Baylisascaris procyonis (raccoon roundworm), postexposure prophylaxis and treatment: Limited data available:
Children and Adolescents: Oral: 20 to 50 mg/kg/day in a single dose or 2 divided doses or 400 mg twice daily for 10 to 20 days. Longer duration (eg, 3 to 4 weeks) has also been described. Initiate as soon as possible after potential exposure (ideally within 3 days) to prevent clinical disease in any child at risk (eg, ingestion of raccoon stool or contaminated soil) (Ref).
Capillariasis: Limited data available: Children and Adolescents: Oral: 400 mg once daily for at least 10 days (Ref).
Giardiasis (Giardia duodenalis) (alternative therapy): Limited data available: Children ≥2 years and Adolescents: Oral: 10 to 15 mg/kg/dose once daily for 5 to 10 days; maximum dose: 400 mg/dose (Ref).
Gnathostomiasis, cutaneous:
Children and Adolescents: Limited data available: Oral: 400 mg twice daily for 21 days (Ref).
Hookworm-related cutaneous larva migrans (Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylanicum, Uncinaria stenocephala):
Infants ≥2 months and Children ≤2 years: Very limited data available: Oral: 15 mg/kg/dose once daily for 3 days; maximum dose: 200 mg/dose. Dosing based on case reports; some patients ≥8 months of age received fixed doses of 200 mg/dose and in one case the dosing was split into two divided doses (Ref).
Children >2 years and Adolescents: Limited data available: Oral: 15 mg/kg/dose once daily for 3 days; maximum dose: 400 mg/dose (Ref). Fixed dosing of 400 mg once daily for 3 days has also been recommended (Ref).
Hookworms, human (Ancylostoma duodenale or N. americanus) :
Infants ≥3 months: Very limited data available: Oral: 200 mg as a single dose. Dosing based on two cases (patient #1: age: 12 weeks, weight: 4.2 kg; and patient #2: age: 8 months, weight: 5.8 kg) of exclusively breastfed infants who showed clinical improvement after single-dose albendazole therapy (Ref).
Children <2 years: Limited data available: Oral: 200 to 400 mg as a single dose; may repeat in 3 weeks if needed (Ref).
Children ≥2 years and Adolescents: Limited data available: Oral: 400 mg as a single dose; may repeat in 3 weeks if needed (Ref).
Hydatid disease (E. granulosus, dog tapeworm): Children and Adolescents: Oral: 5 to 7.5 mg/kg/dose twice daily for 1 to 6 months; maximum dose: 400 mg/dose (Ref).
Liver flukes (Clonorchiasis or Opisthorchiasis) (alternative therapy): Limited data available: Children and Adolescents: Oral: 10 mg/kg/dose once daily for 7 days (Ref).
Loiasis: Children and Adolescents: Limited data available: Oral: 200 mg twice daily for 21 days (Ref).
Microsporidia infection: Limited data available: Note: Limited or no efficacy against Enterocytozoon spp. (eg, Enterocytozoon bieneusi) or Vittaforma corneae (Ref).
Children and Adolescents: Oral: 7.5 mg/kg/dose twice daily; maximum dose: 400 mg/dose (Ref). Duration of therapy is not well established but should be individualized based on immune status, site of infection (localized or disseminated), and clinical response; 2 to 4 weeks has been suggested, though 7 days of therapy may be adequate in immunocompetent patients with infection limited to the GI tract. In patients with HIV, continue until resolution of signs and symptoms and sustained immune reconstitution (>6 months at CDC immunologic category 1 or 2) after antiretroviral therapy initiation (Ref).
Neurocysticercosis (T. solium, pork tapeworm), parenchymal disease: Note: Patients should receive concurrent corticosteroid for the first week of albendazole therapy and antiseizure medication therapy as required. If >2 viable cysts present, combination therapy with praziquantel is recommended (Ref).
Children and Adolescents: Oral: 7.5 mg/kg/dose twice daily for 10 to 14 days; maximum dose: 600 mg/dose. Treatment for up to 30 days has also been recommended (Ref).
Strongyloidiasis (S. stercoralis) (alternative agent): Limited data available: Children and Adolescents: Oral: 400 mg twice daily for 7 days; patients with hyperinfection and disseminated disease may need prolonged or repeated treatment (eg, daily treatment until stool and/or sputum exams are negative for 2 weeks) (Ref).
Toxocariasis: Limited data available:
Children and Adolescents: Oral: 400 mg twice daily. Treatment for 5 days is recommended; however, optimal treatment duration unknown. Treatment for ocular larva migrans has been reported for up to 2 to 4 weeks (Ref).
Trichinellosis (Trichinosis): Limited data available: Children and Adolescents: Oral: 400 mg twice daily for 8 to 14 days (Ref).
