Alopecia albendazole

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. 

There are various well-documented reports of reversible alopecia in patients taking albendazole (SEDA-17, 358) (SEDA-22, 324), which in one study occurred in 2% of cases (SEDA-18, 315) and in another study in one case of 20 (SED-13, 913) (27). 

Severe alopecia has been described in an almost 3-year-old child who took albendazole 400 mg/d for 3 days 2 months later alopecia developed and resolved within 1 month (37). 

Herdy R. Alopecia associated to albendazole a case report. An Bras Dermatol 2000 75 715-19. 

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 In 13 patients treatment had to be withdrawn because of adverse effects n —10) or non-adherence to therapy (n = 3). 

Toxicity Albendazole has few toxic effects during short courses of therapy. Reversible leukopenia, alopecia, and changes in liver enz3mes may occur with prolonged use. Longterm animal toxicity studies report bone marrow suppression and fetal toxicity. 

Albendazole has been a first-line agent for treatment of parasitic infections since 1972 and is still a valuable and commonly used medication. Documented side effects after short-term use include mild abdominal discomfort, nausea, diarrhoea, headaches, dizziness, lassitude and insomnia. Longer term treatment for hydatid disease can lead to the same adverse reactions as seen in shorter courses in addition to alopecia, transaminitis and pancytopenia. 

Alopecia universalis was seen in a 70-year-old male on day 20 of daily treatment with albendazole 15mg/kg/ day for Echinococcus. Alopecia fully recovered 1 month after stopping the medication [lO ]. 

Another case of alopecia in the form of telogen effluvium was reported in a 27-year-old female patient in her second week of a 2-week course of daily albendazole 400 mg for treatment of cutaneous larva migrans. Remission was noted in 3 months will full restoration of normal hair observed at 11 months [ll ]. 

---