Albendazole

Name: Albendazole

Other uses for this medicine

Albendazole is also sometimes used to treat infections caused by roundworms, hookworms, threadworm, whipworm, pinworm, flukes, and other parasites (a plant or animal that lives within another living organism to receive some benefit). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Pharmacology

Mechanism of Action

Causes degeneration of cytoplasmic microtubule in intestinal and tegmental cells of intestinal helminths

Pharmacokinetics

Absorption: <5%; may increase up to 4-5 times with a fatty meal

Distribution: Well inside hydatid cysts & CSF

Protein Bound: 70%

Metabolism: Hepatic; extensive first-pass effect; pathways include rapid sulfoxidation (major), hydrolysis, & oxidation

Half-life: 8-12 hr

Peak Plasma Time: 2-5 hr

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

What is albendazole?

Albendazole is an anthelmintic (an-thel-MIN-tik) or anti- worm medication. It prevents newly hatched insect larvae (worms) from growing or multiplying in your body.

Albendazole is used to treat certain infections caused by worms such as pork tapeworm and dog tapeworm.

Albendazole may also be used for purposes not listed in this medication guide.

What is the most important information I should know about albendazole?

Albendazole should not be used during pregnancy, unless there is no alternate treatment. You may need to have a negative pregnancy test before starting this treatment.

How should I take albendazole?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take with food.

In a young child (or anyone who is unable to swallow a whole albendazole tablet), the tablet should be crushed or chewed and swallowed with a full glass of water.

You may be given other medicines to prevent certain side effects of albendazole, or certain effects that can result when the parasites die within your body.

Tell your doctor if you have any changes in weight. Albendazole doses are based on weight.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Albendazole will not treat a viral infection such as the flu or a common cold.

Albendazole can weaken your immune system. Your blood may need to be tested often. You will need frequent blood tests (every 2 weeks) to check your liver function.

Store at room temperature away from moisture and heat.

What other drugs will affect albendazole?

Other drugs may interact with albendazole, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Advice to Patients

  • Importance of taking with food to increase oral bioavailability.1

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

  • Importance of completing full course of therapy, even if feeling better after a few days.1

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

  • Importance of initiating albendazole therapy in women of childbearing age only after a negative pregnancy test is obtained.1

  • Importance of cautioning women of childbearing age against becoming pregnant while receiving albendazole or within 1 month of completing treatment.1

  • Importance of routine (every 2 weeks) monitoring of blood counts and liver function tests to detect harm to the bone marrow or liver.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 informing patients of other important precautionary information.1 (See Cautions.)

Off Label Uses

Microsporidiosis in HIV-infected patients (adolescents and adults)

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, 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 HIV-infected patients.

Additional off-label uses:

Albendazole has activity against Ascaris lumbricoides (roundworm); Ancylostoma caninum; Ancylostoma duodenale and Necator americanus (hookworms); Cutaneous larva migrans; Enterobius vermicularis (pinworm); Giardia duodenalis (giardiasis); Gnathostoma spinigerum; Gongylonema sp; Mansonella perstans (filariasis); Oesophagostomum bifurcum; Opisthorchis sinensis (liver fluke); Trichinella spiralis (Trichinellosis); visceral larva migrans (toxocariasis); liver fluke Clonorchis sinensis; Giardia lamblia; Cysticercus cellulosae; Echinococcus multilocularis

Microsporidiosis (not limited to HIV-infected patients): Disseminated microsporidiosis (E. hellem, E. cuniculi, E. intestinalis, Pleistophora sp, Trachipleistophora sp, Brachiola vesicularum); Intestinal microsporidiosis (Encephalitozoon intestinalis); Ocular microsporidiosis (E. hellem, E. cuniculi, Vittaforma corneae)

Dosing Adult

Neurocysticercosis: Oral:

<60 kg: 15 mg/kg/day in 2 divided doses (maximum: 800 mg/day) for 8 to 30 days

≥60 kg: 800 mg/day in 2 divided doses for 8 to 30 days

Note: Give concurrent anticonvulsant and corticosteroid therapy.

Hydatid: Oral:

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

≥60 kg: 800 mg/day in 2 divided doses

Note: Administer dose for three 28-day cycles with a 14-day drug-free interval in between each cycle.

