What is the recommended treatment regimen for Albendazole (albendazole)?

Albendazole Treatment Regimens

Dosing by Indication

The recommended albendazole regimen depends entirely on the parasitic infection being treated, with dosing ranging from a single 400 mg dose for intestinal helminths to 15 mg/kg/day divided twice daily for 8-30 days in neurocysticercosis. 1

Neurocysticercosis

For patients with 1-2 viable parenchymal cysticerci, use albendazole monotherapy 15 mg/kg/day (maximum 1200 mg/day) divided into 2 daily doses for 10-14 days with food. 2

For patients with >2 viable parenchymal cysticerci, combine albendazole 15 mg/kg/day with praziquantel 50 mg/kg/day for 10-14 days. 2 This combination therapy provides superior parasite clearance compared to monotherapy in heavier cyst burdens.

• For patients weighing ≥60 kg: 400 mg twice daily with meals for 8-30 days 1
• For patients <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) 1

Critical pre-treatment requirements:

• Perform fundoscopic examination to exclude retinal cysticercosis before starting therapy, as albendazole-induced parasite death can cause irreversible retinal damage 2, 1
• Initiate oral or intravenous corticosteroids to prevent cerebral hypertensive episodes during the first week of treatment 1
• Start anticonvulsant therapy in patients with seizures 2

Do NOT treat with antiparasitics if untreated hydrocephalus or diffuse cerebral edema is present—manage elevated intracranial pressure first. 2

Hydatid Disease (Echinococcosis)

• For patients ≥60 kg: 400 mg twice daily with meals 1
• For patients <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) 1
• Duration: 28-day cycle followed by 14-day drug-free interval, repeated for total of 3 cycles 1

Alternative regimen for disseminated/inoperable cases: Albendazole 400 mg twice daily plus praziquantel 40 mg/kg/day twice weekly for 4 weeks, repeated for 3 courses with 2-week intervals between courses 3

Intestinal Helminth Infections

Single-dose therapy is highly effective for most intestinal nematodes:

• Ascariasis (roundworm): 400 mg single dose (95.3% cure rate) 4
• Hookworm: 400 mg single dose (92.2% cure rate) 4
• Trichuriasis (whipworm): 400 mg single dose (90.5% cure rate) 4
• Enterobiasis (pinworm): 400 mg single dose (100% cure rate) 4

For tapeworm infections:

• Taenia species: 400 mg daily for 3 consecutive days (86.1% cure rate) 4
• Hymenolepis nana: 400 mg daily for 3 consecutive days (63.4% cure rate) 4

Alternative for hookworm when albendazole unavailable: Mebendazole 500 mg single dose or 100 mg twice daily for 3 days 5

Pulmonary Eosinophilia (Parasitic)

• 400 mg twice daily for 5-7 days, with duration depending on suspected cause and severity 6
• Note: For strongyloidiasis with pulmonary manifestations, ivermectin 200 μg/kg single dose is preferred first-line; albendazole 400 mg twice daily for 7 days is second-line 6

Mandatory Monitoring Requirements

For treatment >14 days, monitor for hepatotoxicity and leukopenia: 2

• Check complete blood count at beginning of each 28-day cycle and every 2 weeks during therapy 1
• Check liver enzymes (transaminases) at beginning of each cycle and at least every 2 weeks during treatment 1
• Discontinue if liver enzymes exceed 2× upper limit of normal or if clinically significant decreases in blood cell counts occur 1

For short courses (≤5 days) in patients without pre-existing liver disease, routine monitoring is not typically required. 7

Patients with liver disease or hepatic echinococcosis require more frequent monitoring due to increased risk of bone marrow suppression 1

Critical Safety Considerations

Pregnancy and contraception:

• Obtain pregnancy test in females of reproductive potential before starting therapy 1
• Advise effective contraception during treatment and for 3 days after final dose due to teratogenic risk 1
• Albendazole causes embryotoxicity and skeletal malformations in animal studies 1

Screen for co-infections before prolonged corticosteroid use:

• Latent tuberculosis 2
• Strongyloides stercoralis (empiric therapy or screening)—critical because steroids can precipitate fatal hyperinfection syndrome 2, 6, 7
• Loa loa in travelers to endemic regions if considering ivermectin 6

Common Adverse Effects

• Gastrointestinal symptoms (abdominal pain, nausea, vomiting): up to 6% of patients 7
• Elevated liver enzymes: approximately 16% of patients, especially with prolonged treatment 7, 1
• Reversible alopecia: approximately 2% of patients 7
• Fever: approximately 1% of patients 7

Rare but serious: Bone marrow suppression (leukopenia, granulocytopenia, pancytopenia, agranulocytosis) in <1%, more common with prolonged courses 7, 1

Key Clinical Pitfalls

• Never start albendazole in neurocysticercosis without concurrent corticosteroids—inflammatory reaction from parasite death can cause seizures, increased intracranial pressure, and focal neurologic deficits 2, 1
• Always perform fundoscopic exam before treating neurocysticercosis—retinal involvement is a relative contraindication due to risk of vision loss from inflammation 2, 1
• Do not assume longer treatment is better—for parenchymal neurocysticercosis with few cysts, 8 days of 800 mg/day is as effective as 15-30 day courses 8
• Screen for neurocysticercosis in at-risk patients before treating other helminth infections—albendazole can unmask undiagnosed neurocysticercosis 1