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Albendazole

Medically reviewed by Drugs.com. Last updated on Mar 26, 2020.

Pronunciation

(al BEN da zole)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral:

Albenza: 200 mg

Albenza: 200 mg [DSC] [contains saccharin sodium]

Generic: 200 mg

Brand Names: U.S.

  • Albenza

Pharmacologic Category

  • Anthelmintic

Pharmacology

Active metabolite, albendazole sulfoxide, causes selective degeneration of cytoplasmic microtubules in intestinal and tegmental cells of intestinal helminths and larvae; glycogen is depleted, glucose uptake and cholinesterase secretion are impaired, and desecratory substances accumulate intracellulary. ATP production decreases causing energy depletion, immobilization, and worm death.

Absorption

Poor from the GI tract; may increase up to 5 times when administered with a fatty meal

Distribution

Widely distributed throughout the body including urine, bile, liver, cyst wall, cyst fluid, and CSF

Metabolism

Hepatic; extensive first-pass effect; pathways include rapid sulfoxidation to active metabolite (albendazole sulfoxide [major]), hydrolysis, and oxidation

Excretion

Urine (<1% as active metabolite); feces

Time to Peak

Serum: 2 to 5 hours for the metabolite

Half-Life Elimination

8 to 12 hours (albendazole sulfoxide)

Protein Binding

70%

Special Populations: Hepatic Function Impairment

Systemic availability, rate of absorption, and the elimination half-life of albendazole sulfoxide are increased in patients with extrahepatic obstruction.

Use: Labeled Indications

Hydatid disease (Echinococcus granulosus, dog tapeworm): Treatment of cystic hydatid disease of the liver, lung, and peritoneum caused by the larval form of the dog tapeworm, E. granulosus.

Neurocysticercosis (Taenia solium, pork tapeworm), parenchymal disease: Treatment of parenchymal neurocysticercosis due to active lesions caused by larval forms of the pork tapeworm, T. solium.

Off Label Uses

Ancylostoma caninum (eosinophilic enterocolitis)

Clinical experience suggests the utility of albendazole in the treatment of Ancylostoma caninum [Drugs for Parasitic Infections 2013].

Ancylostoma duodenale or Necator americanus (hookworms)

Data from a randomized, controlled, single-blind (outcome assessor-blinded) trial support the use of albendazole for treatment of hookworm infection [Steinmann 2011]. Clinical experience suggests the utility of albendazole in the treatment of hookworm infection [Drugs for Parasitic Infections 2013].

Ascariasis (intestinal roundworm)

Clinical experience suggests the utility of albendazole in the treatment of Ascaris lumbricoides [Drugs for Parasitic Infections 2013].

Clonorchis sinensis (Chinese liver fluke) or Opisthorchis viverrini (Southeast Asian liver fluke)

Clinical experience suggests the utility of albendazole in the treatment of fluke infection [Drugs for Parasitic Infections 2013].

Cutaneous larva migrans (dog and cat hookworm)

Clinical experience suggests the utility of albendazole in the treatment of cutaneous larva migrans [Drugs for Parasitic Infections 2013].

Enterobiasis (pinworm)

Clinical experience suggests the utility of albendazole in the treatment of pinworm infection [Drugs for Parasitic Infections 2013].

Giardiasis (Giardia duodenalis)

Data from a randomized, controlled trial support the use of albendazole for treatment of Giardia duodenalis infection [Karabay 2004]. Clinical experience suggests the utility of albendazole as an alternative agent in the treatment of giardiasis [Drugs for Parasitic Infections 2013].

Gnathostomiasis (Gnathostoma spinigerum)

Clinical experience suggests the utility of albendazole in the treatment of Gnathostoma spinigerum infection [Drugs for Parasitic Infections 2013].

Gongylonemiasis (Gongylonema spp.)

Clinical experience suggests the utility of albendazole in the treatment of Gongylonema spp. infection [Drugs for Parasitic Infections 2013].

Microsporidiosis

Based on the US Department of Health and Human Services guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV, albendazole is an effective and recommended agent in the management of intestinal or disseminated microsporidiosis (caused by microsporidia other than Enterocytozoon bieneusi and Vittaforma corneae) and for disseminated microsporidiosis (caused by Trachipleistophora or Anncaliia) in adolescent and adult patients with HIV. Based on the Infectious Diseases Society of America (IDSA) guideline for the diagnosis and management of infectious diarrhea, albendazole is an effective and recommended agent in the management of intestinal or disseminated microsporidiosis (not ocular) caused by microsporidia other than E. bieneusi or V. corneae. Clinical experience suggests the utility of albendazole in the treatment of microsporidiosis infection [Drugs for Parasitic Infections 2013].

