Is lactation a contraindication for albendazole?

Albendazole Use During Lactation

Recommendation

Albendazole is compatible with breastfeeding as concentrations in breast milk are low and unlikely to cause adverse effects in breastfed infants. 1, 2

Evidence Assessment

FDA Drug Label Information

The FDA drug label provides the most authoritative guidance on albendazole use during lactation:

• Concentrations of albendazole and its active metabolite, albendazole sulfoxide, have been reported to be low in human breast milk 1
• There are no reports of adverse effects on breastfed infants 1
• The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for albendazole 1

Pharmacokinetic Data

Research studies provide supporting evidence for the safety of albendazole during lactation:

• After a single 400mg oral dose, both albendazole and its metabolite (albendazole sulfoxide) reach low concentrations in breast milk that are unlikely to be harmful to breastfed infants 2
• The milk-to-serum ratios for albendazole and albendazole sulfoxide were 0.9 (range 0.2-6.5) and 0.6 (range 0.1-1.5), respectively 2

Clinical Practice Guidelines

While not specifically addressing albendazole, several guidelines provide context for antiparasitic medication use during lactation:

• The UK guidelines for management of eosinophilia mention albendazole as a treatment option without specific contraindications for lactation 3
• Mayo Clinic Proceedings note that β-lactam antibiotics are generally considered safe during lactation, and recommend consulting resources like LactMed for guidance on antimicrobial use during breastfeeding 3

Clinical Application

Dosing and Administration

• Standard adult dose for most intestinal helminth infections is 400 mg as a single dose 4
• Multiple doses may be required for certain infections including strongyloidiasis, trichinellosis, echinococcosis, and neurocysticercosis 4

Monitoring

• No specific monitoring is required for breastfed infants whose mothers are taking albendazole
• Observe for any unusual symptoms in the infant, though adverse effects are unlikely based on available data 1, 2

Important Considerations

• Pregnancy is a contraindication for albendazole use due to potential teratogenic effects 1
• Pregnancy testing is recommended for females of reproductive potential prior to initiating albendazole 1
• Women of reproductive potential should use effective contraception during treatment with albendazole and for 3 days after the final dose 1

Comparison with Other Antiparasitics

• Mebendazole has also been shown to be safe during lactation in a case series of 45 women, with no adverse effects reported in their breastfed infants 5
• For pregnant women, pyrantel pamoate is recommended instead of albendazole or mebendazole due to its established safety profile 4

Conclusion

Based on the available evidence, particularly the FDA drug label information and pharmacokinetic studies, albendazole can be safely used during lactation. The low concentrations in breast milk and absence of reported adverse effects in breastfed infants support this recommendation.