Albendazole (Zentel) is used to treat neurocysticercosis and cystic hydatid diseases caused by Echinococcus granulosus. In hydatid cystic disease, it prevents the recurrence of the disease, causes a reduction in the cyst size, and death of the hydatid cysts [Ref].

Albendazole Uses:

• Ascaris lumbricoides (roundworm);

• Ancylostoma caninum ;

• Ancylostoma duodenale and Necator americanus (hookworms);

• Cutaneous larva migrans;

• Enterobius vermicularis (pinworm);

• Giardia duodenalis (giardiasis);

• Gnathostoma spinigerum;

• Gongylonemasp;

• Mansonella perstans (filariasis);

• Oesophagostomum bifurcum;

• Opisthorchis sinensis (liver fluke);

• Trichinella spiralis(Trichinellosis); and

• Visceral larva migrans (toxocariasis).

It also has activity against the liver fluke Clonorchis Sinensis, Giardia lamblia, Cysticercus cellulosae, and Echinococcus multilocularis. Albendazole is also used for the treatment of intestinal microsporidiosis ( Encephalitozoon intestinalis), disseminated microsporidiosis (E.hellem, E.cuniculi, E.intestinalis, Pleistophora sp, Trachipleistophora sp, Brachiola vesicularum), and ocular microsporidiosis (E. hellem, E. cuniculi, Vittaforma corneae ).

How to take albendazole for deworming?

• It should be administered with a high-fat meal.
• Children may also crush the tablet and take it with water or with food.
• The dose should be repeated after 14 days for eradication as the larvae hatch.

Albendazole Contraindications:

• Allergy to albendazole or benzimidazoles or any component of the formulation

Warnings and precautions

• Suppression of bone marrow
  • Rarely do fatalities result from granulocytosis or granulocytopenia.
  • Hematologic toxicities are more common in patients with liver disease.
  • Cytopenia should be stopped in all patients.
• ELevations in liver enzymes
  • Albendazole could cause reversible elevations of the hepatic enzymes.
  • LFTs above the normal limit should be stopped.
  • Once the liver function tests are normal, therapy may be restarted.
  • Patients with abnormal baseline LFTs or hepatic-hydatid cysts, are particularly at risk.

Concerns about diseases:​​​​​​​

• Neurocysticercosis:
  • To prevent intracranial hypertension, the patient should be given steroids and antiepileptics before being treated for neurocysticercosis. This will reduce inflammation and prevent seizures.
  • During the first week of therapy, antiepileptics can be administered.

Albendazole (Zentel) Dosage in Adults:

Zentel dose in neurocysticercosis:

• Less than 60 kg:

  • 15 mg/kg/day in 2 divided doses (maximum: 800 mg/day) for 8-30 days

• 60 kgs or more:

  • 800 mg/day in 2 divided doses for 8-30 days

Note: Give concurrent anticonvulsant and steroid therapy during the first week of therapy.

Zentel dose in Hydatid cysts:

• Less than 60 kg:

  • 15 mg/kg/day in 2 divided doses (maximum: 800 mg/day)

• 60 kgs or more:

  • 800 mg/day in 2 divided doses

Note: Administer dose for three 28-day cycles with a 14-day drug-free interval in between each cycle.

Zentel dose in Ancylostoma caninum , Round worms (Ascaris lumbricoides), Hookworms (Ancylostoma duodenale), and Necator americanus (hookworm): 

• 400 mg orally as a single dose

Zentel dose in Clonorchis sinensis (Chinese liver fluke): 

• 10 mg/kg/day orally for 7 days

For the treatment of Cutaneous larva migrans: 

• 400 mg orally once daily for 3 days.

Zentel dose in Enterobius vermicularis (pinworm) infections: 

• 400 mg orally as a single dose.
• The dose may be repeated in 2 weeks

Zentel dose in Giardia duodenalis (giardiasis): 

• 400 mg orally once daily for 5 days

Zentel dose in Gnathostoma spinigerum:

• 800 mg/day orally in 2 divided doses for 21 days.

Zentel dose in Gongylonemiasis: 

• 400 mg orally once daily for 3 days

Zentel dose in Mansonella perstans: 

• 800 mg/day orally in 2 divided doses for 10 days

Oesophagostomum bifurcum: 

• 400 mg orally as a single dose.

