Brand name: Albenza
Drug class: Anthelmintics
VA class: AP200
Chemical name: [5-(Propylthio)-1H-benzimidazol-2-yl]-carbamic acid methyl ester
Molecular formula: C₁₂H₁₅N₃O₂S
CAS number: 54965-21-8

Medically reviewed by Drugs.com on Jun 1, 2023. Written by ASHP.

Introduction

Anthelmintic agent; benzimidazole derivative.^{1 4}

Uses for Albendazole

Neurocysticercosis

Treatment of parenchymal neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae, the larval form of Taenia solium (pork tapeworm).^{1 5 7 25 26 27 28 29 105 134}

Recommended antiparasitic treatment usually is albendazole, but a regimen of albendazole and praziquantel may be recommended depending on the number of viable parenchymal cysticerci.²⁵

Corticosteroids and anticonvulsant therapy may be indicated prior to and/or during albendazole treatment.^{1 5 6 25 26 28 29 105 134} (See Precautions Related to Neurocysticercosis under Cautions.)

Diagnosis and management of neurocysticercosis is complex; consult specialized references and experts.^{25 28 29 134}

Hydatid Disease

Treatment of cystic hydatid disease (unilocular hydatid disease) of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm (Echinococcus granulosus).^{1 3 5 7 134}

Surgery often is treatment of choice when medically feasible;^{3 5 7 11 12 134} perioperative use of an anthelmintic may be indicated to minimize risk of intraoperative dissemination of daughter cysts.^{7 11 134} Albendazole is drug of choice when an anthelmintic indicated.^{7 11 12 134}

Has been used for treatment of alveolar hydatid disease^{† [off-label]} caused by Echinococcus multilocularis.^{3 5 7 12 134} Surgical excision of the larval mass is the recommended and only reliable treatment.^{105 134} Long-term (months to years) albendazole treatment has been associated with clinical stability in some nonresectable cases and may rarely cure the infection.¹³⁴

Ascariasis

Treatment of ascariasis^{† [off-label]} caused by Ascaris lumbricoides (roundworm).^{105 134} Albendazole, mebendazole, and ivermectin are drugs of choice.^{105 134}

Baylisascariasis

Treatment of baylisascariasis^{† [off-label]} caused by Baylisascaris procyonis (raccoon roundworm);^{18 30 31 32 105 134} used with or without a corticosteroid.^{30 31 32 105 134}

CNS damage can occur before patient exhibits symptoms of baylisascariasis;^{18 30 32 105} anthelmintic started within 1–3 days of possible infection might prevent clinical disease by killing larvae before they enter CNS.^{18 134}

CDC and others recommend that albendazole (with or without a corticosteroid) be initiated as soon as possible in all probable or suspected cases of baylisascariasis (e.g., CNS disease with CSF eosinophilia and likely exposure).^{30 32 105 134} These experts also recommend immediate preemptive treatment with albendazole following known or suspected exposure to B. procyonis (e.g., ingestion of raccoon feces, oral exposure to soil or objects contaminated with raccoon feces, playing or working near raccoon latrines) while further diagnostic investigations are being conducted.^{30 32 105 134} Concomitant use of a corticosteroid usually recommended.^{30 31 32 105 134}

Information on prevention, diagnosis, and treatment of baylisascariasis is available from CDC at [Web].

Capillariasis

Treatment of capillariasis^{† [off-label]} caused by Capillaria philippinensis (Philippine threadworm).¹³⁴ Mebendazole is drug of choice; albendazole is an alternative.¹³⁴

Enterobiasis

Treatment of enterobiasis^{† [off-label]} caused by Enterobius vermicularis (pinworm).^{105 134} Albendazole, mebendazole, and pyrantel pamoate are drugs of choice.^{105 134}

Filariasis

Treatment of filariasis caused by Wuchereria bancrofti or Brugia malayi^† (roundworms).^{20 21 22 23 105 134} Diethylcarbamazine (available in the US from CDC) is the drug of choice.^{105 134} Ivermectin (with or without albendazole) has been used.^{20 21 22 23 105 134} A single dose of albendazole used in conjunction with either a single dose of diethylcarbamazine or ivermectin may be more effective than any one drug alone for suppression of microfilaremia caused by these organisms.^{20 21 22 105 134}