Oesophagostomum bifurcum

Data from an open-label, uncontrolled trial suggest that albendazole may be beneficial for the treatment of Oesophagostomum bifurcum infection [Ziem 2004]. Clinical experience also suggests the utility of albendazole in the treatment of O. bifurcum infection [Drugs for Parasitic Infections 2013].

Toxocariasis

Clinical experience suggests the utility of albendazole in the treatment of ocular larva migrans with sight-threatening ocular inflammation and moderate to severe visceral larva migrans [Barisani-Asenbauer 2001], [Drugs for Parasitic Infections 2013], [Jee 2016].

Trichinellosis (Trichinella spiralis)

Based on the IDSA guideline for the diagnosis and management of infectious diarrhea, albendazole is an effective and recommended agent in the management of Trichinella spp. infection.

Clinical experience also suggests the utility of albendazole in the treatment of T. spiralis infection [Drugs for Parasitic Infections 2013].

Contraindications

Hypersensitivity to albendazole, benzimidazoles, or any component of the formulation

Dosing: Adult

Ancylostoma caninum (eosinophilic enterocolitis) (off-label use): Oral: 400 mg as a single dose (Drugs for Parasitic Infections 2013).

Ancylostoma duodenale or Necator americanus (hookworms) (off-label use): Oral: 400 mg as a single dose (Drugs for Parasitic Infections 2013; Steinmann 2011).

Ascariasis (intestinal roundworm) (off label): Oral: 400 mg as a single dose (Drugs for Parasitic Infections 2013).

Clonorchis sinensis (Chinese liver fluke) or Opisthorchis viverrini (Southeast Asian liver fluke) (off-label use): Oral: 10 mg/kg/day for 7 days (Drugs for Parasitic Infections 2013).

Cutaneous larva migrans (dog and cat hookworm) (off-label use): Oral: 400 mg once daily for 3 days (Drugs for Parasitic Infections 2013).

Enterobiasis (pinworm) (off-label use): Oral: 400 mg as a single dose; repeat in 2 weeks (Drugs for Parasitic Infections 2013).

Giardiasis (Giardia duodenalis) (alternative agent) (off-label use): Oral: 400 mg once daily for 5 days (Drugs for Parasitic Infections 2013; Karabay 2004).

Gnathostomiasis (Gnathostoma spinigerum) (off-label use): Oral: 400 mg twice daily for 21 days (Drugs for Parasitic Infections 2013).

Gongylonemiasis (Gongylonema spp.) (off-label use): Oral: 400 mg once daily for 3 days (Drugs for Parasitic Infections 2013).

Hydatid disease (Echinococcus granulosis, dog tapeworm): Oral:

<60 kg: 15 mg/kg/day in 2 divided doses (maximum: 800 mg/day).

≥60 kg: 800 mg/day in 2 divided doses.

Duration: Optimal duration uncertain; 1 to 6 months based on clinical factors (Drugs for Parasitic Infections 2013).

Microsporidiosis(off-label use):

Immunocompetent patients:

Disseminated infection: Oral: 400 mg twice daily (Drugs for Parasitic Infections 2013).

Intestinal (Encephalitozoon intestinalis) infection: Oral: 400 mg twice daily for 21 days (Drugs for Parasitic Infections 2013).

Ocular infection: Oral: 400 mg twice daily, in combination with topical fumagillin (Drugs for Parasitic Infections 2013).

Immunocompromised patients (eg, patients with HIV):

Disseminated or intestinal infection (other than Enterocytozoon bieneusi or Vittaforma corneae): Oral: 400 mg twice daily for 21 days (HHS [OI Adults 2019]; La Hoz 2019); for patients with HIV, continue until CD4 count >200 cells/mm3 for >6 months after initiation of antiretroviral therapy (HHS [OI Adults 2019]).

Ocular infection: Oral: 400 mg twice daily, in combination with topical fumagillin; continue until resolution of ocular symptoms and until CD4 count >200 cells/mm3 for >6 months after initiation of antiretroviral therapy (HHS [OI Adults 2019]).

