 123 weeks at doses of 5, 15, 45, and 135 mg/kg b.w./day. Diarrhoea was observed at 45 and 135 mg/kg b.w./day; weight gain was reduced at these doses and in females at 5 mg/kg b.w./day. Lymph nodes were affected at all but the low dose of 5 mg/kg b.w./day, showing enlargement or cyst formation, sinus dilatation and reactive hyperplasia. The incidence of testicular interstitial-cell adenomas was increased in males at the dose level of 135 mg/kg b.w./day. The major target organ was the liver, which was affected at and above 15 mg/kg b.w./day. The following alterations were noted: increased serum alkaline phosphatase activity, hepatocellular hypertrophy and hyperplasia, bile duct proliferation and biliary cysts, and cytoplasmic vacuolation. There was a slight increase in the incidence of hepatocellular carcinomas in females at 135 mg/kg b.w./day. The Committee noted that the liver histopathology slides from the chronic toxicity study in rats had been assessed three times and, although there were some differences in criteria and terminology, a consensus had been reached. The incidence of hepatocellular carcinomas was very low, and there was no statistically significant increase as compared with controls. Nevertheless, given the extremely low incidence in concurrent and historical controls, tumours found in females receiving the highest dose of fenbendazole may have been related to treatment. It was noted that the small increase in carcinomas was observed against a background of statistically significant focal hyperplasia. The NOEL in this study was found to be 5 mg/kg b.w./day, based on pathological changes in the liver and lesions in the lymph nodes. In a series of studies in dogs, fenbendazole was administered in capsules for periods of 6 days to 6 months. The major toxic effect was lymphoid hyperplasia in the gastric mucosa and mesenteric lymph nodes, resulting in an overall NOEL of 4 mg/kg b.w./day. This effect was considered by the Committee less important than the changes seen in the liver of rats. A three-generation reproduction study was conducted in rats given fenbendazole in the diet at doses of 5, 15, 45, and 135 mg/kg b.w./day. Toxic effects in adult animals including diarrhoea, reduced weight gain, and pathological changes in the liver, were observed at and above 45 mg/kg b.w./day. At these doses there were also reductions in fertility, survival, and growth of neonates during lactation. The NOEL was 15 mg/kg b.w./day. Fenbendazole was tested for embryotoxicity and teratogenicity in rats and rabbits dosed by gavage. Embryotoxicity was not seen in either species, while fetotoxicity in the form of an increased frequency of occurrence of 13th ribs and delayed ossification of cranial bones occurred in rabbits given a dose of 63 mg/kg b.w./day. The NOEL were 2500 mg/kg b.w./day in rats and 25 mg/kg b.w./day in rabbits. In dogs, pigs, sheep, and cattle, the oral administration of fenbendazole at various times during the gestation period did not result in treatment-related effects in the offspring. Fenbendazole did not produce mutations in bacteria or chromosomal aberrations in two different in vivo tests. It increased the mitotic index of HeLa cells in vitro, an effect that could be related to the ability of benzimidazoles to interfere with tubulin polymerization and thus inhibit spindle formation. 4. EVALUATION The most significant toxicological findings with fenbendazole were in the rat liver. Since fenbendazole appears to be nongenotoxic, the Committee considered that a threshold would exist for these effects. Thus a NOEL was based on the absence of histopathological changes in the liver at 5 mg/kg b.w./day in the long-term toxicity/carcinogenicity study in rats. A temporary ADI of 0-25 µg/kg b.w. was established based on the NOEL of 5 mg/kg b.w./day and the application of a safety factor of 200. Even though a temporary ADI was established, it was not used for recommending MRLs. Before the toxicological issues relating to this compound can be resolved, additional information is required to explain the mechanism of the observed increased incidence of tumours in female rats at high doses, including the results of a study of in vivo DNA binding in the rat liver following oral administration of fenbendazole (see Summary section on the benzimadozoles). 5. REFERENCES BAEDER (1988) Teratogenicity study of fenbendazole in sows (German porker) when administered orally in the feed. 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See Also: Toxicological Abbreviations FENBENDAZOLE (JECFA Evaluation)