Has been used to reduce microfilaremia in the treatment of loiasis^† caused by Loa loa (roundworm).¹³⁴ Diethylcarbamazine (available in the US from the CDC) is the drug of choice;¹³⁴ albendazole may be useful when diethylcarbamazine is ineffective or cannot be used, but repeated courses may be necessary.¹³⁴

Gnathostomiasis

Treatment of gnathostomiasis^† caused by Gnathostoma spinigerum.¹³⁴ Albendazole or ivermectin (with or without surgical removal) is recommended.¹³⁴

Gongylonemiasis

Treatment of gongylonemiasis^† caused by Gongylonema.¹³⁴ Albendazole or surgical removal is recommended.¹³⁴

Hookworm Infections

Treatment of cutaneous larva migrans^† (creeping eruption) caused by dog or cat hookworms.^{105 134} Usually self-limited with spontaneous cure after several weeks or months; albendazole or ivermectin are drugs of choice when treatment is indicated.^{105 134}

Treatment of intestinal hookworm infections^† caused by Ancylostoma duodenale or Necator americanus.^{105 134} Albendazole, mebendazole, and pyrantel pamoate are drugs of choice.^{105 134}

Treatment of eosinophilic enterocolitis^† caused by Ancylostoma caninum (dog hookworm).¹³⁴ Treatment of choice is albendazole, mebendazole, or endoscopic removal of worms.¹³⁴

Oesophagostomiasis

Treatment of oesophagostomiasis^† caused by Oesophagostomum bifurcum.^{19 134} Albendazole or pyrantel pamoate may be effective.^{19 134}

Strongyloidiasis

Treatment of strongyloidiasis^† caused by Strongyloides stercoralis (threadworm).^{105 134} Drug of choice is ivermectin; albendazole is an alternative.^{105 134} Prolonged or repeated treatment may be necessary in people with hyperinfection and disseminated strongyloidiasis, and relapse can occur.¹⁰⁵

Toxocariasis (Visceral Larva Migrans)

Treatment of toxocariasis^† (visceral larva migrans) caused by Toxocara canis or T. cati (dog or cat roundworm).^{105 134} Albendazole and mebendazole are drugs of choice.^{105 134} Concomitant corticosteroids may be indicated in severe cases with cardiac, ocular, or CNS involvement.^{105 134} Antiparasitic treatment may not be effective for ocular larva migrans; inflammation may be reduced by corticosteroid injections; surgery may be necessary for secondary damage.¹⁰⁵

Trichinellosis

Treatment of trichinellosis^† (trichinosis) caused by Trichinella spiralis (pork worm).^{105 134} Drug of choice is albendazole; mebendazole is an alternative.¹³⁴ Concomitant corticosteroids usually recommended, especially for severe disease.^{105 134} Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.¹⁰⁵

Trichostrongyliasis

Treatment of trichostrongyliasis^† caused by Trichostrongylus.¹³⁴ Pyrantel pamoate is drug of choice; albendazole and mebendazole are alternatives.¹³⁴

Trichuriasis

Treatment of trichuriasis^† caused by Trichuris trichiura (whipworm).^{105 134} Albendazole is drug of choice; mebendazole and ivermectin are alternatives.^{105 134}

Trematode (Fluke) Infections

Treatment of infections caused by Clonorchis sinensis^† (Chinese liver fluke) or Opisthorchis viverrini^† (Southeast Asian liver fluke).¹³⁴ Albendazole and praziquantel are drugs of choice.¹³⁴ Other anthelmintics (usually praziquantel) recommended for all other fluke infections.¹³⁴

Giardiasis

Treatment of giardiasis^† caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis).^{105 134} Metronidazole, tinidazole, and nitazoxanide are drugs of choice.^{105 134} Albendazole is an alternative.¹³⁴

Microsporidiosis

Treatment of intestinal microsporidiosis^† caused by Encephalitozoon intestinalis.^{14 15 16 17 105 134 155 156} Albendazole is drug of choice.^{105 134 155 156}

