How to administer albendazole (anti-parasitic medication) syrup?

How to Administer Albendazole Syrup

Albendazole syrup should be given with food (preferably a fatty meal) to enhance absorption, and the dose is weight-based: 400 mg as a single dose for children over 24 months and adults weighing ≥60 kg, or 15 mg/kg/day (maximum 800 mg/day) divided into two doses for those <60 kg. 1

Dosing by Weight and Age

• Adults and children ≥60 kg: 400 mg as a single dose for most intestinal parasites, or 400 mg twice daily with meals for systemic infections 1
• Children <60 kg and >24 months: 15 mg/kg/day divided into two doses with meals (maximum total daily dose 800 mg) 1
• Children 12-24 months: Requires specialist consultation before administration due to limited safety data 2
• Children <12 months: Should not receive albendazole without expert guidance 3

Administration Technique

• Crushing tablets for syrup preparation: The FDA label explicitly states that albendazole tablets may be crushed or chewed and swallowed with water 1
• Give with food: Administration with a fatty meal (approximately 40 grams of fat) increases absorption up to 5-fold compared to fasting state 1
• Timing: Can be given as a single dose or divided into twice-daily dosing depending on the infection 1

Important Safety Note on Crushing

While crushing tablets is FDA-approved, research shows that crushed tablets significantly increase adverse swallowing events (25.4% vs 3.6% with whole tablets) and choking risk, particularly in young children 4. If crushing is necessary for young children, avoid giving to children who are fussy, fearful, combative, or struggling, as this increases choking risk 20-fold 4.

Duration by Infection Type

The duration varies significantly by parasite:

• Single-dose infections (Ascaris, hookworm, Enterobius): 400 mg once 5, 6
• Trichuris (whipworm): 400 mg daily for 3 days (light infections) or 5-7 days (heavy infections >1000 eggs/g feces) 7
• Strongyloidiasis: 400 mg daily for 3 days 5
• Visceral larva migrans (Toxocara): 400 mg twice daily for 5 days 5, 2
• Neurocysticercosis: 400 mg twice daily for 8-30 days 5
• Hydatid disease: 400 mg twice daily for 28-day cycles with 14-day drug-free intervals 1

Critical Pre-Treatment Screening

Before administering albendazole, especially with concurrent medications:

• Pregnancy test: Required for all females of reproductive potential, as albendazole causes fetal harm 1
• Loa loa screening: Must exclude loiasis before giving ivermectin combinations, as co-administration causes severe reactions 3
• Strongyloides screening: Essential before starting corticosteroids, which can cause fatal hyperinfection syndrome 5

Monitoring Requirements

• Treatment >14 days: Monitor liver enzymes (transaminases) and complete blood counts at baseline, beginning of each 28-day cycle, and every 2 weeks during treatment 1, 5
• Hepatotoxicity and leukopenia: Discontinue if clinically significant decreases occur 1
• Patients with liver disease: Require more frequent monitoring due to increased bone marrow suppression risk 1

Concomitant Medications

• Neurocysticercosis patients: Should receive corticosteroids (e.g., 30 mg prednisolone daily) initiated prior to albendazole to prevent cerebral hypertensive episodes during the first week 5
• Anticonvulsants: Required for all neurocysticercosis patients with seizures 5
• Avoid dexamethasone: May reduce praziquantel levels through increased metabolism 5

Contraception Requirements

• Females of reproductive potential: Must use effective contraception during treatment and for 3 days after the final dose 1

Common Pitfalls to Avoid

• Not giving with food: This is the most common error, reducing absorption by up to 80% 1
• Underdosing Trichuris: Single-dose therapy has poor cure rates (27-60%); requires 3-7 days depending on infection severity 5, 7
• Giving crushed tablets to distressed children: Dramatically increases choking risk 4
• Starting albendazole before corticosteroids in neurocysticercosis: Can precipitate cerebral edema 5