For the treatment of Trichinellosis (Trichinella spiralis): 

• 800 mg/day orally in two divided doses for 8-14 days.
• Give  steroids for severe symptoms

Toxocariasis (Visceral Larva migrans): 

• 800 mg/day orally in two divided doses for 5 days

Cysticercus cellulosae: 

• 800 mg/day orally in two divided doses for 8-30 days.
• It may be repeated as necessary.

Zentel dose in disseminated microsporidiosis: 

• 800 mg/day orally in 2 divided doses

Zentel dose in Echinococcus granulosus (tapeworm): 

• 800 mg/day orally in 2 divided doses for 1-6 months

Zentel dose in Intestinal microsporidiosis ( E. intestinalis):

• 800 mg/day orally in 2 divided doses for 21 days

Zentel dose in Ocular microsporidiosis: 

• 800 mg/day orally in 2 divided doses, in combination with fumagillin.

Albendazole (Zentel) dose in children:

Albendazole dose in Neurocysticercosis (Taenia solium):

(Note: Patients with neurocysticercosis should receive steroids and anticonvulsants during the first week of therapy)

• Less than 60 kg:

  • 15 mg/kg/day in 2 divided doses for 8-30 days (maximum: 800 mg/day)

• 60 kgs or more:

  • 400 mg twice daily for 8-30 days

Albendazole dose in Hydatid disease (Echinococcus granulosus):

• Less than 60 kg:

  • 15 mg/kg/day in 2 divided doses (maximum: 800 mg/day) for 28-days followed by a 14-day albendazole-free interval.
  • Three cycles of the therapy should be given

• 60 kgs or more:

  • 400 mg twice daily.
  • The 28-day cycle should be followed by a 14-day albendazole-free interval, for a total of 3 cycles

Zentel dose in Ancylostoma caninum , round worm (ascariasis), hookworm, and whipworm (trichuriasis) infections:

• 400 mg as a single dose

Zentel dose in Ascariasis:

• Children 12 months to 2 years: 200 mg as a single dose

Zentel dose in Capillariasis:

• 400 mg daily for 10 days

Zentel dose in Clonorchis sinensis or Chinese liver fluke: 

• 10 mg/kg/day daily for 7 days

Zentel (Albendazole) dose in cutaneous larva migrans:

• 400 mg once a day for 3 days

Zentel (Albendazole) dose in Enterobius vermicularis or pinworm):

• a single 400 mg dose which should be repeated after 2 weeks

Zentel dose in Filariasis or Mansonella perstans ):

• 400 mg twice a day for 10 days

Zentel dose in Filariasis or Wuchereria Bancroft, microfilaria reduction or suppression: 

• 400 mg as a single dose (in combination with either diethylcarbamazine or ivermectin).

Zentel (Albendazole) dose in Giardiasis (Giardia duodenalis):

Children: 10 mg/kg/day daily for 5 days

Adults: 400 mg once a day for 5 days

Zentel dose in Gnathostoma spinigerum (Gnathostomiasis):

• 400 mg twice a day for 21 days

Zentel dose in Gongylonema sp (Gongylonemiasis):

• 400 mg once a day for 3 days

Zentel dose in microsporidia infection in HIV-exposed/positive infants and children:

• 15 mg/kg/day in 2 divided doses (maximum: 800 mg/day) continued until immune reconstitution after HAART initiation

Zentel dose in microsporidiosis in non-HIV patients:

• Disseminated infection:

  • 400 mg twice daily

• Intestinal infection:

  • 400 mg twice daily for 21 days

• Ocular infection:

  • 400 mg twice daily in combination with fumagillin

Zentel dose in Strongyloidiasis ( Strongyloides stercoralis): 

• 400 mg twice daily for 7 days

Zentel dose in Trichinellosis ( Trichinella spiralis ):

• 400 mg twice daily for 8-14 days

Zentel dose in visceral larva migrans ( Toxocariasis ): 

• 400 mg twice daily for 5 days

Albendazole Dose in renal disease:

• No dose adjustment is required in patients with renal disease

Albendazole Dose in liver disease:

• Patients with liver disease are at risk of developing side effects.
• However, the manufacturer does not recommend any dose adjustment in patients with liver disease.
• Liver enzymes should be monitored at least every two weeks while on therapy.