Neurocysticercosis (Taenia solium, pork tapeworm), parenchymal disease: Oral: 15 mg/kg/day in 2 divided doses (maximum: 1.2 g/day) for 10 to 14 days; may be repeated if persistent viable lesions on 6-month follow-up imaging. Note: Concomitant therapy with praziquantel is recommended if >2 viable cysts present (Garcia 2014; IDSA/ASTMH [White 2018]). Initiate adjunctive corticosteroid therapy prior to initiation of albendazole. Antiparasitic therapy should not be initiated in patients with untreated hydrocephalus, calcified lesions, or cysticercal encephalitis; consult an infectious diseases specialist for specific treatment recommendations (IDSA/ASTMH [White 2018]).

Oesophagostomum bifurcum (off-label use): Oral: 400 mg as a single dose (Ziem 2004).

Toxocariasis (off-label use):

Ocular larva migrans with sight-threatening ocular inflammation: Oral: Optimal dose is unknown: 400 mg twice daily for 2 weeks (Jee 2016); 800 mg twice daily has also been described (Barisani-Asenbauer 2001). Give with concomitant corticosteroids (Barisani-Asenbauer 2001; Jee 2016).

Visceral larva migrans, moderate to severe: Oral: 400 mg twice daily generally for 5 days; consider concomitant corticosteroids for severe infection (Drugs for Parasitic Infections 2013).

Trichinellosis (Trichinella spiralis) (off-label use): Oral: 400 mg twice daily for 8 to 14 days; concomitant corticosteroids may be given for severe symptoms (Drugs for Parasitic Infections 2013).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Ascariasis (intestinal roundworm): Limited data available:

Children ≤2 years: Oral: 200 mg as a single dose; may repeat in 3 weeks (WHO 2010).

Children >2 years and Adolescents: Oral: 400 mg as a single dose; may repeat in 3 weeks (Parasitic Infections 2013; Red Book [AAP 2018]; WHO 2010).

Baylisascaris procyonis (raccoon roundworm), postexposure prophylaxis and treatment: Limited data available:

Children and Adolescents: Oral: Frequently reported dose: 40 mg/kg/day (range: 20 to 50 mg/kg/day) in a single or 2 divided doses or 400 mg twice daily. Initiate as soon as possible after potential exposure (ideally within 3 days) to prevent clinical disease in any child at risk (eg, ingestion of raccoon stool or contaminated soil). Duration for prophylaxis is at least 10 days. Reported treatment duration is usually 4 weeks (Gavin 2002; Graeff-Teixeira 2016; Hajek 2009; Murray 2004; Pai 2007; Park 2000; Peters 2012).

Capillariasis: Limited data available: Children and Adolescents: Oral: 400 mg once daily for at least 10 days (CDC 2020; Parasitic Infections 2013; Sawamura 1999).

Enterobiasis (pinworm): Limited data available:

Children ≤2 years: Oral: 200 mg as a single dose; may repeat in 3 weeks (WHO 2010).

Children >2 years and Adolescents: Oral: 400 mg as a single dose; repeat in 2 to 3 weeks (Bradley 2019; Red Book [AAP 2018]; WHO 2010).

Giardiasis (Giardia duodenalis) (alternative therapy): Limited data available: Children ≥2 years and Adolescents: Oral: 10 mg/kg/dose once daily for 5 days; maximum dose: 400 mg/dose (Parasitic Infections 2013; Yereli 2004).

Hookworm, zoonotic (cutaneous larva migrans) (Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylanicum, Uncinaria stenocephala):

Infants ≥8 months: Very limited data available: Oral: 200 mg once daily for 3 days. Dosing based on 4 cases (ages 8, 11, 12, and 13 months) of infants who showed clinical improvement after therapy. There was complete resolution of infection in 2 of these infants; one infant had initial improvement, then recurrence requiring a second course of therapy and eventually alternate therapy, and another infant had resolution of symptoms followed by appearance of a similar lesion at a different location 3 months later, received a second course, and had rapid resolution of all symptoms (Black 2010).

Children and Adolescents: Limited data available: Oral: 15 mg/kg/dose once daily for 3 days; maximum dose: 400 mg/dose (Bradley 2019; CDC 2020; Red Book [AAP 2018]; WHO 2010).

Hookworms, human (Ancylostoma duodenale or N. americanus):

Infants ≥3 months: Very limited data available: Oral: 200 mg as a single dose. Dosing based on two cases (patient #1: age: 12 weeks, weight: 4.2 kg; and patient #2: age: 8 months, weight: 5.8 kg) of exclusively breastfed infants who showed clinical improvement after single-dose albendazole therapy (Bhatia 2010).

