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

Albendazole Dosing Recommendations

Standard Dose for Common Parasitic Infections

For most common intestinal parasitic infections in adults and children over 24 months, albendazole 400 mg as a single oral dose is the recommended treatment. 1, 2

Single-Dose Regimens (400 mg)

• Ascariasis (roundworm): 400 mg single dose 2, 3
• Hookworm infections: 400 mg single dose (initial treatment) 2, 3
• Enterobiasis (pinworm): 400 mg single dose, repeat in 2 weeks 1, 2
• Empirical treatment of asymptomatic eosinophilia: 400 mg single dose plus ivermectin 200 μg/kg 1, 2

Multi-Day Regimens

For infections requiring prolonged treatment, dosing varies from 400 mg once daily to 400 mg twice daily depending on the specific parasite:

Once Daily Dosing

• Hookworm (complete treatment): 400 mg daily for 3 days 2
• Loiasis: 400 mg daily for 10-28 days (or 800 mg daily for treatment failure) 2

Twice Daily Dosing

• Visceral larva migrans (Toxocariasis): 400 mg twice daily for 5 days 2, 4
• Capillariasis: 400 mg twice daily for 21 days 4, 5
• Strongyloidiasis: 400 mg twice daily for 3-7 days (though ivermectin is preferred) 2, 6
• Gnathostomiasis: 400 mg twice daily for 21 days 1

FDA-Approved Dosing for Specific Conditions

For neurocysticercosis and hydatid disease, the FDA-approved dosing is weight-based: 7

Neurocysticercosis

• Patients ≥60 kg: 400 mg twice daily with meals for 8-30 days 7
• Patients <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) for 8-30 days 7
• Critical: Concomitant steroids and anticonvulsants are required to prevent cerebral hypertensive episodes during the first week 7

Hydatid Disease (Echinococcosis)

• Patients ≥60 kg: 400 mg twice daily with meals 7
• Patients <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) 7
• Duration: 28-day cycle followed by 14-day drug-free interval, for total of 3 cycles 7

Pediatric Dosing

Children over 24 months receive the same 400 mg dose as adults for most infections. 2, 4

• Children 12-24 months: Discuss with specialist before treatment 1, 4
• Children under 12 months: Expert guidance required 8
• Microsporidiosis: 7.5 mg/kg (maximum 400 mg) twice daily 2, 4

Critical Administration Guidelines

Always take albendazole with food to enhance absorption. 7

• Tablets may be crushed or chewed and swallowed with water 7
• Exclude Loa loa infection before administering ivermectin to prevent severe adverse reactions 1, 2, 8
• For schistosomiasis, repeat treatment at 8 weeks as immature parasites are resistant to initial treatment 1, 2

Monitoring Requirements

For treatment courses longer than 14 days or in high-risk patients, mandatory monitoring includes: 7

• Blood counts at the beginning of each 28-day cycle and every 2 weeks during therapy 7
• Liver enzymes (transaminases) at the beginning of each cycle and at least every 2 weeks 7
• Pregnancy test in females of reproductive potential prior to therapy 7
• Patients with liver disease or hepatic echinococcosis require more frequent monitoring due to increased risk of bone marrow suppression 7

Common Pitfalls to Avoid

Discontinue albendazole immediately if clinically significant decreases in blood cell counts occur, as fatalities from granulocytopenia and pancytopenia have been reported. 7

• Never use in pregnancy: Albendazole causes embryotoxicity and skeletal malformations in animal studies 7
• Females of reproductive potential must use effective contraception during treatment and for 3 days after the final dose 7
• For neurocysticercosis, failure to provide steroids can result in life-threatening cerebral edema from parasite death 7
• For T. solium intestinal infection, use niclosamide instead of praziquantel unless neurocysticercosis is excluded 2