Should Albendazole be taken before or after food?

Albendazole Should Be Taken With Food, Preferably a Fatty Meal

Albendazole should be taken with food, particularly a high-fat meal, to significantly improve its absorption and bioavailability. 1, 2

Pharmacokinetic Rationale

Albendazole is generally poorly absorbed when taken on an empty stomach. The evidence clearly demonstrates:

• Taking albendazole with food enhances its absorption 3
• A high-fat meal can double the bioavailability compared to a low-fat meal 2
• The FDA label specifically states that "Albendazole tablets should be taken with food" 1

Optimal Administration

For maximum effectiveness:

• Take albendazole with a meal containing fat
• Divide the daily dose into two administrations with meals
• For a standard 400mg dose, take 200mg with breakfast and 200mg with dinner
• If using a single daily dose, take it with the fattiest meal of the day

Evidence Strength

The recommendation to take albendazole with food is supported by:

1. FDA labeling that explicitly instructs taking the medication with food 1
2. Clinical research showing that a high-fat breakfast doubles the area under the concentration-time curve (AUC) and maximum concentration (Cmax) compared to a low-fat breakfast 2
3. IDSA/ASTMH guidelines noting that "absorption can be improved by dosing it with food, especially with fatty meals" 3

Clinical Implications

Taking albendazole with food, particularly fatty food, has important clinical implications:

• Improves treatment efficacy for parasitic infections
• May reduce the need for higher doses or prolonged treatment courses
• Could potentially reduce treatment failures in mass drug administration programs 4

Potential Pitfalls

Several common mistakes should be avoided:

• Taking albendazole on an empty stomach significantly reduces absorption
• Not specifying the importance of fat content in the meal when counseling patients
• Assuming that any food will provide the same enhancement of bioavailability

Special Considerations

For specific conditions:

• For neurocysticercosis: The IDSA/ASTMH guidelines recommend albendazole at 15 mg/kg/day divided into 2 daily doses with food 3, 5
• For hydatid disease: The FDA label recommends 400 mg twice daily with meals for patients ≥60 kg 1
• For soil-transmitted helminth infections: A single 400 mg dose with a fatty meal is typically sufficient 6, 7

While one recent study did not find significant improvement in cure rates with fatty food co-administration for hookworm infections 8, the preponderance of evidence, including pharmacokinetic studies, supports taking albendazole with food, especially fatty food, to maximize absorption and therapeutic effect.