Trichuriasis (whipworm): Limited data available: Children and Adolescents: Oral: 400 mg once daily for 3 days; heavy infestations may be treated for 5 to 7 days (Ref).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). However, the need for adjustment not likely since albendazole is primarily eliminated by hepatic metabolism.
There are no dosage adjustments provided in the manufacturer's labeling; consider discontinuing therapy if hepatic enzymes increase to twice the ULN while on therapy based on patient clinical status.
(For additional information see "Albendazole: Drug information")
Dosage guidance:
Clinical considerations: For systemic infections, coadministration with a high-fat meal is recommended to increase absorption (Ref); for intraluminal infections, administration on an empty stomach may be appropriate (Ref).
Capillariasis (off-label use): Oral: 400 mg once or twice daily for ≥10 to 30 days (Ref).
Echinococcosis ( dog tapeworm):
Alveolar echinococcosis (E. multilocularis) (off-label use):
Note: Surgical resection is the primary approach to treatment; antiparasitic therapy is recommended postoperatively to reduce relapse or as palliative therapy when surgery is unfeasible (Ref).
Oral: 15 mg/kg/day (maximum: 800 mg/day) in 2 divided doses. Optimal duration is uncertain; give for ≥2 years to indefinitely, depending on extent of surgical resection (Ref).
Cystic echinococcosis (E. granulosus, also known as hydatid disease):
Note: For cysts with diameter >5 cm or multiple compartments (WHO stage CE2 or CE3b), use in combination with surgical resection or percutaneous treatment; initiate albendazole ≥1 day preoperatively (Ref).
Oral: 15 mg/kg/day (maximum: 800 mg/day) in 2 divided doses. Optimal duration uncertain; give for 1 to 6 months based on clinical factors (Ref).
Giardiasis (alternative agent) (off-label use):
Note: Treatment of asymptomatic infection is warranted in selected settings to prevent transmission to vulnerable populations (eg, group settings, household contacts of immunocompromised or pregnant individuals, food handlers) (Ref).
Oral: 400 mg once daily for 5 days (Ref). For patients with refractory infection after repeated courses of preferred agents, some experts suggest albendazole 400 mg once daily in combination with metronidazole for 5 to 7 days (Ref).
Intestinal tapeworm infection (Taeniasis) (alternative agent) (off-label use): Oral: 400 mg once daily for 3 days (Ref).
Liver fluke infection (Clonorchis sinensis or Opisthorchis viverrine) (alternative agent) (off-label use):Oral: 10 mg/kg/day for 7 days (maximum dose: 400 mg twice daily) (Ref).
Microsporidiosis (off-label use):
Note: Albendazole is not recommended for Enterocytozoon bieneusi or Vittaforma corneae because of limited efficacy (Ref).
Immunocompromised (including patients with HIV):
Disseminated or intestinal infection: Oral: 400 mg twice daily for ≥14 to 21 days (Ref); for patients with HIV, continue until CD4 count >200 cells/mm3 for ≥3 months after initiation of antiretroviral therapy (Ref). For disseminated disease due to Trachipleistophora or Anncaliia, use in combination with itraconazole (Ref).
Ocular infection: Oral: 400 mg twice daily in combination with topical fumagillin until CD4 count >200 cells/mm3 and ocular symptoms resolve (Ref).
Immunocompetent:
Extraintestinal infection: Oral: 400 mg twice daily for 7 to 14 days (Ref); some experts give for up to 3 weeks for severe or slowly resolving symptoms (Ref). For ocular infection, use in combination with topical fumagillin (Ref).
Intestinal (Encephalitozoon intestinalis) infection: Oral: 400 mg twice daily (Ref) for 7 to 14 days (Ref).
Neurocysticercosis, parenchymal disease ( Taenia solium , pork tapeworm):
Note: For viable or degenerating noncalcified cysts only; avoid with untreated hydrocephalus, diffuse cerebral edema with multiple cysts (ie, cysticercal encephalitis), or ocular lesions because of risks from worsening inflammation. Manage in consultation with an expert in neurocysticercosis (Ref).
Oral: 15 mg/kg/day in 2 divided doses (maximum: 1.2 g/day) in combination with adjunctive glucocorticoids; start >1 day after glucocorticoid initiation. For patients with >2 viable cysts present, use in combination with praziquantel (Ref). Duration of antiparasitic therapy is 7 to 14 days (Ref). For persistent viable lesions on 6-month follow-up imaging, may re-treat with same regimen as initial therapy (Ref).
Pinworm infection (Enterobiasis) (off-label use): Oral: 400 mg as a single dose; repeat dose in 2 weeks (Ref).
Toxocariasis (off-label use):
Ocular larva migrans with sight-threatening ocular inflammation:Optimal dose and duration are not well-defined: Oral: 400 mg twice daily for 2 weeks (Ref); use in combination with glucocorticoids (Ref).