Children ≤2 years: Limited data available: Oral: 200 mg as a single dose; may repeat in 3 weeks (WHO 2007; WHO 2010).

Children >2 years and Adolescents: Limited data available: Oral: 400 mg as a single dose; may repeat in 3 weeks (Red Book [AAP 2018]; WHO 2007; WHO 2010).

Hydatid disease (E. granulosus, dog tapeworm): Children and Adolescents: Oral: 5 to 7.5 mg/kg/dose twice daily for 1 to 6 months; maximum dose: 400 mg/dose (CDC 2020; Red Book [AAP 2018]).

Liver flukes (C. sinensis or O. viverrini): Limited data available: Children and Adolescents: Oral: 10 mg/kg/dose once daily for 7 days (CDC 2020; Parasitic Infections 2013).

Microsporidia infection (except Enterocytozoon spp. and Vittaforma corneae): Limited data available:

Children and Adolescents: Oral: 7.5 mg/kg/dose twice daily; maximum dose: 400 mg/dose (HHS [pediatric 2016]; Parasitic Infections 2013) in HIV-exposed/-infected, continue until resolution of signs and symptoms and sustained immune reconstitution (>6 months at CDC immunologic category 1 or 2) after antiretroviral therapy initiation (HHS [pediatric 2019]).

Neurocysticercosis (T. solium, pork tapeworm), parenchymal disease: Note: Patients should receive concurrent corticosteroid for the first week of albendazole therapy and anticonvulsant therapy as required.

Children and Adolescents: Oral: 7.5 mg/kg/dose twice daily for 8 to 30 days; maximum dose: 600 mg/dose (IDSA/ASTMH [White 2018]; Red Book [AAP 2018]; manufacturer's labeling). Note: Guidelines recommend treating for 10 to 14 days and addition of praziquantel if >2 viable cysts present (IDSA/ASTMH [White 2018]).

Strongyloidiasis (S. stercoralis): Limited data available: Children and Adolescents: Oral: 400 mg twice daily for 7 days (Bradley 2019; Parasitic Infections 2013; Red Book [AAP 2018]).

Toxocariasis: Limited data available:

Ocular larva migrans: Oral: Children and Adolescents: 400 mg twice daily for 10 to 14 days in combination with corticosteroids (Barisani-Asenbaur 2001; Frazier 2009; Red Book [AAP 2018]); durations of up to 4 weeks have also been reported (Bradley 2019; Parasitic Infections 2013).

Visceral larva migrans: Oral: Children and Adolescents: 400 mg twice daily for 5 days (Bradley 2019; CDC 2020; Parasitic Infections 2013; Red Book [AAP 2018]).

Trichinellosis (Trichinosis): Limited data available: Children and Adolescents: Oral: 400 mg twice daily for 8 to 14 days (CDC 2020; Parasitic Infections 2013; WHO 2010).

Trichuriasis (whipworm): Limited data available: Children >2 years and Adolescents: Oral: 400 mg once daily for 3 days (Parasitic Infections 2013; WHO 2010); mild cases may be treated with a single dose of 200 to 400 mg; may repeat course in 3 weeks (WHO 2010).

Administration

Oral: Administer with a high-fat meal if treating a systemic infection (to increase absorption). Administration on an empty stomach may be appropriate for treating an intraluminal infection with no systemic involvement (Lange 1988). If patients have difficulty swallowing, tablets may be crushed or chewed, then swallowed with a drink of water.

Storage

Store between 20°C and 25°C (68°F to 77°F)

Drug Interactions

CarBAMazepine: May decrease serum concentrations of the active metabolite(s) of Albendazole. Monitor therapy

Grapefruit Juice: May increase serum concentrations of the active metabolite(s) of Albendazole. Monitor therapy

PHENobarbital: May decrease serum concentrations of the active metabolite(s) of Albendazole. Monitor therapy

Phenytoin: May decrease serum concentrations of the active metabolite(s) of Albendazole. Monitor therapy

Ritonavir: May decrease the serum concentration of Albendazole. Monitor therapy

Adverse Reactions

>10%:

Central nervous system: Headache (neurocysticercosis: 11%; hydatid: 1%)

Hepatic: Increased liver enzymes (hydatid: 16%; neurocysticercosis: <1%)

1% to 10%:

Central nervous system: Increased intracranial pressure (≤2%), dizziness (≤1%), vertigo (≤1%), meningism (1%)

Dermatologic: Alopecia (<1% to 2%)

