Albendazole

Pharmacologic Category

Anthelmintic

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; Moro 2020).

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; some experts use 400 mg twice daily for 2 weeks (Jee 2016; Weller 2020); 800 mg twice daily has also been described (Barisani-Asenbauer 2001). Give with concomitant corticosteroids (Barisani-Asenbauer 2001; Jee 2016; Weller 2020).

Visceral larva migrans, moderate to severe: Oral: 400 mg twice daily generally for 5 days; consider concomitant corticosteroids for severe infection with respiratory, myocardial, or CNS involvement (Drugs for Parasitic Infections 2013; Weller 2020).

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).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). However, the need for adjustment not likely since albendazole is primarily eliminated by hepatic metabolism.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in manufacturer's labeling. However, patients with underlying liver disease may be more at risk for adverse effects.

Dosing: Pediatric

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

<60 kg: Oral: 7.5 mg/kg/dose twice daily for 8 to 30 days; maximum dose: 400 mg/dose

≥60 kg: Oral: 400 mg twice daily for 8 to 30 days

Hydatid disease (Echinococcus granulosus, dog tapeworm): Children and Adolescents (WHO 2010):

<60 kg: Oral: 7.5 mg/kg/dose twice daily; maximum dose: 400 mg/dose; 28-day cycle followed by a 14-day albendazole-free interval, for a total of 3 cycles

≥60 kg: Oral: 400 mg twice daily; 28-day cycle followed by a 14-day albendazole-free interval, for a total of 3 cycles

Ancyclostoma caninum (Eosinophilic enterocolitis):Limited data available: Children and Adolescents: Oral: 400 mg as a single dose (Medical Letter [Parasitic infections 2013])

Ancylostoma duodenale or Necator americanus (hookworms):

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 2010)

Children >2 years and Adolescents: Limited data available: Oral: 400 mg as a single dose; may repeat in 3 weeks (CDC; Medical Letter [Parasitic infections 2013]; WHO 2010)

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 (CDC; Medical Letter [Parasitic infections 2013]; 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 two 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; Medical Letter [Parasitic infections 2013]; Sawamura 1999)

Clonorchis sinensis (Chinese liver fluke): Limited data available: Children and Adolescents: Oral: 10 mg/kg/dose once daily for 7 days (CDC; Medical Letter [Parasitic infections 2013]

Cutaneous larva migrans (dog and cat hookworm):

Infants ≥8 months and Children ≤10 kg: Very limited data available: Oral: 200 mg once daily for 3 days. Dosing based on four cases (ages 8, 11, 12, and 13 months) of infants who showed clinical improvement after therapy. There was complete resolution of infection in two 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 weighing >10 kg and Adolescents: Limited data available: Oral: 400 mg once daily for 3 days (Medical Letter [Parasitic infections 2013]; WHO 2010); some patients may only need a single dose (WHO 2010)

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; may repeat in 2 to 3 weeks (Medical Letter [Parasitic infections 2013]; WHO 2010)

Filariasis (Wuchereria Bancroft);microfilaria, reduction or suppression or community eradication programs: Limited data available. Administer in combination with either ivermectin or diethylcarbamazine. Note: Does not kill all the adult worms (Medical Letter [Parasitic infections 2013]; WHO 2010).

Children ≤10 kg: Oral: 200 mg once annually for 5 years

Children >10 kg and Adolescents: Oral: 400 mg once annually for 5 years

Giardiasis (Giardia duodenalis): Limited data available: Children ≥2 years and Adolescents: Oral: 10 mg/kg/day once daily for 5 days; maximum dose: 400 mg/dose or 400 mg once daily for 5 days (Escobedo 2016, Medical Letter [Parasitic infections 2013]; Yereli 2004)

Microsporidia infection (except Enterocytozoon sp. and V. corneae): Limited data available: Children and Adolescents: Oral: 7.5 mg/kg/dose twice daily; maximum dose: 400 mg/dose (HHS [pediatric 2016]; Medical Letter [Parasitic infections 2013]) in HIV-exposed/-positive, continue until resolution of signs and symptoms and sustained immune reconstitution (>6 months at CDC immunologic category 1 or 2) after ART initiation (HHS [pediatric 2016])

Strongyloidiasis (Strongyloides stercoralis): Limited data available:

Children ≤10 kg: Oral: 200 mg once daily for 3 days; may repeat course in 3 weeks (WHO 2010)

