Dexamethasone Albendazole

Albendazole is contraindicated in patients with known hypersensitivity to the drug and during pregnancy (Category C). The drug has exhibited embiyotoxic and teratogenic effects in experimental animals. Albendazole is used cautiously in patients witii hepatic impairment and during lactation. The effects of albendazole are increased with dexamethasone and cimetidina... 

Dexamethasone reduced the clearance of albendazole and increased its half-life plasma concentrations almost doubled (SEDA-22, 450 476). 

Takayanagui OM, Lanchote VL, Marques MP, Bonato PS. Therapy for neurocysticercosis pharmacokinetic interaction of albendazole sulfoxide with dexamethasone. Ther Drug Monit 1997 19(l) 51-5. 

Increased risk of albendazole toxicity with praziquantel and dexamethasone... 

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. 

Albendazole has sometimes aggravated extrapyramidal disorders or precipitated seizures in patients with prior epileptic symptoms. The risk of intracranial hypertension has led some to suggest that glucocorticoids should be given preventively when using albendazole in neurocysticercosis (24) however, dexamethasone can interact with albendazole, increasing its plasma concentrations (25), and it is not clear whether this might produce new problems. 

Inducers of hepatic CYPs such as carbamazepine and phenobarbital reduce the bioavaUabihty of praziquantel. Dexamethasone reduces the bioavailability of praziquantel, but the mechanism is not understood. Under certain conditions, praziquantel may increase the bioavailability of albendazole. 

Dexamethasone can raise levels of albendazole sulfoxide by 50%, which might increase its efficacy in systemic worm infections. 

In one study albendazole 15 mg/kg daily in three divided doses was given to 8 patients with eystieereosis. The plasma levels of the active metabolite of albendazole (albendazole sulfoxide) were found to be increased by about 50% by the use of dexamethasone 8 mg every 8 hours. Another study did not detect significantly increased maximum plasma levels of albendazole sulfoxide, when dexamethasone was given, but the AUC was increased twofold, and there was a decrease in its clearance. ... 

Uncertain. Dexamethasone is an inducer of the cytochrome P450 isoenzyme CYP3A4, and might therefore be expected to reduce levels of albendazole, so the finding is unexpected. Dexamethasone appears not to alter the rate of formation of albendazole sulfoxide, but decreases its elimination. ... 

Information about albendazole seems to be limited but the interaction would appear to be established. It would appear that albendazole can be given concurrently with dexamethasone without compromising treatment, and combined use may actually be beneficial. ... 

Jung H, Hurtado M, Tulio Medina M, Sanchez M, Sotelo J, Dexamethasone increases plasma levels of albendazole. JWewra/ (1990) 237, 279-80,... 

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