Ancylostoma caninum, Ascaris lumbricoides (roundworm), Ancylostoma duodenale (hookworm), and Necator americanus (hookworm) (off-label use): Oral: 400 mg as a single dose (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 (Parasitic Infections 2013)

Cutaneous larva migrans (off-label use): Oral: 400 mg once daily for 3 days (Parasitic Infections 2013)

Cysticercus (off-label use): Oral: 15 mg/kg/day (maximum: 800 mg/day) in 2 divided doses for 8 to 30 days; may be repeated as necessary (Parasitic Infections 2013)

Echinococcus granulosus (tapeworm) (off-label use): Oral: 15 mg/kg/day (maximum: 800 mg/day) in 2 divided doses for 1 to 6 months (Parasitic Infections 2013)

Enterobius vermicularis (pinworm) (off-label use): Oral: 400 mg as a single dose; repeat in 2 weeks (Parasitic Infections 2013)

Giardia duodenalis (giardiasis) (off-label use): Oral: 400 mg once daily for 5 days (Parasitic Infections 2013)

Gnathostoma spinigerum (off-label use): Oral: 800 mg/day in 2 divided doses for 21 days (Parasitic Infections 2013)

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

Microsporidiosis:

Immunocompetent patients:

Disseminated (off-label use): 800 mg/day in 2 divided doses (Parasitic Infections 2013)

Intestinal (E. intestinalis) (off-label use): 800 mg/day in 2 divided doses for 21 days (Parasitic Infections 2013)

Ocular (off-label use): 800 mg/day in 2 divided doses, in combination with topical fumagillin (Parasitic Infections 2013)

Immunocompromised (HIV-positive) patients

Disseminated or intestinal infection (other than Enterocytozoon bieneusi or V. corneae) (off-label use): 800 mg/day in 2 divided doses; continue until CD4 count >200 cells/mm3 for >6 months after initiation of antiretroviral therapy (DHHS [OI Adults 2015])

Ocular (off-label use): 800 mg/day in 2 divided doses, 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 (DHHS [OI Adults 2015])

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

Trichinella spiralis (Trichinellosis) (off-label use): Oral: 800 mg/day in 2 divided doses for 8 to 14 days plus corticosteroids for severe symptoms (Parasitic Infections 2013)

Visceral larva migrans (toxocariasis) (off-label use): Oral: 800 mg/day in 2 divided doses for 5 days (Parasitic Infections 2013)

Administration

Administer with a high-fat meal if treating a systemic infection. Administer on an empty stomach if treating an intraluminal infection (Lange 1988). If patients have difficulty swallowing, tablets may be crushed or chewed, then swallowed with a drink of water; chewable tablets are available for patients with difficulty swallowing.

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: Corticosteroids should be administered before or upon initiation of albendazole therapy to minimize inflammatory reactions and prevent increased intracranial pressure. Anticonvulsant therapy should be used concurrently to prevent seizures. If retinal lesions exist, weigh risk of further retinal damage due to albendazole-induced inflammatory changes to the retinal lesion vs benefit of disease treatment.

Where can i get more information?

Your pharmacist can provide more information about albendazole.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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Usual Adult Dose for Pinworm Infection (Enterobius vermicularis)

Some experts recommend: 400 mg orally as a single dose; repeat in 2 weeks

Comments: Some clinicians recommend all household contacts of infected patients receive treatment, especially when multiple or repeated symptomatic infections occur, since such contacts commonly also are infected; retreatment after 14 to 21 days may be needed.

Usual Adult Dose for Hookworm Infection (Necator or Ancylostoma)

US CDC recommendations: 400 mg orally as a single dose

Comments: Recommended for infection due to Ancylostoma duodenal or Necator americanus

Usual Pediatric Dose for Neurocysticercosis

Less than 60 kg: 15 mg/kg/day orally in divided doses twice a day with meals
Maximum dose: 800 mg/day

60 kg or more: 400 mg orally twice a day with meals

Duration of therapy: 8 to 30 days

Comments:
-Patients should receive appropriate steroid and anticonvulsant therapy as needed.
-Oral or IV corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of therapy.

Use: For the treatment of parenchymal neurocysticercosis due to active lesions caused by larval forms of T solium

Usual Pediatric Dose for Hookworm Infection (Necator or Ancylostoma)

US CDC and AAP recommendations: 400 mg orally as a single dose

Comments: Recommended for infection due to A duodenal or N americanus

Usual Pediatric Dose for Trichinosis

US CDC and AAP recommendations: 400 mg orally twice a day for 8 to 14 days

Dialysis

Data not available

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