Albendazole: Drug Interactions

Major Interactions — Avoid or Monitor Closely

• ⚠Carbamazepine, phenytoin, dexamethasone — CYP3A4 inducers accelerate albendazole metabolism, reducing active sulphoxide levels; dose adjustment may be required for systemic infections
• ⚠Praziquantel (for echinococcosis/cysticercosis) — pharmacokinetic synergy: praziquantel increases albendazole sulphoxide AUC; clinically beneficial combination for tissue parasites

Moderate Interactions — Use With Caution

• •Cimetidine — CYP3A4 inhibition increases albendazole sulphoxide plasma levels ~50%; may enhance efficacy
• •Theophylline — albendazole may inhibit theophylline metabolism; monitor levels
• •Glucocorticoids — often co-prescribed for neurocysticercosis/echinococcosis to reduce inflammation; also reduce albendazole levels via CYP3A4 induction
• •Levamisole — additive efficacy in combination MDA programmes for soil-transmitted helminths

Food & Drink Interactions

• •High-fat meal — increases albendazole absorption 5-fold (critical for systemic infections; take with fatty food for echinococcosis/neurocysticercosis)
• •Grapefruit juice — CYP3A4 inhibition increases albendazole sulphoxide exposure
• •Food has no significant effect on mebendazole (poorly absorbed regardless)

Monitoring Requirements

Liver function tests (ALT, AST) — hepatotoxicity risk with prolonged albendazole courses (>4 weeks); full blood count — rare bone marrow suppression; pregnancy test before treatment (benzimidazoles are teratogenic — contraindicated in first trimester)