Albendazole and Liquid Paraffin Should NOT Be Administered Together
Liquid paraffin should be avoided when administering albendazole because it will significantly impair the absorption of albendazole, which requires fatty meals for optimal therapeutic efficacy. 1, 2
Why This Combination Is Problematic
Albendazole Requires Fat for Absorption
- Albendazole is poorly absorbed orally (<5%) and requires administration with fatty meals to achieve therapeutic drug levels. 2, 3
- Oral bioavailability of albendazole increases up to 5-fold when administered with fatty meals, which is essential for systemic absorption needed to treat tissue parasites. 4
- The World Health Organization specifically recommends taking albendazole with food, especially fatty meals, to maximize absorption and therapeutic efficacy. 2
Liquid Paraffin Interferes with Drug Absorption
- Liquid paraffin is a mineral oil that acts as a lubricant laxative and is specifically NOT recommended in advanced disease management due to multiple safety concerns. 1
- Mineral oils like liquid paraffin can interfere with the absorption of fat-soluble substances and medications by creating a physical barrier in the gastrointestinal tract. 1
- Liquid paraffin carries additional risks including aspiration leading to lipoid pneumonia, anal seepage, skin excoriation, and foreign body reactions if there is a break in the anorectal mucosa. 1
Clinical Implications
The Mechanism of Interference
- When liquid paraffin coats the intestinal mucosa, it prevents the proper emulsification and absorption of dietary fats that are necessary for albendazole uptake. 1, 2
- This would effectively negate the 4-5 fold increase in bioavailability that occurs when albendazole is taken with fatty meals. 4, 3
Impact on Treatment Efficacy
- Reduced albendazole absorption would compromise antiparasitic efficacy against intestinal nematodes (hookworm, Ascaris, Trichuris, Strongyloides, Enterobius) and tissue parasites. 4, 5
- For neurocysticercosis treatment, where systemic absorption is critical, this interaction could lead to treatment failure. 1, 2
Recommended Approach
If Constipation Management Is Needed During Albendazole Therapy
- Use osmotic laxatives such as polyethylene glycol (PEG/Macrogol) or lactulose instead of liquid paraffin. 1
- These agents are strongly endorsed for chronic constipation and do not interfere with drug absorption. 1
- Magnesium salts can be used cautiously in patients without renal impairment. 1
Optimal Albendazole Administration
- Administer albendazole with meals containing fatty food to ensure maximum therapeutic benefit. 2, 4
- For neurocysticercosis, give 15 mg/kg/day divided into 2 daily doses (maximum 1200 mg/day) with food. 2
- Avoid any agents that could coat the gastrointestinal tract or interfere with fat absorption during the treatment period. 1, 2