Albedzole
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albendazole antiparasitic clinical use
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Here is a thorough overview of Albendazole (note the correct spelling - "Albendazole"):
Albendazole
Drug Class
Albendazole is a benzimidazole (BZ) anthelmintic - a broad-spectrum antiparasitic agent. It replaced older, more toxic anthelmintics like thiabendazole and piperazine.
Mechanism of Action
Albendazole acts through two main mechanisms:
- Microtubule inhibition - binds selectively to parasite β-tubulin, blocking microtubule polymerization. It has much greater affinity for parasite β-tubulin than for human tubulin, which gives it selective toxicity.
- Metabolic disruption - inhibits fumarate reductase (mitochondrial enzyme) in helminths, reduces glucose transport, and uncouples oxidative phosphorylation.
Net effect: depletes glycogen stores, disrupts ATP production, and paralyzes/kills the worm.
- Goldman-Cecil Medicine, 2-Vol Set
- Goodman & Gilman's Pharmacological Basis of Therapeutics
Pharmacokinetics (ADME)
| Parameter | Detail |
|---|---|
| Absorption | Variably absorbed orally; enhanced up to 5-fold by fatty foods |
| Active metabolite | Rapidly converted by first-pass liver metabolism to albendazole sulfoxide (the main active form for tissue-dwelling parasites) |
| Half-life | Albendazole sulfoxide: 8-9 hours |
| Distribution | CSF concentration ~40% of serum; penetrates cysts well |
| Elimination | Primarily renal (metabolites) |
Drug interaction note: Dexamethasone (commonly co-administered for neurocysticercosis) increases albendazole sulfoxide serum levels by ~50%. Praziquantel's bioavailability is reduced by corticosteroids, but albendazole is NOT affected this way - making albendazole preferable in patients needing concurrent steroids.
- Goldman-Cecil Medicine; Katzung's Basic & Clinical Pharmacology, 16th Ed.
Clinical Uses (Indications)
| Indication | Dose/Notes |
|---|---|
| Ascaris lumbricoides (roundworm) | Single 400 mg oral dose |
| Enterobius (pinworm), hookworm, Trichuris | Single or short-course doses |
| Neurocysticercosis | 15 mg/kg/day in 2 divided doses x 10-14 days; combine with corticosteroids to reduce intracranial inflammation |
| Echinococcal (hydatid) disease | Prolonged high-dose therapy |
| Trichinosis (trichinellosis) | Standard regimen |
| Lymphatic filariasis | Often combined with ivermectin or DEC in mass drug administration programs |
| Strongyloidiasis, Gnathostomiasis | Used as alternative or adjunct |
Drug of choice in neurocysticercosis (over praziquantel) because its absorption is NOT reduced by co-administered corticosteroids.
Adverse Effects
- Low-dose / single dose: Generally well tolerated. Mild GI discomfort; patients may see expelled worms.
- High-dose / prolonged therapy (e.g., for echinococcal disease):
- Alopecia
- Hepatitis (monitor LFTs)
- Bone marrow suppression (may be irreversible)
- Contraindicated in pregnancy (possibly teratogenic - inhibits glucose uptake in embryonic tissue)
Contraindications
- Ocular or spinal cysticercosis (risk of severe inflammatory reaction causing irreversible damage to these structures)
- Pregnancy (teratogenic risk; avoid particularly in first trimester)
Key Drug Interactions
- Dexamethasone - increases albendazole sulfoxide levels (~50% increase); used intentionally in neurocysticercosis
- Combined with praziquantel - increases parasiticidal effect in patients with multiple brain cysts
- Unlike praziquantel, albendazole levels are not reduced by corticosteroids
Summary
Albendazole is one of the most widely used antiparasitic drugs globally, featured in WHO's Essential Medicines List. It is the drug of choice for multiple helminthic infections, particularly neurocysticercosis and echinococcosis, and is a cornerstone of mass deworming programs for soil-transmitted helminths (STH) worldwide.
Albendazole dose
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Albendazole Dosing
Standard Adult Dose: 400 mg orally
The base dose for most intestinal worm infections is a single 400 mg oral dose, taken with a fatty meal to enhance absorption.
Dosing by Indication
| Indication | Adult Dose | Pediatric Dose | Duration |
|---|---|---|---|
| Ascaris lumbricoides | 400 mg once | Same (>2 yrs) | Single dose |
| Hookworm (Necator, Ancylostoma) | 400 mg once or daily x 3 days | Same (>2 yrs) | 1 or 3 days |
| Pinworm (Enterobius) | 400 mg once; repeat in 2 weeks | Same | Single dose (x2) |
| Whipworm (Trichuris trichiura) | 400 mg/day x 3 days (single dose less effective) | Same | 3 days |
| Cutaneous larva migrans | 400 mg/day | Same | 3 days |
| Strongyloidiasis | 400 mg/day x 3 days (less effective than ivermectin) | Same | 3 days |
| Trichostrongylus | 400 mg/day | Same | Up to 10 days |
| Neurocysticercosis | 15 mg/kg/day in 2 divided doses (max 800 mg/day) + corticosteroids | Same weight-based | 10-14 days (or longer) |
| Echinococcal (hydatid) disease | 400 mg twice daily | 15 mg/kg/day (max 800 mg/day) | 1-6 months |
| Lymphatic filariasis (mass drug admin) | 400 mg once (with DEC or ivermectin) | Same (>2 yrs) | Single dose annually |
Key Dosing Notes
- Children >2 years: same dose as adults (400 mg) for intestinal nematodes
- Children <2 years: not routinely recommended; if used, 200 mg single dose (consult guidelines)
- Echinococcosis / high-dose regimens: use cycles (e.g., 28 days on, 14 days off) to reduce toxicity
- Take with fatty food: bioavailability increases up to 5-fold with a fatty meal
- Neurocysticercosis: always combine with corticosteroids (dexamethasone) to reduce inflammation; dexamethasone also raises albendazole levels by ~50%
Monitoring for Long-Term / High-Dose Therapy
| Monitor | Reason |
|---|---|
| LFTs (liver function tests) | Risk of hepatitis |
| CBC (complete blood count) | Risk of bone marrow suppression |
| Clinical symptoms | Alopecia (hair loss) is a warning sign |
Contraindications
-
Pregnancy - possibly teratogenic; delay treatment if possible
-
Ocular or spinal cysticercosis - risk of severe inflammatory damage
-
Hypersensitivity to benzimidazoles
-
Goldman-Cecil Medicine, Table 327-1
-
Goodman & Gilman's Pharmacological Basis of Therapeutics, p. 1345
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