Treatment of ocular microsporidiosis^†.^{14 15 16 17 134} Albendazole in conjunction with topical ophthalmic fumagillin (not commercially available in US) recommended.^{134 155 156} While topical fumagillin may clear susceptible microsporidia from the eye, albendazole is used to clear microsporidia that persist systemically.^{155 156} Topical fumagillin generally not effective for ocular lesions caused by Vittaforma corneae and keratoplasty may be necessary.¹³⁴

Treatment of disseminated microsporidiosis^† caused by microsporidia other than Enterocytozoon bieneusi and V. corneae.^{14 15 16 17 134 155 156} Albendazole is drug of choice.^{134 155 156} Used in conjunction with itraconazole for treatment of disseminated disease caused by Trachipleistophora or Anncaliia.¹⁵⁵

Ineffective for infections caused by E. bieneusi^{15 17 105 155} and V. corneae.¹⁵⁵

Related/similar drugs

doxycycline, metronidazole, vancomycin, Flagyl, ivermectin, itraconazole, mebendazole

Albendazole Dosage and Administration

General

• Evaluate blood cell counts prior to and during albendazole treatment.¹ (See Hematologic Effects under Cautions.)

• Evaluate hepatic enzymes (aminotransferases) prior to and during albendazole treatment.¹ (See Hepatic Effects under Cautions.)

• Perform pregnancy test prior to initiating albendazole in women of reproductive potential.¹ (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Administration

Oral Administration

Administer orally with food.¹ Food, especially fatty food, increases bioavailability.^{1 3 7}

In patients who have difficulty swallowing tablets whole (particularly children), tablets may be crushed or chewed and swallowed with a drink of water.¹

Dosage

Pediatric Patients

Neurocysticercosis

Oral

Children weighing <60 kg: 15 mg/kg daily (up to 800 mg daily), administered as 2 equally divided doses with meals, for 8–30 days.^{1 134} Repeat as necessary.¹³⁴

Children weighing ≥60 kg: 400 mg twice daily with meals for 8–30 days.^{1 134} Repeat as necessary.¹³⁴

Use corticosteroids and appropriate anticonvulsant therapy concomitantly as indicated.¹ (See Precautions Related to Neurocysticercosis under Cautions.)

Hydatid Disease

Oral

Children weighing <60 kg: 15 mg/kg daily (up to 800 mg daily), administered in 2 equally divided doses with meals for 28 days, followed by a 14-day albendazole-free interval.¹ Repeat for a total of 3 dosage cycles.¹

Children weighing ≥60 kg: 400 mg twice daily with meals for 28 days, followed by a 14-day albendazole-free interval.¹ Repeat for a total of 3 dosage cycles.¹

Alternatively, 15 mg/kg daily (up to 800 mg daily) for 1–6 months has been recommended by some clinicians.¹³⁴

Ascariasis (Roundworm)†

Oral

Single 400-mg dose.¹³⁴

Baylisascariasis (Raccoon Roundworm)†

Oral

20–50 mg/kg daily with or without a corticosteroid is recommended by CDC and others for treatment, including preemptive treatment (see Baylisascariasis under Uses).^{18 30 32 134}

Initiate treatment immediately if baylisascariasis is probable;^{18 32 105} do not delay treatment until patient is symptomatic or diagnosis confirmed.¹⁸ Continue treatment for at least 10 days;³² usually has been continued for 3–6 weeks.^{31 32}

Initiate preemptive treatment immediately following suspected or confirmed exposure to B. procyonis.^{30 32} Continue for 10–20 days while conducting further diagnostic investigations.³⁰

Capillariasis (Philippine Threadworm)†

Oral

400 mg once daily for 10 days.¹³⁴

Enterobiasis (Pinworm)†

Oral

400-mg initial dose followed by a second 400-mg dose given 2 weeks later.¹³⁴

Some clinicians state consider treating all household contacts, especially when multiple or repeated symptomatic infections are occurring in the household.^{105 134}

Gnathostomiasis†

Oral

400 mg twice daily for 21 days.¹³⁴

Gongylonemiasis†

Oral

400 mg daily for 3 days.¹³⁴

Hookworm Infections†

Cutaneous Larva Migrans (Creeping Eruption)†

Oral

400 mg once daily for 3 days.¹³⁴

Intestinal Hookworm Infections†

Oral

Single 400-mg dose.¹³⁴

Perform a repeat stool examination (using a concentration technique) for eggs of A. duodenale or N. americanus 2 weeks after treatment; repeat dose if results are positive.¹⁰⁵

