What is the recommended dose of Albendazole (anti-parasitic medication) for adults?

Albendazole Dosing for Adults

For most common parasitic infections in adults, albendazole 400 mg as a single oral dose is the standard recommendation, though specific parasites require different regimens based on infection type. 1, 2

Standard Single-Dose Regimens (400 mg)

The following infections are effectively treated with a single 400 mg oral dose:

• Ascariasis (roundworm): 400 mg single dose achieves 100% cure rate 1, 3
• Hookworm (initial treatment): 400 mg single dose 1
• Enterobiasis (pinworm): 400 mg single dose with 100% cure rate 1, 4

Multiple-Day Treatment Regimens

For infections requiring extended therapy:

• Hookworm (complete treatment): 400 mg daily for 3 days 1
• Whipworm (Trichuris trichiura): While mebendazole is preferred, albendazole can be used; consider higher doses or extended duration for better cure rates 1
• Strongyloidiasis (normal immunity): 400 mg twice daily for 3-7 days (though ivermectin 200 μg/kg single dose is preferred first-line) 1, 5

FDA-Approved Indications with Weight-Based Dosing

For the two FDA-approved indications, dosing differs based on body weight: 6

Neurocysticercosis:

• ≥60 kg: 400 mg twice daily with meals for 8-30 days 6
• <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) for 8-30 days 6
• Critical: Must use concomitant steroids and anticonvulsants to prevent neurological symptoms from inflammatory reactions 6

Hydatid Disease (Echinococcosis):

• ≥60 kg: 400 mg twice daily with meals for 28-day cycles, followed by 14-day drug-free intervals, for total of 3 cycles 6
• <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) using same cycle pattern 6

Specialized Infections Requiring Higher or Prolonged Dosing

• Visceral larva migrans (Toxocariasis): 400 mg twice daily for 5 days 1
• Pulmonary eosinophilia: 400 mg twice daily for 5-7 days depending on severity 5
• Microsporidiosis: 7.5 mg/kg (maximum 400 mg/dose) twice daily until immune reconstitution 1
• Loiasis: 400 mg daily for 10-28 days for high microfilarial loads; may increase to 800 mg daily if treatment fails 1

Critical Administration Guidelines

Always take albendazole with food to enhance absorption and efficacy 6

Tablets may be crushed or chewed and swallowed with water for ease of administration 6

Essential Safety Precautions and Monitoring

Before initiating treatment:

• Exclude Loa loa infection in anyone who has traveled to endemic regions BEFORE giving ivermectin, as co-administration can cause severe adverse reactions 1, 2, 5
• Obtain pregnancy test in females of reproductive potential, as albendazole causes fetal harm and skeletal malformations 6
• Screen for Strongyloides before administering corticosteroids to prevent hyperinfection syndrome 2

During treatment (especially for prolonged courses):

• Monitor blood counts at the beginning of each 28-day cycle and every 2 weeks during therapy, as albendazole can cause bone marrow suppression, agranulocytopenia, and pancytopenia 6
• Monitor liver enzymes at the beginning of each cycle and at least every 2 weeks, particularly in patients with liver disease 6
• Discontinue immediately if clinically significant decreases in blood cell counts occur 6

Common Pitfalls to Avoid

• For T. solium intestinal infection, niclosamide is preferred over praziquantel unless neurocysticercosis has been excluded 1
• For schistosomiasis, repeat treatment at 8 weeks as eggs and immature forms are resistant to initial treatment 1, 5
• Single-dose regimens have limited efficacy against Trichuris trichiura compared to hookworm and Ascaris; triple-dose regimens significantly improve cure rates 7
• Females of reproductive potential must use effective contraception during treatment and for 3 days after the final dose 6