Children >10 kg and Adolescents:

CDC recommendations: Oral: 400 mg twice daily for 7 days (CDC)

WHO recommendations: Oral: 400 mg once daily for 3 days; may repeat course in 3 weeks (WHO 2010)

Trichinellosis (Trichinosis): Limited data available:

CDC recommendations: Children and Adolescents: Oral: 400 mg twice daily for 8 to 14 days (CDC; Medical Letter [Parasitic infections 2013])

WHO recommendations: Children >10 kg and Adolescents: Oral: 400 mg once daily for 8 to 14 days (WHO 2010)

Trichuriasis (whipworm): Limited data available: Children >2 years and Adolescents: Oral: 400 mg once daily for 3 days (Medical Letter [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)

Toxocariasis (ocular larva migrans, visceral larva migrans): Limited data available:

CDC recommendations: Children and Adolescents: Oral: 400 mg twice daily for 5 days (CDC; Medical Letter [Parasitic infections 2013])

WHO recommendation: Children and Adolescents: Oral: 10 mg/kg/dose once daily for 5 days; maximum dose: 400 mg/dose (WHO 2010)

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied). However, the need for adjustment not likely since albendazole is primarily eliminated by hepatic metabolism.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

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.

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

Ancylostoma caninum (eosinophilic enterocolitis)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of Ancylostoma caninum Ref.

Ancylostoma duodenale or Necator americanus (hookworms)Level of Evidence [B]

Data from a randomized, controlled, single-blind (outcome assessor-blinded) trial support the use of albendazole for treatment of hookworm infection Ref. Clinical experience suggests the utility of albendazole in the treatment of hookworm infection Ref.

Ascariasis (intestinal roundworm)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of Ascaris lumbricoides Ref.

Clonorchis sinensis (Chinese liver fluke) or Opisthorchis viverrini (Southeast Asian liver fluke)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of fluke infection Ref.

Cutaneous larva migrans (dog and cat hookworm)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of cutaneous larva migrans Ref.

Enterobiasis (pinworm)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of pinworm infection Ref.

Giardiasis (Giardia duodenalis)Level of Evidence [B]

Data from a randomized, controlled trial support the use of albendazole for treatment of Giardia duodenalis infection Ref. Clinical experience suggests the utility of albendazole as an alternative agent in the treatment of giardiasis Ref.

Gnathostomiasis (Gnathostoma spinigerum)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of Gnathostoma spinigerum infection Ref.

Gongylonemiasis (Gongylonema spp.)Level of Evidence [C]

Clinical experience suggests the utility of albendazole in the treatment of Gongylonema spp. infection Ref.

MicrosporidiosisLevel of Evidence [C, G]

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 Ref.

Oesophagostomum bifurcumLevel of Evidence [C]

Data from an open-label, uncontrolled trial suggest that albendazole may be beneficial for the treatment of Oesophagostomum bifurcum infection Ref. Clinical experience also suggests the utility of albendazole in the treatment of O. bifurcum infection Ref.

ToxocariasisLevel of Evidence [C]

Clinical experience also suggests the utility of albendazole in the treatment of ocular larva migrans with sight-threatening ocular inflammation and moderate to severe visceral larva migrans Ref.

Trichinellosis (Trichinella spiralis)Level of Evidence [C, G]

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 Ref.

Level of Evidence Definitions

Level of Evidence Scale

Clinical Practice Guidelines

Infectious Diarrhea:

IDSA, "Diagnosis and Management of Infectious Diarrhea," 2017

Neurocysticercosis:

IDSA/ASTMH, "Diagnosis and Treatment of Neurocysticercosis," 2018

Opportunistic Infections:

American Academy of Neurology, "Guidelines for Treatment of Parenchymal Neurocysticercosis," April 2013

HHS, Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children, November 2013

HHS, Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

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.

Administration: Pediatric

Oral: Administer with food. For patients who have difficulty swallowing whole tablets, tablet may be crushed or chewed and swallowed with a drink of water.

Storage/Stability

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

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat infections caused by worms.

Frequently reported side effects of this drug

• Headache

• Abdominal pain

• Vomiting

• Nausea

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• 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 a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of 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 brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

International issues:

Contraindications

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

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]).

* See Cautions in AHFS Essentials for additional information.