Eosinophilic Enterocolitis Caused by Ancylostoma caninum (Dog Hookworm)†

Oral

Single 400-mg dose.¹³⁴

Strongyloidiasis†

Oral

400 mg twice daily for 7 days.¹³⁴

Repeated or prolonged treatment or use of other agents may be necessary in immunocompromised individuals or those with disseminated disease.^{105 134}

Toxocariasis (Visceral Larva Migrans Caused by Dog or Cat Roundworm)†

Oral

400 mg twice daily for 5 days has been recommended.¹³⁴

Optimum duration of treatment not known; some clinicians recommend up to 20 days of treatment.¹³⁴ For severe symptoms or eye involvement, some clinicians state treatment may be extended to 2–4 weeks.¹³⁴

Trichinellosis (Pork Worm)†

Oral

400 mg twice daily for 8–14 days.¹³⁴

Trichostrongyliasis†

Oral

Single 400-mg dose.¹³⁴

Trichuriasis (Whipworm)†

Oral

400 mg once daily for 3 days.¹³⁴

Trematode (Fluke) Infections Caused by C. sinensis or O. viverrini†

Oral

10 mg/kg daily for 7 days.¹³⁴

Giardiasis†

Oral

10 mg/kg daily for 5 days.¹³⁴

Microsporidiosis†

Intestinal Microsporidiosis†

Oral

7.5 mg/kg (up to 400 mg) twice daily.^{134 156}

Some clinicians recommend treatment duration of 21 days.¹³⁴ In HIV-infected patients, experts recommend continuing treatment until symptoms resolve and sustained immune response to antiretroviral therapy attained (CDC immunologic category 1 or 2 for >6 months).¹⁵⁶

Ocular Microsporidiosis†

Oral

7.5 mg/kg (up to 400 mg) twice daily.^{134 156}

In HIV-infected patients, experts recommend continuing treatment until ocular symptoms resolve and sustained immune response to antiretroviral therapy attained (CDC immunologic category 1 or 2 for >6 months).¹⁵⁶

Disseminated Microsporidiosis†

Oral

7.5 mg/kg (up to 400 mg) twice daily.^{134 156}

In HIV-infected patients, experts recommend continuing treatment until symptoms resolve and sustained immune response to antiretroviral therapy attained (CDC immunologic category 1 or 2 for >6 months).¹⁵⁶

Adults

Neurocysticercosis

Oral

Adults <60 kg: 15 mg/kg daily (up to 800 mg daily), administered in 2 equally divided doses with meals, for 8–30 days.^{1 134} Repeat as necessary.¹³⁴

Adults ≥60 kg: 400 mg twice daily with meals for 8–30 days.^{1 5 134} Repeat as necessary.¹³⁴

Use corticosteroids and appropriate anticonvulsant therapy concomitantly as indicated.¹ (See Precautions Related to Neurocysticercosis under Cautions.)

Hydatid Disease

Oral

Adults <60 kg: 15 mg/kg daily (up to 800 mg daily), administered in 2 equally divided doses with meals for 28 days, followed by a 14-day albendazole-free interval.¹ Repeat for a total of 3 dosage cycles.¹

Adults ≥60 kg: 400 mg twice daily with meals for 28 days, followed by a 14-day albendazole-free interval.¹ Repeat for a total of 3 dosage cycles.¹

Alternatively, 15 mg/kg daily (not to exceed 800 mg daily) for 1–6 months has been recommended by some clinicians.¹³⁴

Ascariasis (Roundworm)†

Oral

Single 400-mg dose.¹³⁴

Baylisascariasis (Raccoon Roundworm)†

Oral

20–50 mg/kg daily with or without a corticosteroid is recommended by CDC and others for treatment, including preemptive treatment (see Baylisascariasis under Uses).^{18 30 32 134}

