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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Albendazole

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
12-06-2010

Zambia Specific Information

  • Available formulation in Zambia: Tablet (chewable): 400 mg.
  • Cyst caused by E. granulosus: 15 mg/kg/d up to 400 mg bid x 28 days. Repeat cycle x 2 with 14 days break between courses. Cure rates achieved in only 1/3 of pts; consider surgery if cyst accessible.
  • Neurocysticercosis: >60 kg: 400 mg PO twice-daily x 8 days; <60 kg: 7.5 mg/kg (max 800 mg/d). Consider adding dexamethasone 2 mg q6h x 8 days.
  • First line treatment of tapeworm (T. saginata and T. solium): 400mg once-daily x 3d. If pregnant, use praziquantel 10-20 mg/kg x 1.
  • First line treatment of roundworm (A. lumbricoides), pinworm (E. vermicularis), hookworm (A. duodenale), whipworm (Trichuris trichiura or Trichocephalus trichiuris): 400 mg x1, may repeat after 3-4 wks if needed.
  • Sandworm (A. braziliense): 400 mg once daily x 3d.
  • Avoid in pregnancy

REFERENCES

Zambia Information Author: Paul A. Pham Pharm.D.

INDICATIONS

FDA

  • Neurocysticercosis caused by Taenia solium
  • Hydatid disease caused by Echinococcus granulosus (Tape-worm)
NON-FDA APPROVED USES

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Albenza AlbendazoleGlaxoSmithKlineoral
tablet
200 mg
$1.58
Eskazole; Zentel (non-US brands)Albendazolenon-US manufacturerOral
tablet
200 mg
n/a

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

  • Microsporidiosis: 400 mg PO twice-daily with fatty meals (treat until CD4 count >200)
  • Hookworm: 400 mg PO x 1
  • Hydatid disease: 400 mg PO twice-daily with meals x 28 d followed by a 14-day drug-free interval for a total of 3 cycles. Note: when medically feasible, surgery is considered treatment of choice.
  • Neurocysticercosis: 400 mg PO twice-daily with meals for 8 to 30 days with corticosteroids during 1st wk of treatment to prevent cerebral hypertensive episodes
  • Toxocariasis: 400 mg PO twice-daily with meals x 5 d

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Usual dose.

DOSING IN HEMODIALYSIS

Not removed in hemodialysis. Use usual dose.

DOSING IN PERITONEAL DIALYSIS

No data.

DOSING IN HEMOFILTRATION

No data.

ADVERSE DRUG REACTIONS

GENERAL

  • Generally well tolerated
OCCASIONAL

  • Reversible hepatoxicity (monitor LFTs q 2 wks)
  • GI intolerance: Nausea, vomiting, diarrhea and abdominal pain
RARE

  • Bone marrow suppression (i.e pancytopenia, aplastic anemia, agranulocytosis, and leukopenia), especially in pts with liver disease, including echinococcosis.
  • Dizziness and headache
  • Hypersensitivity reaction
  • Alopecia
  • Increased transaminase levels

DRUG INTERACTIONS

  • Dexamethasone: Monitor for albendazole toxicity; dose may need to be decreased. In some case reports trough concentration of albendazole was increased up to 56%.
  • Praziquantel: Monitor adverse events of albendazole. Dose of albendazole may need to be decreased. In some case reports mean plasma concentration of albendazole was increased up to 50%.
  • Theophylline: No reported interaction.
  • Cimetidine: Increased albendazole levels in bile and cystic fluid following co-administration with cimetidine (clinical significance unknown).

SPECTRUM

Active against Encephalitozoon intestinalis but poor activity against the more common Enterocytozoon bieneusi (parasites causing microsporidiosis). These species can be distinguished by EM or PCR. Also active against E. cuniculi.

PHARMACOLOGY

Pharmacology

COMMENTS

Well-tolerated, oral, broad-spectrum anti-helminthic. Effective agent against microsporidiosis involving Encephalitozoon intestinalis. Unfortunately, 80% of HIV-related microsporidiosis caused by Enterocytozoon bieneusi, which has poor response to albendazole. ART is preferred treatment for microsporidiosis. Albendazole (400 mg PO x1) resulted in higher cure rate compared to mebendazole in the treatment of Ascaris, hookworm, and Trichuris.

REFERENCES

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