Reproductive Considerations

Evaluate pregnancy status prior to use in females of reproductive potential. Effective contraception is recommended during chronic therapy (Persichino 2018) and for 3 days 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). 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; 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 Adults]; 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 Adults]; 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).

Breast-Feeding Considerations

Albendazole is present in breast milk.

Albendazole excretion into breast milk was studied following a single oral 400 mg dose in breastfeeding women 2 weeks' to 6 months' postpartum (n=33). Mean albendazole concentrations 6 hours after the dose were 63.7 ± 11.9 ng/mL (maternal serum) and 31.9 ± 9.2 ng/mL (milk). An active and inactive metabolite were also detected in breast milk (Abdel-tawab 2009).

A case report describes use of albendazole for the treatment of hydatid disease of the breast in a lactating woman (Siddiqui 2015).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. However, albendazole is generally considered compatible with breastfeeding (WHO 2002). Breastfeeding women arriving as refugees from specific countries may be given albendazole for the presumptive treatment of intestinal parasites (CDC 2019).

Briggs' Drugs in Pregnancy & Lactation

• Albendazole

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

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Benzimidazole Anthelmintics Allergy

Metabolism/Transport Effects

Substrate of CYP1A2 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions Open Interactions

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

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

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

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

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

Food Interactions

Albendazole serum levels may be increased if taken with a fatty meal (increases the oral bioavailability by up to 5 times). Management: Should be administered with a high-fat meal when treating systemic infections.

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])

Advanced Practitioners Physical Assessment/Monitoring

Assess laboratory results for reduction or elimination of ova and parasites. Obtain liver function tests and CBC with differential at beginning of each 28 day cycle and repeat every 2 weeks while on therapy. Obtain baseline ophthalmic exam for retinal lesions. Monitor for cerebral hypertension, focal neurologic deficits, or seizures after initiation of therapy; if develop, begin steroid and anti-convulsant therapy.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities. Monitor for cerebral hypertension, focal neurologic deficits, or seizures after initiation of therapy and educate patient to report any signs or symptoms.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Albenza: 200 mg [contains saccharin sodium]

Generic: 200 mg

Anatomic Therapeutic Chemical (ATC) Classification

• P02CA03

Generic Available (US)

Yes

Pricing: US

Tablets (Albendazole Oral)

200 mg (per each): $228.91 - $276.65

Tablets (Albenza Oral)

200 mg (per each): $291.21

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

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.

Pharmacodynamics/Kinetics

Note: In pediatric patients (6-13 years), pharmacokinetic values were reported to be similar to adult data.

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

Protein binding: 70%

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

Half-life elimination: 8 to 12 hours (albendazole sulfoxide)

Time to peak, serum: 2 to 5 hours for the metabolite

Excretion: Urine (<1% as active metabolite); feces

Pharmacodynamics/Kinetics: Additional Considerations

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

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

FDA Approval Date

June 11, 1996

References

Albenza (albendazole) tablets [prescribing information]. Hayward, CA: Impax Specialty Pharma; July 2019.

Abdel-tawab AM, Bradley M, Ghazaly EA, et al, "Albendazole and its Metabolites in the Breast Milk of Lactating Women Following a Single Oral Dose of Albendazole," Br J Clin Pharmacol, 2009, 68(5):737-42.[PubMed 19916998]

Auer H, Kollaritsch H, Jüptner J, Aspöck H. Albendazole and pregnancy. Appl Parasitol. 1994;35(2):146-147.[PubMed 8087155]

Baird RA, Wiebe S, Zunt JR, et al, “Evidence-Based Guideline: Treatment of Parenchymal Neurocysticercosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology,” Neurology, 2013, 80(15):1424-9.[PubMed 23568997]

Baranwal AK, Singhi PD, Khandelwal N, et al, “Albendazole Therapy in Children With Focal Seizures and Single Small Enhancing Computerized Tomographic Lesions: A Randomized, Placebo-Controlled, Double Blind Trial,” Pediatr Infect Dis J, 1998, 17(8):696-700.[PubMed 9726343]

Barisani-Asenbauer T, Maca SM, Hauff W, et al. Treatment of ocular toxocariasis with albendazole. J Ocul Pharmacol Ther. 2001;17(3):287-294. doi: 10.1089/108076801750295317.[PubMed 11436948]