Initiate treatment immediately if baylisascariasis is probable;^{18 32 105} do not delay treatment until patient is symptomatic or diagnosis confirmed.¹⁸ Continue treatment for at least 10 days;³² usually has been continued for 3–6 weeks.^{31 32}

Initiate preemptive treatment immediately following suspected or confirmed exposure to B. procyonis.^{30 32} Continue for 10–20 days while conducting further diagnostic investigations.³⁰

Capillariasis (Philippine Threadworm)†

Oral

400 mg once daily for 10 days.¹³⁴

Enterobiasis (Pinworm)†

Oral

400-mg initial dose followed by a second 400-mg dose given 2 weeks later.¹³⁴

Some clinicians state consider treating all household contacts, especially when multiple or repeated symptomatic infections are occurring in the household.^{105 134}

Gnathostomiasis†

Oral

400 mg twice daily for 21 days.¹³⁴

Gongylonemiasis†

Oral

400 mg daily for 3 days.¹³⁴

Hookworm Infections†

Cutaneous Larva Migrans (Creeping Eruption)†

Oral

400 mg once daily for 3 days.¹³⁴

Intestinal Hookworm Infections†

Oral

Single 400-mg dose.¹³⁴

Perform a repeat stool examination (using a concentration technique) for eggs of A. duodenale or N. americanus 2 weeks after treatment; repeat dose if results are positive.¹⁰⁵

Eosinophilic Enterocolitis Caused by Ancylostoma caninum (Dog Hookworm)†

Oral

Single 400-mg dose.¹³⁴

Strongyloidiasis†

Oral

400 mg twice daily for 7 days.¹³⁴

Repeated or prolonged treatment or use of other agents may be necessary in immunocompromised individuals or those with disseminated disease.^{105 134}

Toxocariasis (Visceral Larva Migrans Caused by Dog or Cat Roundworm)†

Oral

400 mg twice daily for 5 days has been recommended.¹³⁴

Optimum duration of treatment not known; some clinicians recommend up to 20 days of treatment.¹³⁴ For severe symptoms or eye involvement, some clinicians state treatment may be extended to 2–4 weeks.¹³⁴

Trichinellosis (Pork Worm)†

Oral

400 mg twice daily for 8–14 days.¹³⁴

Trichostrongyliasis†

Oral

Single 400-mg dose.¹³⁴

Trichuriasis (Whipworm)†

Oral

400 mg once daily for 3 days.¹³⁴

Trematode (Fluke) Infections Caused by C. sinensis or O. viverrini†

Oral

10 mg/kg daily for 7 days.¹³⁴

Giardiasis†

Oral

400 mg daily for 5 days.¹³⁴

Microsporidiosis†

Intestinal Microsporidiosis†

Oral

400 mg twice daily.¹³⁴

Some clinicians recommend a treatment duration of 21 days.¹³⁴ In HIV-infected patients, experts recommend continuing treatment until symptoms resolve and sustained immune response to antiretroviral therapy attained (CD4⁺ T-cell count >200 cells/mm³ for at least 6 months).¹⁵⁵

Ocular Microsporidiosis†

Oral

400 mg twice daily.¹³⁴

In HIV-infected patients, experts recommend continuing treatment until ocular symptoms resolve and sustained immune response to antiretroviral therapy attained (CD4⁺ T-cell count >200 cells/mm³ for at least 6 months).¹⁵⁵

Disseminated Microsporidiosis†

Oral

400 mg twice daily.¹³⁴

In HIV-infected patients, experts recommend continuing treatment until symptoms resolve and sustained immune response to antiretroviral therapy attained (CD4⁺ T-cell count >200 cells/mm³ for at least 6 months).¹⁵⁵

Prescribing Limits

Pediatric Patients

Neurocysticercosis

Oral

Children weighing <60 kg: Maximum 800 mg daily.^{1 134}

Hydatid Disease

Oral

Children weighing <60 kg: Maximum 800 mg daily.^{1 134}

Microsporidiosis†

Oral

Maximum dose 400 mg.¹³⁴

Adults

Neurocysticercosis

Oral

Adults weighing <60 kg: Maximum 800 mg daily.^{1 134}

Hydatid Disease

Oral

Adults weighing <60 kg: Maximum 800 mg daily.^{1 134}

Special Populations

No special population dosage recommendations.