Visceral larva migrans, moderate to severe: Oral: 400 mg twice daily for 5 days (Ref). For individuals in East Asia, some experts favor a longer duration (eg, 4 weeks) (Ref). For severe infection, use in combination with glucocorticoids (Ref).
Trichinellosis (off-label use): Oral: 400 mg twice daily for 8 to 14 days; for severe symptoms, may be used in combination with glucocorticoids (Ref).
Trichostrongylosis (off-label use): Oral: 400 mg as a single dose (Ref).
Whipworm infection (Trichuriasis) (off-label use): Oral: 400 mg once daily for 3 days alone or in combination with ivermectin (Ref); monotherapy is considered an alternative as it associated with lower efficacy (Ref). For resource-limited settings, may use single-dose combination therapy (400 mg as a single dose in combination with single-dose ivermectin) (Ref).
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: Oral: No dosage adjustment necessary for any degree of kidney impairment (<1% urinary excretion of active metabolite) (Ref).
Hemodialysis, intermittent (thrice weekly): Oral: Dialyzability unknown: No supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Oral: Dialyzability unknown: No dosage adjustment necessary (Ref).
CRRT: Oral: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): Oral: No dosage adjustment necessary (Ref).
There are no dosage adjustments provided in manufacturer's labeling. However, patients with underlying liver disease may be more at risk for adverse effects.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Central nervous system: Headache (neurocysticercosis: 11%; hydatid: 1%)
Hepatic: Increased liver enzymes (hydatid: 16%; neurocysticercosis: <1%)
1% to 10%:
Central nervous system: Increased intracranial pressure (≤2%), dizziness (≤1%), vertigo (≤1%), meningism (1%)
Dermatologic: Alopecia (<1% to 2%)
Gastrointestinal: Abdominal pain (≤6%), nausea and vomiting (4% to 6%)
Miscellaneous: Fever (≤1%)
<1%, postmarketing, and/or case reports: Acute hepatic failure, acute renal failure, agranulocytosis, aplastic anemia, erythema multiforme, granulocytopenia, hepatitis, hypersensitivity reaction, leukopenia, neutropenia, pancytopenia, skin rash, Stevens-Johnson syndrome, thrombocytopenia, urticaria
Hypersensitivity to albendazole, benzimidazoles, or any component of the formulation
Concerns related to adverse effects:
• Bone marrow suppression: Agranulocytosis, aplastic anemia, granulocytopenia, leukopenia, and pancytopenia have occurred leading to fatalities (rare); use with caution in patients with hepatic impairment (more susceptible to hematologic toxicity). Discontinue therapy in all patients who develop clinically significant decreases in blood cell counts.
• Transaminase elevations: Reversible elevations in hepatic enzymes have been reported. Patients with abnormal LFTs and hepatic echinococcosis are at an increased risk of hepatotoxicity. Discontinue therapy if LFT elevations are >2 times the upper limit of normal; may consider restarting treatment (with frequent monitoring of LFTs) when hepatic enzymes return to pretreatment values. Discontinue therapy if hepatic enzymes are significantly increased.
Disease-related concerns:
• Neurocysticercosis: Appropriate use: Antiparasitic therapy may worsen symptoms of neurocysticercosis by inducing an inflammatory response; adjunctive corticosteroid therapy should be started before initiation of albendazole. Antiparasitic therapy should not be initiated in patients with untreated hydrocephalus, calcified lesions, or cysticercal encephalitis. Perform funduscopic exam prior to initiation of antiparasitic therapy to exclude intraocular cysticerci; antiparasitic therapy may lead to blindness in some cases with unsuspected intraocular parasites (IDSA/ASTMH [White 2018]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral:
Albenza: 200 mg [DSC]
Generic: 200 mg
Yes
Tablets (Albendazole Oral)
200 mg (per each): $18.00 - $276.65
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Oral: Administer with a high-fat meal to increase absorption. For patients who have difficulty swallowing whole tablets, tablet may be crushed or chewed and swallowed with a drink of water.
Oral: For systemic infection, coadministration with a high-fat meal is recommended to increase absorption (Ref); for intraluminal infection, administration on an empty stomach may be appropriate (Ref). If patients have difficulty swallowing, tablets may be crushed or chewed, then swallowed with a drink of water.
Store between 20°C and 25°C (68°F to 77°F)
Treatment of parenchymal neurocysticercosis due to active lesions caused by larval forms of Taenia solium (pork tapeworm) and treatment of cystic hydatid disease of the liver, lung, and peritoneum caused by the larval form of Echinococcus granulosus (dog tapeworm) (FDA approved in pediatric patients [age not specified] and adults); has also been used in the treatment of zoonotic hookworms (cutaneous larva migrans), ascariasis (intestinal roundworm), Baylisascaris procyonis (raccoon roundworm), capillariasis, liver flukes (Clonorchis sinensis and Opisthorchis viverrini), enterobiasis (pinworm), filariasis (Wuchereria bancroft), giardiasis, microsporidiosis, Necator americanus (hookworm), Strongyloides stercoralis, trichinellosis (trichinosis), Trichuris trichiura (whipworm), and toxocariasis (ocular larva migrans, visceral larva migrans).