Gastrointestinal: Abdominal pain (≤6%), nausea and vomiting (4% to 6%)

Miscellaneous: Fever (≤1%)

<1%, postmarketing, and/or case reports: Acute hepatic failure, acute renal failure, agranulocytosis, aplastic anemia, erythema multiforme, granulocytopenia, hepatitis, hypersensitivity reaction, leukopenia, neutropenia, pancytopenia, skin rash, Stevens-Johnson syndrome, thrombocytopenia, urticaria

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Agranulocytosis, aplastic anemia, granulocytopenia, leukopenia, and pancytopenia have occurred leading to fatalities (rare); use with caution in patients with hepatic impairment (more susceptible to hematologic toxicity). Discontinue therapy in all patients who develop clinically significant decreases in blood cell counts.

• Transaminase elevations: Reversible elevations in hepatic enzymes have been reported. Patients with abnormal LFTs and hepatic echinococcosis are at an increased risk of hepatotoxicity. Discontinue therapy if LFT elevations are >2 times the upper limit of normal; may consider restarting treatment (with frequent monitoring of LFTs) when hepatic enzymes return to pretreatment values. Discontinue therapy if hepatic enzymes are significantly increased.

Disease-related concerns:

• Neurocysticercosis: Appropriate use: Antiparasitic therapy may worsen symptoms of neurocysticercosis by inducing an inflammatory response; adjunctive corticosteroid therapy should be started before initiation of albendazole. Antiparasitic therapy should not be initiated in patients with untreated hydrocephalus, calcified lesions, or cysticercal encephalitis. Perform funduscopic exam prior to initiation of antiparasitic therapy to exclude intraocular cysticerci; antiparasitic therapy may lead to blindness in some cases with unsuspected intraocular parasites (IDSA/ASTMH [White 2018]).

Monitoring Parameters

LFTs and CBC with differential at start of each 28-day cycle and every 2 weeks during therapy (more frequent monitoring for patients with liver disease); pregnancy test

Patients with neurocysticercosis: Ophthalmic exam for retinal lesions prior to therapy initiation; MRI every 6 months after completing therapy until resolution of cystic lesion (IDSA/ASTMH [White 2018])

Reproductive Considerations

Evaluate pregnancy status prior to use in females of reproductive potential. Effective contraception is recommended during chronic therapy (Persichino 2018) and for 1 month after the last dose (per the manufacturer).

The World Health Organization recommends preventive therapy with a benzimidazole, such as albendazole, in females of reproductive potential who live in areas where the baseline prevalence of soil-transmitted helminth infections is ≥20% (WHO 2017).

Pregnancy Considerations

Information following first trimester use of albendazole is limited (Gyorkos 2019; Lau 2020). Most pregnancy outcome information is available from studies using a single dose of albendazole administered to women during the second or third trimester (Gyorkos 2019; Lau 2020; Mofid 2017; Salam 2015). However, case reports are also available following longer term treatment of hydatid disease (Auer 1994; Bhattacharyya 2013; Pallua 2010).

Untreated soil-transmitted helminth infections during pregnancy are associated with adverse maternal outcomes (eg, maternal iron deficiency anemia, impaired nutrient absorption) (WHO 2017).

Use during the first trimester of pregnancy is not recommended (HHS [OI Adult 2019]; IDSA/ASTMH [White 2018]; WHO 1996; WHO 2017). Pregnant patients with neurocysticercosis should be treated for symptoms (eg, increased intracranial pressure, seizures) the same as nonpregnant patients; however, antihelminthic therapy with albendazole can be deferred until after delivery (IDSA/ASTMH [White 2018]). Albendazole should not be used for the treatment of microsporidiosis in HIV-infected pregnant patients during the first trimester; use later in pregnancy may be considered when the benefits outweigh potential risks (HHS [OI Adult 2019]; White 2018). The WHO also recommends treatment of soil-transmitted helminthiases (such as hookworm) in pregnant patients after the first trimester (WHO 1996). Pregnant women arriving as refugees from specific countries should not be given albendazole for the presumptive treatment of intestinal parasites prior to arrival in the United States (CDC 2019).

Patient Education

What is this drug used for?

• It is used to treat infections caused by worms.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Headache

• Abdominal pain

• Vomiting

• Nausea

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Infection

• Bleeding like vomiting blood or vomit that looks like coffee grounds; coughing up blood; blood in the urine; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding.

• Liver problems like dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin.

• Severe loss of strength and energy

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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