What is the recommended adult dose of albendazole?

Albendazole Adult Dosing

The recommended adult dose of albendazole is 400 mg as a single dose for most common helminth infections, or 400 mg twice daily (with meals) for 8-30 days for neurocysticercosis and hydatid disease, depending on the specific parasitic infection being treated. 1

Standard Single-Dose Regimen (400 mg)

For the majority of intestinal helminth infections in adults, a single 400 mg dose is the established standard 2:

• Ascariasis (roundworm): Single 400 mg dose achieves 100% cure rates 3, 4
• Hookworm: Single 400 mg dose, though may be extended to 3 days for complete eradication 3
• Enterobiasis (pinworm): Single 400 mg dose, repeated in 2 weeks 3, 1
• Empirical treatment of asymptomatic eosinophilia: Single 400 mg dose combined with ivermectin 200 μg/kg 2

Critical administration point: Albendazole must be taken with food to enhance absorption 3, 1. The tablet may be crushed or chewed and swallowed with water 3, 1.

Extended Multi-Day Regimens

Weight-Based Dosing for Serious Infections

For adults weighing ≥60 kg with neurocysticercosis or hydatid disease, the FDA-approved regimen is 400 mg twice daily with meals 1:

• Neurocysticercosis: 400 mg twice daily for 8-30 days 2, 1
• Hydatid disease: 400 mg twice daily for 28-day cycles, followed by 14-day drug-free intervals, for a total of 3 cycles 1

For adults <60 kg, use 15 mg/kg/day divided into two daily doses (maximum 800 mg/day total) 2, 1.

Specific Infection Protocols

• Strongyloidiasis: 400 mg once daily for 3 days, though ivermectin is preferred 3, 5
• Taenia species (tapeworm): 400 mg once daily for 3 days 3
• Capillariasis: 400 mg twice daily for 21 days 5
• Visceral larva migrans (Toxocara): 400 mg twice daily for 5 days 5

Critical Safety Monitoring

For treatment courses exceeding 14 days, mandatory monitoring is required 3:

• Blood counts: Check at baseline, at the beginning of each 28-day cycle, and every 2 weeks during therapy 1
• Liver enzymes (transaminases): Check at baseline, at the beginning of each 28-day cycle, and at least every 2 weeks during treatment 1
• Discontinue albendazole if clinically significant decreases in blood cell counts occur, as fatalities from granulocytopenia and pancytopenia have been reported 1

Essential Precautions

Neurocysticercosis-Specific Requirements

Patients with neurocysticercosis require concomitant therapy to prevent inflammatory reactions from parasite death 2, 3, 1:

• Initiate oral or intravenous corticosteroids prior to antiparasitic therapy to prevent cerebral hypertensive episodes during the first week 2, 1
• Administer anticonvulsant therapy as required 1
• Perform fundoscopic examination before treatment to exclude retinal involvement 3

Contraindications and Warnings

• Screen for Strongyloides stercoralis before prolonged corticosteroid use in neurocysticercosis patients, as steroids can precipitate fatal hyperinfection syndrome 3
• Exclude Loa loa infection before co-administering ivermectin in patients who have traveled to endemic regions 2, 3
• Pregnancy testing is required for females of reproductive potential prior to therapy; albendazole causes embryotoxicity and skeletal malformations in animal studies 1

Common Pitfalls

Trichuriasis (whipworm) shows poor response to albendazole monotherapy, with cure rates of only 27-60% even at higher doses 5, 6. The 600 mg dose showed only 25.6% cure rates in school-aged children and flat dose-response curves across all studied populations 6. Consider alternative agents or combination therapy for this infection 5.

For schistosomiasis, albendazole is insufficient—praziquantel is the drug of choice 2. If albendazole is used empirically for eosinophilia where schistosomiasis is possible, repeat treatment at 8 weeks because eggs and immature schistosomulae are relatively resistant 2.