Bethony J, Brooker S, Albonico M, et al, “Soil-Transmitted Helminth Infections: Ascariasis, Trichuriasis, and Hookworm,” Lancet, 2006, 367(9521):1521-32.[PubMed 16679166]

Bhatia V, Das MK, Kumar P, Arora NK. Infantile hookworm disease. Indian Pediatr. 2010;47(2):190-192.[PubMed 20228435]

Bhattacharyya SK, Bhattacharya S, Alam H, Patua B, Chattopadhyay P. Dilemmas encountered while dealing a pregnancy complicated by pelvic Hydatid disease. Arch Gynecol Obstet. 2013;288(5):965-966.[PubMed 23625356]

Black MD, Grove DI, Butcher AR, Warren LJ. Cutaneous larva migrans in infants in the Adelaide Hills. Australas J Dermatol. 2010;51(4):281-284.[PubMed 21198527]

Centers for Disease Control and Prevention (CDC) parasite website. Available at https://www.cdc.gov/parasites/index.html. Date accessed was 11/11/2016

Centers for Disease Control and Prevention (CDC). Parasites - Cysticercosis. Available at http://www.cdc.gov/parasites/cysticercosis/health_professionals/index.html#drugs. Updated April 2016.

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Brand Names: International

Abentel (BD, CN, TH); ABZ (IN, ZW); Acure (PK); Adazol (EC); Albatel (TH); Alben (BR); Alben-VC (TH); Albenda (AE, BH, KW, LB, QA, SA); Albentel (PE); Albentox (LK); Albenzol (EC); Albenzole (EG); Albex (AE, CY, IQ, IR, JO, KW, LB, LK, LY, OM, QA, SA, SY, VN, YE); Albezole (IN); Albi (KR); Aldaben (BD); Aldazol (PH); Alfuca (TH); Allbacom (KR); Almex (MY); Alminth (IN); Alzental (AE, BH, CY, EG, ET, IQ, IR, JO, KW, LB, LY, MY, OM, QA, SA, SG, SY, VN, YE); Alzol (TH); Andazol (TR); Anhelmin (UA); Ascarol (EC); Ben A (BD); Bendax (EG); Bendex (ET); Bendex-400 (ZA); Benzol (PH); Bruzol (CR, DO, GT, HN, MX, NI, PA, SV); Buxol (CR, DO, GT, HN, NI, PA, SV); CB-400 (TH); Ciclopar (CO); Cystazole (JO); Dalben (HR); Daxol Plus (PY); Dazole (LK); Digezanol (MX); Emanthal (IN); Eskasole (MX); Eskazole (AT, AU, DE, ES, GB, GR, IL, JP, NL, NZ); Estazole (LK); Falben (TH); Fintel (PE); Frantel (VN); Gascop (MX); Gelmodol (RU); Gloalbendazole (KR); Helmiben (UY); Helmidazole (AE, CY, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Hyemex (PH); Labenda (TH); Lokaben (LK); Lomsin (MX); Lurdex (MX); Mebenix (BR); Mitizen 200 (VN); Mitizen 400 (VN); Nematel (AR); Nemozole (IN, RU, ZW); Olworm (LK); Ovis (ET); Oxal (MX); Pantex (PY); Paranthil (ZA); Parhel (CR, DO, GT, HN, NI, PA, SV); Rex (KR); Rotopar (EC); Sanoxal (RU); Sintel (BD); Sioban (IN); Temizol (PY); Thelban (MY); Unizol (SV); Valbazen Vet (NO); Vastus (AR); Vemizol (MY); Vermicet (AR); Vermin Plus (MX); Vermizol (EG); Vermizole (AR); Vetoben (TH); Vormil (UA); Wormed (ZW); Zeben (TH); Zela (TH); Zental (RO); Zentel (AE, AU, BB, BF, BG, BH, BJ, BM, BR, BS, BZ, CH, CI, CL, CN, CO, CR, CY, CZ, EC, ET, FR, GH, GM, GN, GT, GY, HN, IQ, IR, IT, JM, JO, KE, KR, KW, LB, LR, LY, MA, ML, MR, MU, MW, MX, MY, NE, NG, NI, OM, PA, PE, PL, PR, PT, QA, SA, SC, SD, SG, SI, SK, SL, SN, SR, SY, TH, TN, TT, TZ, UA, UG, VE, VN, YE, ZA, ZM, ZW); Zestaval (TR, ZW)

Last Updated 4/10/20