How to take Albendazole?

• It should be taken with a high-fat meal. If required, the tablet can be chewed or crushed and swallowed with water.
• Patients being treated for neurocysticercosis with albendazole should receive steroids and anticonvulsants during the first week of therapy.
• If patients have difficulty swallowing, tablets may be crushed or chewed, then swallowed with a drink of water.

Albendazole in Pregnancy - Risk Factor C​​​​​​​

• Animal studies have shown that Albendazole is teratogenic.
• A pregnancy test is required before you start therapy.
• If pregnancy is confirmed, it should be stopped immediately
• Patients are advised to not become pregnant within one month of treatment with albendazole.

Use during breastfeeding:

• Breastfeeding women should not use Albendazole It is unknown if the drug will be excreted into breast milk.

Side effects of Albendazole (Severe):

• hepatic failure,
• renal failure, and
• rhabdomyolysis

Albendazole side effects (Moderate):

• Elevated hepatic enzymes,
• hepatitis, and
• blurred vision

Zentel Side effects (Mild):

• diarrhea,
• drowsiness, and
• asthenia

Monitoring Parameters:

• After treatment, a stool examination should be done for 3 weeks to look for ova and parasites. Retreatment may be required if the stool test is positive.
• Monitor CBC and LFTs every two weeks during therapy. Patients with liver disease may require more frequent monitoring.
• Patients with neurocysticercosis should undergo an ophthalmologic examination.
• Female patients should have a pregnancy test done prior to the start of treatment.

Albendazole mechanism of action:

• Albendazole sulfuride is the active metabolite.
• It causes:
  • Degeneration of cytoplasmic micrules in intestinal, tegmental and larval helminths and helminths;
  • Depletes glycogen,
  • Reduces glucose uptake and secretion of cholinesterase.
  • This can lead to the accumulation of desecration materials within cells.
  • This causes depletion and immobilization of the parasites, which ultimately leads to death.

Drug Absorption: Absorption is poor when taken with a fatty meal.

Distribution: Well inside hydatid cysts and cerebrospinal fluid

Protein binding is 70%

Metabolism: Albendazole undergoes extensive first-pass hepatic metabolism and is converted into the active metabolite.

Half-life elimination is 8-12 hours

The time to reach peak serum levels is 2-5 hours

Excretion is primarily via Urine and feces

Albendazole Brand Names in Pakistan:

ACURE (PHARMIX LABORATORIES (PRIVATE) LIMITED)

Tablets : 200 mg :

2 tablets pack : Rs. 15.40

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ALBA (PAKHEIM INTERNANATIONAL PHARMA)

Tablets : 200 mg :

2 tablets pack : Rs. 15.00

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ALBAGEN (GENERA PHARMACEUTICALS)

Tablets : 200 mg :

2 tablets pack : Rs. 15.00

10 tablets pack : Rs. 50.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.40

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ALBEN (BRYON PHARMACEUTICALS (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 17.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.40

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ALBENDIX (NEO MEDIX)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

Suspension : 200mg/5ml :

10 ml pack : Rs. 16.00

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ALBENDO (DAVIS PHARMACEUTICAL LABORATORIES)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

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ALBENZA (PARAMOUNT PHARMACEUTICALS)

Tablets : 200 mg :

2 tablets pack : Rs. 17.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 19.00

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ALIZ (GLITZ PHARMA)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

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ALOVAC (SIZA INTERNATIONAL (PVT) LTD)

Tablets : 200 mg :

6 tablets pack : Rs. 35.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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ALWORM (ALSON PHARMACEUTICALS)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

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ANTHEL (MEDERA PHARMACEUTICALS (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

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BENDA (PHARMEDIC (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 14.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 18.00

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BENDAZOL (STANLEY PHARMACEUTICALS (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

Suspension : 200mg/5ml :

10 ml pack : Rs. 17.00

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BENDOLE (PHARMAWISE LABS (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 10.00

10 atblets pack : Rs. 50

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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DESENZ (WEBROS PHARMACEUTICALS)

Tablets : 200 mg :

