Albendazole adverse effects

Albendazole selectively blocks glucose uptake and depletes glycogen stores. ATP formation is thus inhibited. It should be administered on an empty stomach for intraluminal parasites and with a fatty meal for tissue parasites. It is metabolized to an active sulfoxide metabolite resulting in very low Albendazole blood levels. Albendazole sulfoxide is excreted in the urine with an elimination half-life of about 8 h. Used for 1-3 days in doses recommended for intestinal worms the incidence of adverse effects is similar in treatment and control groups. Hepato-toxicity may occur, especially after the higher doses that are needed for hydatid disease. Also alopecia has been reported. 

When used for 1-3 days, albendazole is nearly free of significant adverse effects. Mild and transient epigastric distress, diarrhea, headache, nausea, dizziness, lassitude, and insomnia can occur. In long-term use for hydatid disease, albendazole is well tolerated, but it can cause abdominal distress, headaches, fever, fatigue, alopecia, increases in liver enzymes, and pancytopenia. 

Mebendazole is a synthetic benzimidazole (compare with albendazole) that has a wide spectrum of anthelmintic activity and a low incidence of adverse effects. 

The efficacy of 2 years of mass chemotherapy against ascariasis has been evaluated in Iran (5). A single dose of albendazole 400 mg was given at 3-month intervals for 2 years to every person, except children under 2 years of age and pregnant women. After 2 years of treatment the prevalences, based on 2667 post-treatment samples, had fallen (Table 1). There were no adverse effects of mass treatment with albendazole. 

In a report on the use of albendazole 15 mg/kg/day in two divided doses for 14 days in the treatment of persistent neurocysticercosis (10), adverse reactions were monitored in 43 patients with seizures and a sohtary cysticercal cyst, who had not been treated before. In aU patients CT scans confirmed the presence of a solitary cyst less than 2 cm in diameter. Antiepileptic treatment was continued. In seven patients dexamethasone 8 mg/day in four divided doses was given for the first 5-7 days after the start of treatment. Follow-up CT scans at 4-10 weeks after the start of treatment showed responses in 20 patients, with complete disappearance in seven patients and a reduction to 50% of the pretreatment size in the other 13. There were adverse effects in 15 patients, with a maximum on the fifth day after the start of treatment. Six patients had severe headaches, 11 had partial seizures, and 2 had epileptic seizures and severe postictal hemiparesis that persisted for a week or more. Because of these serious adverse effects treatment was discontinued in seven patients and dexamethasone was added in those patients who were not already taking it, although its use proved questionable. Adverse effects were seen in three of seven patients who took prophylactic steroid therapy and in 12 of 36 patients who did not. 

In 110 children with ascariasis or trichuriasis the efficacy of a single dose of albendazole 400 mg has been compared with that of nitazoxanide 100 mg bd for 3 days in children aged 1-3 years and 200 mg bd for 3 days in children aged 4-11 years (16). Nitazoxanide cured 89 and 89% of the cases of ascariasis and trichuriasis respectively. Albendazole cured 91 and 58% of the cases of ascariasis and trichuriasis respectively. Abdominal pain (n — 9), nausea (n = 1), diarrhea (n — 2), and headache (n — 1) were reported as mild adverse effects in 105 patients who took nitazoxanide, and abdominal pain (n — 1), nausea (n = 1), and vomiting (n — 1) were reported as adverse effects in 54 patients who took albendazole. AU the adverse events were mild and transient and drug withdrawal was not necessary. 

Albendazole has been used in the treatment and prophylaxis of microsporidiosis in patients with AIDS. In a small, double-blind, placebo-controUed trial from France (17) the efficacy and safety of treatment with albendazole was studied in four patients treated with albendazole 400 mg bd for 3 weeks and in four patients treated with placebo. Microsporidia were cleared in all patients given albendazole but in none of those given placebo. Afterwards aU eight patients were again randomized to receive either maintenance treatment with albendazole 400 mg bd or no treatment for the next 12 months none of the three patients taking maintenance treatment had a recurrence, while three of the five who took no maintenance therapy developed a recurrence. During the doubleblind part of the trial there were no serious adverse effects in the patients who took albendazole, although two complained of headache, one of abdominal pain, one had raised transaminase activities, and one had... 

As with other antihelminthic drugs, the general adverse effects of albendazole can reflect the destruction of the parasite rather than a direct action of the drug pyrexia is likely to be seen, even in the absence of other problems. Albendazole was well tolerated in 30-day courses of 10-14 mg/kg/day separated by 2-week intervals. 

With a single oral dose of albendazole 400 mg, there is usually little more in the way of adverse effects than mild gastrointestinal disturbances (notably epigastric pain or dry mouth), occurring only in about 6% of patients in some large series a few patients have abdominal pain. With higher doses, irritation of the central nervous system can lead to nausea and vomiting. 

