What is the recommended dosage of Albendazole (anti-parasitic medication) for adults and children with intestinal helminth infections or neurocysticercosis, considering factors such as age, weight, and impaired renal function?

Albendazole Dosing Recommendations

For intestinal helminth infections in adults and children, albendazole 400 mg as a single oral dose is the standard treatment, with repeat dosing at 2 weeks for hookworm and pinworm infections. 1, 2

Dosing by Indication

Intestinal Helminth Infections (Standard Dosing)

Single-dose regimens (400 mg):

• Ascariasis (roundworm): Albendazole 400 mg as a single oral dose 1
• Pinworm (Enterobius): Albendazole 400 mg as a single dose, repeated in 2 weeks 1
• Empirical treatment for undetected geohelminths: Albendazole 400 mg single dose plus ivermectin 200 μg/kg 1

Multi-day regimens:

• Hookworm infection: Albendazole 400 mg daily for 3 days 1
• Whipworm (Trichuris): Albendazole 400 mg daily for 3 days 1

Neurocysticercosis

Weight-based dosing is critical for this indication:

• Patients ≥60 kg: Albendazole 400 mg twice daily with meals for 8-30 days 2
• Patients <60 kg: Albendazole 15 mg/kg/day divided into two doses with meals (maximum 800 mg/day total) for 8-30 days 2
• Corticosteroids must be initiated prior to albendazole to prevent treatment-induced inflammation and seizures 3, 2

Hydatid Disease (Echinococcosis)

Extended treatment cycles are required:

• Patients ≥60 kg: Albendazole 400 mg twice daily with meals for 28-day cycles, followed by 14-day drug-free intervals, for a total of 3 cycles 2
• Patients <60 kg: Albendazole 15 mg/kg/day divided into two doses with meals (maximum 800 mg/day) for the same cycle regimen 2

Special Parasitic Infections

Tissue-dwelling parasites requiring prolonged therapy:

• Gnathostomiasis (if worm not removed): Albendazole 400 mg twice daily for 21 days 1
• Toxocariasis: Albendazole dosing requires specialist consultation, often with corticosteroids 1

Pediatric Considerations

Age-specific restrictions apply:

• Children >24 months: Standard adult dosing of 400 mg can be used for single-dose regimens 1
• Children 12-24 months: Expert consultation is required before treatment 1
• For neurocysticercosis and hydatid disease in children <60 kg: Use weight-based dosing of 15 mg/kg/day divided twice daily (maximum 800 mg/day) 2

Administration Requirements

Absorption is critically dependent on proper administration:

• Always administer albendazole with food, preferably fatty meals, to maximize absorption 3, 2
• Avoid liquid paraffin (mineral oil) during treatment as it significantly impairs albendazole absorption 3
• Tablets may be crushed or chewed and swallowed with water 2

Renal Impairment

No dose adjustment is specified in FDA labeling for renal impairment, as albendazole is primarily metabolized hepatically and excreted in bile 2. However, patients with hepatic disease require more frequent monitoring due to increased risk of bone marrow suppression 2.

Monitoring Requirements

Safety monitoring is essential for prolonged therapy (>14 days):

• Monitor complete blood counts at the beginning of each 28-day cycle and every 2 weeks during therapy 3, 2
• Monitor liver enzymes (transaminases) at the beginning of each cycle and at least every 2 weeks during treatment 3, 2
• Obtain pregnancy test in females of reproductive potential prior to initiating therapy 2
• Leukopenia occurs in up to 10% of patients and elevated liver enzymes in up to 16% with prolonged treatment 3

Critical Drug Interactions

Corticosteroid selection matters:

• Dexamethasone increases albendazole levels by approximately 56%, which may be therapeutically beneficial in neurocysticercosis but reduces praziquantel levels 3
• Praziquantel significantly increases albendazole exposure but co-administration is safe and commonly recommended without additional monitoring 3

Common Pitfalls to Avoid

Pre-treatment screening prevents serious complications:

• Perform fundoscopic examination before treatment to detect retinal cysticercosis 3
• Screen for Strongyloides stercoralis in patients requiring prolonged corticosteroids, as hyperinfection syndrome can be fatal 3
• Exclude Loa loa infection before administering ivermectin in patients from endemic regions (Central/West Africa) 1
• Undiagnosed neurocysticercosis may be uncovered when treating other parasitic conditions, potentially causing seizures 3