albendazole
Brand: Albenza
Prototype Drug
Drug Class: benzimidazole antiparasitic
Drug Family: antiparasitic
Subclass: broad-spectrum benzimidazole
Organ Systems: infectious-disease
Mechanism of Action
Binds helminth beta-tubulin, preventing tubulin polymerization; disrupts microtubule function, impairs glucose uptake and energy metabolism, and inhibits secretory vesicle function; the active metabolite albendazole sulfoxide has high tissue penetration for cystic disease.
beta-tubulin of helminths and protozoa
Indications
- neurocysticercosis (Taenia solium)
- cystic echinococcosis (hydatid disease)
- filariasis
- strongyloidiasis
- ascariasis, hookworm, pinworm, whipworm (standard intestinal helminths)
- giardiasis (alternative)
Contraindications
- albendazole hypersensitivity
- pregnancy (teratogenic — verify negative pregnancy test before initiating)
Adverse Effects
Common
- elevated liver enzymes
- abdominal pain
- nausea
Serious
- hepatotoxicity
- bone marrow suppression (agranulocytosis)
- Steven-Johnson syndrome (rare)
- CNS effects in neurocysticercosis (seizures from dying larvae)
Pharmacokinetics (ADME)
| Absorption | poorly absorbed orally; high-fat meal increases absorption by ~5-fold; always administer with fatty food |
| Distribution | albendazole sulfoxide (active metabolite) distributes widely including CSF, cyst fluid |
| Metabolism | extensive first-pass to albendazole sulfoxide (active) and sulfone (inactive) |
| Excretion | biliary/fecal (primarily); renal minor |
| Half-life | 8–12 hours (albendazole sulfoxide) |
| Onset | 2–5 hours |
| Peak | 2–5 hours |
| Duration | 28-day cycles (neurocysticercosis, echinococcosis) |
| Protein Binding | 70% |
| Vd | large |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| cimetidine | increases albendazole sulfoxide levels ~50%; potentially beneficial for systemic infections | minor |
| dexamethasone | increases albendazole sulfoxide levels ~56%; co-administered for neurocysticercosis to reduce inflammation | minor |
| anticonvulsants (carbamazepine, phenytoin) | reduce albendazole levels; monitor response | moderate |
Nursing Considerations
- Administer with a fatty meal for systemic infections (neurocysticercosis, echinococcosis) to maximize absorption; for simple intestinal infections, standard administration suffices.
- For neurocysticercosis, co-administer corticosteroids (dexamethasone) to prevent CNS inflammatory reactions from dying parasites; monitor for seizure activity.
- Obtain baseline LFTs and CBC before starting therapy; monitor monthly — both hepatotoxicity and agranulocytosis can occur.
- Confirm negative pregnancy test before prescribing; use contraception during and for 3 days after therapy.
Clinical Pearls
- Albendazole's active metabolite (sulfoxide) penetrates to echinococcal cyst fluid and CSF at therapeutic concentrations, enabling treatment of systemic cystic infections that mebendazole cannot adequately reach due to poor absorption.
- For neurocysticercosis, antiparasitic therapy is controversial in purely calcified lesions; it is indicated for viable or transitional cysts, and should always be combined with corticosteroids and anticonvulsants to manage the inflammatory response to dying parasites.
Safety Profile
Pregnancy contraindicated
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.