What is the recommended dose of albendazole (anti-parasitic medication) for an adult patient with a parasitic infection?

Albendazole Dosing for Adults

For most common intestinal parasitic infections in adults, albendazole 400 mg as a single oral dose is the standard treatment, though specific parasites require different regimens ranging from single-dose to extended courses of 400 mg twice daily. 1

Standard Single-Dose Regimens (400 mg once)

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

• Ascariasis (roundworm): 400 mg single dose 1
• Enterobiasis (pinworm): 400 mg single dose 1
• Hookworm (initial treatment): 400 mg single dose 1

Extended Treatment Regimens

Multiple-Day Standard Dosing (400 mg daily)

• Hookworm (complete treatment): 400 mg daily for 3 days 1
• Taenia species (tapeworm): 400 mg daily for 3 days 2
• Whipworm (Trichuris trichiura): While mebendazole is preferred, albendazole can be used 1

Twice-Daily Dosing (400 mg BID)

• Strongyloidiasis (when ivermectin unavailable): 400 mg twice daily for 3-7 days 1
• Visceral larva migrans (Toxocariasis): 400 mg twice daily for 5 days 1
• Pulmonary eosinophilia: 400 mg twice daily for 5-7 days 3

Prolonged Treatment Courses

• Loiasis: 400 mg daily for 10-28 days (for high microfilarial loads or when diethylcarbamazine not feasible); may increase to 800 mg daily if treatment fails 1
• Microsporidiosis: 7.5 mg/kg (maximum 400 mg/dose) twice daily until immune reconstitution 1

FDA-Approved Indications (Higher Doses)

For patients weighing ≥60 kg with FDA-approved indications 4:

• Neurocysticercosis: 400 mg twice daily with meals for 8-30 days 4
• Hydatid disease: 400 mg twice daily with meals for 28-day cycles, followed by 14-day drug-free intervals, for total of 3 cycles 4

For patients <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) 4

Critical Administration Guidelines

• Always take with food to enhance absorption 4
• Tablets may be crushed or chewed if needed 4
• Empirical treatment for asymptomatic eosinophilia in travelers: Single dose of albendazole 400 mg plus ivermectin 200 μg/kg 1

Essential Safety Monitoring

For treatment courses >14 days or high-dose regimens 2, 4:

• Blood counts: Monitor at beginning of each 28-day cycle and every 2 weeks during therapy; discontinue if clinically significant decreases occur (fatalities from bone marrow suppression have been reported) 4
• Liver enzymes: Monitor at beginning of each cycle and at least every 2 weeks; discontinue if clinically significant elevations occur 4
• Pregnancy testing: Required for females of reproductive potential before therapy 4

Critical Pitfalls to Avoid

• Always exclude Loa loa in patients who traveled to endemic regions BEFORE treating with ivermectin 1, 3
• Neurocysticercosis patients: Must receive concomitant steroids and anticonvulsants to prevent cerebral hypertensive episodes, seizures, and focal neurologic deficits 1, 4
• Examine for retinal lesions before treating neurocysticercosis, as retinal involvement contraindicates treatment 4
• Avoid steroids in strongyloidiasis as they may precipitate hyperinfection syndrome 3
• Schistosomiasis: Repeat treatment at 8 weeks as eggs and immature forms resist initial treatment 1, 3
• Contraception required: Females of reproductive potential must use effective contraception during treatment and for 3 days after final dose due to teratogenicity risk 4

Drug Interactions Requiring Dose Adjustment

• Dexamethasone: Increases albendazole sulfoxide levels by 56%; no dose adjustment typically needed but monitor for toxicity 4
• Praziquantel: Increases albendazole levels by 50% when taken with food 4
• Cimetidine: Doubles albendazole concentrations in bile and cystic fluid 4
• Theophylline: Monitor plasma concentrations during and after albendazole treatment 4