2 tablets pack : Rs. 8.20

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GIBENDA (NIMRALL LABORATORIES)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

10 tablets pack : Rs. 50.00

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NENZOLE (NENZA PHARMACEUTICALS (PVT) LIMITED)

Tablets : 200 mg :

2 tablets pack : Rs. 13.00

Suspension : 200mg/5ml :

10 ml pack : Rs. 15.00

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ROBIAZOLE (ZINTA PHARMACEUTICALS INDUSTRIES)

Tablets : 200 mg :

2 tablets pack : Rs. 10.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 11.00

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VALOPALAC (VALOR PHARMACEUTICALS)

Tablets : 200 mg :

2 tablets pack : Rs. 10.00

10 tablets pack : Rs. 50.00

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VAPALAC (VALOR PHARMACEUTICALS)

Tablets : 200 mg :

10 tablets pack : Rs. 50.00

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VERID (CANDID PHARMACEUTICALS)

Tablets : 200 mg :

2 tablets pack : Rs. 13.00

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WORCYT (QINTAR PHARMACUTICALS)

Tablets : 200 mg :

10 tablets pack : Rs. 100.00

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WORMED (MEDICRAFT PHARMACEUTICALS (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 18.00

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WORMGO (MEDICEENA PHARMA (PVT) LTD)

Tablets : 200 mg :

10 tablets pack : Rs. 100.00

Suspension : 200mg/5ml :

10 ml pack : Rs. 18.00

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WORMOCID (DELTA PHARMA (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 17.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 19.00

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XEDOL (XENON PHARMACEUTICALS (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 13.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 15.00

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ZAVIC (HARMANN PHARMACEUTICAL LABORATORIES (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 16.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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ZENTEL (GLAXOSMITHKLINE)

Tablets : 200 mg :

2 tablets pack : Rs. 20.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 22.00

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ZEPAR (Shaigan Pharmaceuticals (PVT) LTD)

Tablets : 200 mg :

2 tablets pack : Rs. 17.00

Suspension : 100mg/5ml :

10 ml pack : Rs. 19.00

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AIMED (RAKAPOSHI PHARMACEUTICAL (PVT) LTD)

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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ALBENSEL (SELMORE AGENCIES)

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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ALMED (RAAZEE THERAPUTICS (PVT) LTD)

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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BAZOLE (NEUTRO PHARMA (PVT) LTD)

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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INTESTINIL (SAPIENT PHARMA)

Suspension : 100mg/5ml :

10 ml pack : Rs. 25.00

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POLYWORM (POLYFINE CHEMPHARMA (PVT) LTD)

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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WORMNOR (WAHABSONS PHARMA)

Suspension : 100mg/5ml :

10 ml pack : Rs. 19.00

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XANTINIL (MIRACLE PHARMACEUTICALS(PVT) LTD)

Suspension : 100mg/5ml :

10 ml pack : Rs. 16.00

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ZOLIVE (OLIVE LABORATORIES)

Suspension : 100mg/5ml :

10 ml pack : Rs. 17.00

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LEVAZOL (UNIVET PHARMACEUTICALS)

Powder : 6g/25g , Levamisole : 3g/25g :

100 g powder pack :  Rs. 360.00

250 g powder pack : Rs. 855.00

25 g powder pack : Rs. 95.00

Albendazole Brand Names (International):

• ABZ
• Acure
• Albatel
• Alben
• Alben-VC
• Albentel
• Albenza
• Albenzol
• Albex
• Albezole
• Alfuca
• Almex
• Alminth
• Alzental
• Alzol
• Andazol
• Ascarol
• Bendex-400
• Benzol
• Bruzol
• CB-400
• Ceprazol
• Ciclopar
• Dalben
• Digezanol
• Emanthal
• Eskasole
• Eskazole
• Fintel
• Gascop
• Helmiben
• Helmidazole
• Hyemex
• Labenda
• Lomsin
• Lurdex
• Mebenix
• Mesin-C
• Nemozole
• Pantex
• Paranthil
• Rotopar
• Sioban
• Thelban
• Tilminth
• Valbazen Vet
• Vastus
• Vemizol
• Vermin Plus
• Vetoben
• Zeben
• Zela
• Zendal
• Zentel