Cautions for Albendazole

Contraindications

• Hypersensitivity to benzimidazole derivatives or any component in the formulation.¹

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions, including rash and urticaria, reported rarely.¹ Erythema multiforme and Stevens-Johnson syndrome reported during postmarketing experience.¹

Hematologic Effects

May cause bone marrow suppression, aplastic anemia, and agranulocytosis.¹ Leukopenia, granulocytopenia, pancytopenia, agranulocytosis, and thrombocytopenia reported in <1% of patients receiving the drug.¹ Fatalities related to granulocytopenia or pancytopenia reported.¹

Monitor blood cell counts at the beginning of each 28-day cycle of albendazole treatment and every 2 weeks during treatment.¹ Patients with liver disease and those with hepatic echinococcosis are at increased risk for bone marrow suppression; monitor blood cell counts more frequently in such patients.¹

Discontinue albendazole if clinically important decreases in blood cell counts occur.¹

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm.¹ Teratogenic effects (embryotoxicity, skeletal malformations) reported in rats and rabbits.¹

Exclude pregnancy before initiating albendazole in women of reproductive potential.¹ Avoid pregnancy during and for at least 1 month after final dose.¹

If patient becomes pregnant, immediately discontinue the drug and apprise patient of the potential hazard to the fetus.¹ (See Pregnancy under Cautions.)

Hepatic Effects

Mild to moderate increases of hepatic enzymes reported in about 16% of patients in clinical trials.¹ Hepatic enzymes generally returned to normal when the drug discontinued, but acute liver failure of uncertain casualty and hepatitis have been reported.¹

Patients with elevated hepatic enzymes are at increased risk for hepatotoxicity.¹ Discontinue albendazole if clinically important increases in hepatic enzymes occur.¹

Evaluate hepatic aminotransferase concentrations at the beginning of each cycle of albendazole treatment and at least every 2 weeks during treatment.¹ If hepatic enzymes exceed twice the ULN, consider discontinuing the drug based on the individual patient circumstance.¹ Decisions to re-institute albendazole when hepatic enzymes return to pretreatment levels should be individualized taking into account the risks and benefits of further albendazole treatment.¹ If the drug is re-instituted, perform laboratory tests frequently.¹

Precautions Related to Neurocysticercosis

In patients with neurocysticercosis, adverse CNS effects (e.g., seizures, increased intracranial pressure and focal signs, hydrocephalus) may occur resulting from inflammatory reactions caused by albendazole-induced death of parasites within the brain.^{1 5 7} Use appropriate corticosteroid and anticonvulsant treatment as required.^{1 5 7 134} Consider oral or IV corticosteroid therapy during first week of treatment to prevent cerebral hypertensive episodes.¹

Patients with neurocysticercosis may have retinal lesions, and destruction of cysticercal lesions by albendazole may cause retinal damage.^{1 5 134} Prior to treatment of neurocysticercosis, examine patient for retinal lesions.¹ In those with such lesions, weigh need for treatment against possibility of irreparable retinal damage resulting from inflammatory reactions caused by albendazole-induced death of parasites in the eye.^{1 5 134}

Undiagnosed neurocysticercosis may be uncovered in patients receiving albendazole treatment for other conditions.¹ Before initiating albendazole, evaluate patients with epidemiologic factors that increase risk for neurocysticercosis.¹

Specific Populations

Pregnancy

May cause fetal harm.¹ Use during pregnancy only if potential benefits justify risks to the fetus and only when no alternative management is appropriate.¹ (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Use in women of childbearing age only after a negative pregnancy test.¹ Advise women of childbearing age to use effective contraceptive measures during and for 1 month after albendazole treatment.¹

Discontinue immediately if patient becomes pregnant;¹ advise the woman of the potential hazard to the fetus.¹

Lactation

Distributed into milk in animals;¹ distribution into human milk also reported.²⁴

Use with caution in nursing women.¹

Pediatric Use

Has been used for treatment of neurocysticercosis in pediatric patients; efficacy appears similar to that in adults and no unusual problems were reported.¹