Rajshekhar V. Incidence and significance of adverse effects of albendazole therapy in patients with a persistent solitary cysticercus granuloma. Acta Neurol Scand 1998 98(2) 121-3. 

Supali T, Ismid IS, Ruckert P, Fischer P. Treatment of Brugia timori and Wuchereria bancrofti infectioirs in Indonesia using DEC or a combination of DEC and albendazole adverse reactions and short-term effects on microfilariae. Trop Med Int Health 2002 7(10) 894-901. 

The epidemiology, clinical presentation, and treatment of alveolar echinococcosis of the liver have been described in French patients followed between 1972 and 1993 (5). From 1982 benzimidazoles were used. Of 117 patients, 72 took either albendazole or mebendazole for 4—134 months. The most common adverse effects were an increase in alanine transaminase activity to more than five times the top of the reference range (in six patients taking albendazole and in three taking mebendazole). Neutropenia (leukocyte count below 1.0 x 10 /1) occurred in two patients taking albendazole. Alopecia occurred in four patients taking mebendazole. Minor adverse effects of albendazole included malaise, anorexia, and digestive intolerance in one patient each. In 13 patients treatment had to be withdrawn because of adverse effects n —10) or non-adherence to therapy (n = 3). 

As antihehninthic drugs go, ivermectin can be considered a reasonably safe drug, and it is generally better tolerated than diethylcarbamazine. Clinical experience has often shown relatively little toxicity, although mild adverse effects, presumably due to the kilting of the microfilariae, involve at least one-third of patients some work has suggested that neutrophil activation may play a role in the development of these reactions (1). It has also been well tolerated in combinations, for example when given with albendazole in order to kill adult worms (which cannot be achieved with ivermectin alone) or with diethylcarbamazine for bancroftian filariasis (SEDA-20, 281). 

A 39-year-old Afro-Caribbean man with stage IVB T cell Ijmphoma due to HTLV-1 infection had invasive Strongyloides hyperinfection that did not respond to oral ivermectin plus albendazole because of concurrent ileus. He was treated with two 6 mg doses of a veterinary formulation of ivermectin subcutaneously. There were no adverse effects, apart from pain at the injection site. 

Administration Methods, Anthelmintic Effects, and Adverse Effects of Mebendazole and Albendazole... 

Among chemotherapeutic agents, thiabendazole, a representative benzimidazole compound, is most effective for strongyloidiasis. However, it has problems with safety, because its use can cause adverse effects and liver dysfunction at a high incidence that can be severe. High incidences of liver dysfunction were observed with mebendazole, and the rate of eradication was not sufficient with albendazole [63, 64]. 

A study in 28 healthy subjects given levamisole 2.5 mg/kg alone or with albendazole 400 mg found that albendazole produced a modest reduction in the AUC of levamisole but no other pharmacokinetic parameters were affected. However, the AUC of albendazole sulfoxide (the active metabolite) was 75% lower when given with levamisole than historical values in subjects who had received levamisole alone. An associated study in 44 patients found that levamisole with or without albendazole was not effective against Onchocerca volvulus infections. Both treatments caused a similar number of adverse effects. The clinical relevance of these findings is unclear, but they suggest that caution is needed if both drugs are to be given for systemic worm infections. 

The efficacy of combining albendazole 15 mg/kg/day for 7 days with either praziquantel 75 mg/kg/day ( = 53) or placebo n = 50) for 1 day has been studied in a double-blind, placebo-controlled, randomized study in North India in children with seizures and single-lesion neurocysticercosis [5. Repeat CT scans were performed after 1, 3, and 6 months. Seizure control and adverse reactions were similar in the two groups. Adverse effects were mild. There was no evidence of raised intracranial pressure and none of the patients reported epigastric discomfort or other gastrointestinal symptoms. None of the patients required drug withdrawal because of adverse reactions. 

A cross-sectional study examined 386 children aged 4-15 in Biankouma, Cote d Ivoire, who were infected with schistosomiasis and soil-transmitted helminthes and were then treated with single-dose PZQ 40mg/kg and albendazole as needed. About 40.8% (exact number unavailable) reported minor adverse effects including abdominal pain, headache and itching2-Ah after intake of PZQ [61 j. 

The poor intestinal absorption of albendazole, which may be enhanced by a fatty meal, contributes to difficulties in predicting its therapeutic response in echinococcosis. The effect of cimetidine co-administration on the systemic availability of albendazole has been studied in six healthy men (42). After an overnight fast, a single oral dose of albendazole (10 mg/kg) was administered on an empty stomach with water, a fatty meal, grapefruit juice, or grapefruit juice plus cimetidine. The systemic availability of albendazole was reduced by cimetidine. There were no adverse events. These results are consistent with presystemic metabolism of albendazole by CYP3A4. 

---