Albenza may be confused with Aplenzin, Relenza.
Albenza [US] may be confused with Avanza brand name for mirtazapine [Australia].
Substrate of CYP1A2 (Minor), CYP3A4 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
CarBAMazepine: May decrease active metabolite exposure of Albendazole. Risk C: Monitor
Grapefruit Juice: May increase active metabolite exposure of Albendazole. Specifically, concentrations of albendazole sulfate may be increased. Risk C: Monitor
Nirmatrelvir and Ritonavir: May decrease serum concentration of Albendazole. Risk C: Monitor
PHENobarbital: May decrease active metabolite exposure of Albendazole. Risk C: Monitor
Phenytoin: May decrease active metabolite exposure of Albendazole. Risk C: Monitor
Ritonavir: May decrease serum concentration of Albendazole. Risk C: Monitor
Albendazole serum levels may be increased if taken with a fatty meal (increases the oral bioavailability by up to 5 times). Management: Should be administered with a high-fat meal when treating systemic infections.
Evaluate pregnancy status prior to use; pregnancy testing is recommended in patients who could become pregnant (CDC 2019a; Persichino 2018). Effective contraception is recommended during chronic therapy (Persichino 2018) and for 1 month after the last dose (per the manufacturer).
The World Health Organization recommends preventive therapy with a benzimidazole, such as albendazole, for patients who could become pregnant who live in areas where the baseline prevalence of soil-transmitted helminth infections is ≥20% (WHO 2017).
Outcome data following first trimester use of albendazole are limited (Gyorkos 2019; Lau 2020). Most pregnancy outcome data are available from studies using a single dose of albendazole administered to patients during the second or third trimester (Gyorkos 2019; Lau 2020; Mofid 2017; Salam 2021). However, case reports are also available following longer term treatment of hydatid disease (Auer 1994; Bhattacharyya 2013; Gul 2023; Llanos 2020; Pallua 2010; Sahin 2021).
Untreated soil-transmitted helminth infections during pregnancy are associated with adverse maternal outcomes (eg, maternal iron deficiency anemia, impaired nutrient absorption) (WHO 2017).
Use of albendazole during the first trimester of pregnancy is not recommended (HHS [OI Adult 2024]; IDSA/ASTMH [White 2018]; WHO 1996; WHO 2017). Pregnant patients with neurocysticercosis should be treated for symptoms (eg, increased intracranial pressure, seizures) the same as nonpregnant patients; however, antihelminthic therapy with albendazole can be deferred until after delivery (IDSA/ASTMH [White 2018]). Albendazole should not be used for the treatment of microsporidiosis in HIV-infected pregnant patients during the first trimester; use later in pregnancy may be considered when the benefits outweigh potential risks (HHS [OI Adult 2024]; White 2018). The WHO also recommends treatment of soil-transmitted helminthiases (such as hookworm) in pregnant patients after the first trimester (WHO 1996). Pregnant patients arriving as refugees from specific countries should not be given albendazole for the presumptive treatment of intestinal parasites prior to arrival in the United States; presumptive treatment can be deferred until arrival (CDC 2019a).
Monitor LFTs and CBC at baseline and every 2 weeks during therapy (more frequently for patients with liver disease); pregnancy test in patients who can become pregnant.
Active metabolite, albendazole sulfoxide, causes selective degeneration of cytoplasmic microtubules in intestinal and tegmental cells of intestinal helminths and larvae; glycogen is depleted, glucose uptake and cholinesterase secretion are impaired, and desecratory substances accumulate intracellulary. ATP production decreases causing energy depletion, immobilization, and worm death.
Note: In pediatric patients (6 to 13 years), pharmacokinetic values were reported to be similar to adult data.
Absorption: Poor from the GI tract; may increase up to 5 times when administered with a fatty meal.
Distribution: Widely distributed throughout the body including urine, bile, liver, cyst wall, cyst fluid, and CSF.
Protein binding: 70%.
Metabolism: Hepatic; extensive first-pass effect; pathways include rapid sulfoxidation to active metabolite (albendazole sulfoxide [major]), hydrolysis, and oxidation.
Half-life elimination: 8 to 12 hours (albendazole sulfoxide).
Time to peak, serum: 2 to 5 hours for the metabolite.
Excretion: Urine (<1% as active metabolite); feces.
Hepatic function impairment: Systemic availability, rate of absorption, and the elimination half-life of albendazole sulfoxide are increased in patients with extrahepatic obstruction.