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Albendazole
Albendazole is a broad-spectrum anthelmintic medication used to treat a variety of parasitic worm infections, including intestinal helminths and tissue-invasive parasites like hydatid cysts and neurocysticercosis. It is a cornerstone therapy in both clinical and public health settings due to its efficacy and versatility. This article provides a detailed overview of albendazole, referencing authoritative sources such as the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology. We will explore its mechanism of action, uses, dosage, side effects, precautions, drug interactions, and generic names in pharmacy.
Albendazole exerts its antiparasitic effects through the following mechanisms:
- Microtubule Inhibition:
- Binds to beta-tubulin in parasitic cells, inhibiting microtubule polymerization (Lippincott).
- Disrupts glucose uptake and intracellular transport, leading to energy depletion and parasite death (Lange).
- Selective Toxicity:
- Higher affinity for parasite tubulin than human tubulin, minimizing host toxicity (BNF).
- Metabolite Activity:
- Converted in the liver to albendazole sulfoxide, the active metabolite responsible for systemic effects (Lippincott).
Albendazole is indicated for:
- Intestinal Helminth Infections:
- Roundworms (Ascaris lumbricoides), Hookworms (Ancylostoma duodenale, Necator americanus), Whipworms (Trichuris trichiura), and Pinworms (Enterobius vermicularis): Single-dose or short-course treatment (BNF).
- Tissue-Invasive Parasites:
- Hydatid Disease (Echinococcus granulosus): Long-term treatment (3–6 months).
- Neurocysticercosis (Taenia solium): 8–30 days of treatment, often with corticosteroids to reduce inflammation (Lange).
- Off-Label Uses:
- Strongyloidiasis, Cutaneous Larva Migrans, and Microsporidiosis (Lippincott).
Dosage varies by infection type and patient age. Always follow prescribing guidelines:
Adults and Children Over 2 Years:
- Intestinal Helminths: 400 mg single dose, repeated after 2–3 weeks if necessary.
- Hydatid Disease: 400 mg twice daily for 28 days, followed by a 14-day break; repeat for 3 cycles (BNF).
- Neurocysticercosis: 400 mg twice daily for 8–30 days (Lange).
Administration Tips:
- Take with fatty meals to enhance absorption.
- Tablets may be crushed or chewed for children or patients with difficulty swallowing.
Albendazole is generally well-tolerated, but potential side effects include:
Common:
- Gastrointestinal: Abdominal pain, nausea, vomiting.
- Headache or dizziness.
Rare but Serious:
- Hepatotoxicity: Elevated liver enzymes, jaundice (Lippincott).
- Hematologic Effects: Leukopenia, pancytopenia (BNF).
- Hypersensitivity Reactions: Rash, Stevens-Johnson syndrome.
Before using albendazole, consider:
- Pregnancy: Avoid in the first trimester; use only if benefits outweigh risks (BNF Category: C).
- Breastfeeding: Low systemic absorption minimizes risk; generally considered safe.
- Hepatic Impairment: Monitor liver function tests during prolonged therapy.
- Corticosteroid Use: Required in neurocysticercosis to reduce inflammation from dying parasites (Lange).
Albendazole interacts with:
- CYP450 Inhibitors (e.g., cimetidine):
- Increase albendazole sulfoxide levels, enhancing efficacy and toxicity risk (BNF).
- CYP450 Inducers (e.g., carbamazepine, phenytoin):
- Reduce albendazole sulfoxide levels, decreasing effectiveness (Lippincott).
- Dexamethasone:
- Increases albendazole sulfoxide levels, requiring dose adjustments in neurocysticercosis (Lange).
Generic Names in Pharmacy
- Albendazole (active ingredient)
Common brand names: Albenza®, Zentel®, Eskazole®