Hydatid disease is uncommon in infants and young children.¹

Geriatric Use

Data insufficient to determine whether safety and efficacy of albendazole in patients ≥65 years of age differ from that in younger patients.¹

Hepatic Impairment

Individuals with hepatic impairment are at increased risk for hepatotoxicity and bone marrow suppression during albendazole treatment.¹

Discontinue albendazole if hepatic enzymes exceed twice the ULN or if clinically important decreases in blood counts occur.¹

Renal Impairment

Not studied.¹

Common Adverse Effects

Treatment of neurocysticercosis: Headache, nausea, vomiting, increased intracranial pressure, meningeal signs.¹

Treatment of hydatid disease: Elevated hepatic enzymes, abdominal pain, nausea, vomiting, reversible alopecia, fever, headache, vertigo, dizziness.¹

Drug Interactions

Induces CYP1A isoenzyme.¹

Specific Drugs

Albendazole Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from GI tract because of low aqueous solubility.¹

Rapidly converted to active metabolite (albendazole sulfoxide) before reaching systemic circulation.¹ Peak plasma concentrations of albendazole sulfoxide attained 2–5 hours after a dose.¹

Food

Oral bioavailability enhanced by coadministration with fatty meal (estimated fat content 40 g); plasma concentrations up to fivefold higher compared with administration in fasted state.¹

Distribution

Extent

Widely distributed throughout body.¹ Detected in urine, bile, liver, cyst wall, cyst fluid, and CSF.¹

Plasma Protein Binding

70%.¹

Elimination

Metabolism

Rapidly converted in liver to active metabolite (albendazole sulfoxide) which is responsible for anthelmintic activity.¹ Further metabolized to albendazole sulfone and other primary oxidative metabolites.¹

Elimination Route

Albendazole is undetectable in urine; <1% of albendazole sulfoxide detectable in urine.¹ Albendazole sulfoxide partially eliminated in bile.¹

Half-life

Albendazole sulfoxide: 8–12 hours.¹

Special Populations

Extrahepatic obstruction: Increased albendazole sulfoxide serum concentrations and prolonged half-life.¹ Elimination half-life of albendazole sulfoxide may be 31.7 hours.¹

Renal impairment: Pharmacokinetics not studied to date.¹

Pediatric patients: Pharmacokinetics in patients 6–13 years of age similar to that in adults.¹

Geriatric patients: Pharmacokinetics not fully evaluated; data from patients up to 79 years of age with hydatid cysts suggest pharmacokinetics similar to healthy young adults.¹

Stability

Storage

Oral

Tablets

20–25°C.¹

Actions and Spectrum

• Benzimidazole derivative anthelmintic agent;^{1 4} structurally related to mebendazole.⁴

• Principal anthelmintic effect of benzimidazoles appears to be specific, high-affinity binding to free β-tubulin in parasite cells,^{1 3 4} resulting in selective inhibition of parasite microtubule polymerization,^{1 3 4} and inhibition of microtubule-dependent uptake of glucose,^{2 3 6} which leads to parasitic death.¹

• Benzimidazole derivatives bind to the β-tubulin of parasites at much lower concentrations than to mammalian β-tubulin protein;⁴ the drugs do not inhibit glucose uptake in mammals, and do not appear to have any effect on blood glucose concentrations in humans.^{2 6}

• Active against the larval forms of Echinococcus granulosus and Taenia solium.¹

• Resistance to albendazole can occur when amino acid changes cause changes in parasite β-tubulin protein resulting in reduced binding of the drug.¹

Advice to Patients

• Advise patients of the importance of taking albendazole with food to increase oral bioavailability.¹

• Advise patients who experience difficulty swallowing the tablets whole (particularly children) that the tablets may be crushed or chewed and swallowed with a drink of water.¹

• Advise patients that albendazole has been associated with adverse hematologic and hepatic effects and that routine (every 2 weeks) monitoring of blood cell counts and liver function tests is important.¹

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹

• Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.¹

• Advise women of reproductive potential to use effective contraceptive measures to avoid becoming pregnant during and for 1 month after completion of albendazole treatment.¹

• Importance of informing patients of other important precautionary information.¹ (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Frequently asked questions

• What are Zentel 400mg used for?
• Albendazole: How long does it take to kill all the pinworms?

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