Albendazole Contraindications and Precautions
- agranulocytosis
- breast-feeding
- anemia
- biliary obstruction
- biliary tract disease
- bone marrow suppression
- chemotherapy
- children
- driving or operating machinery
- females
- hepatic disease
- hepatitis
- infants
- iron-deficiency anemia
- jaundice
- leukopenia
- neutropenia
- pregnancy
- retinal cysticercosis
Albendazole Contraindications and Precautions
Albendazole is contraindicated in any person with known hypersensitivity to albendazole, the benzimidazole class of compounds, or any product components.
Albendazole is extensively metabolized by the liver. Hepatic clearance may be impaired if hepatic disease (e.g., hepatitis, jaundice, cirrhosis) or biliary obstruction are present and may result in increased side effects. Exercise caution when administering this medication to patients with hepatic disease or biliary tract disease. Albendazole has been associated with an increase in liver enzymes, which usually resolves after discontinuation of therapy. However, if enzymes are significantly elevated, therapy should be discontinued. Therapy can be reinstituted when enzymes return to baseline. Rarely, hepatotoxicity has occurred with albendazole therapy (see Adverse reactions). Liver function tests (LFTs) should be monitored prior to each treatment cycle and at least every 2 weeks during treatment.
Central nervous system effects, including dizziness and drowsiness, are common with albendazole therapy. Patients should be advised to avoid activities that require mental alertness, such as driving or operating machinery, until they know how albendazole treatment affects them.
Cysticercosis may rarely involve the retina. Before initiating therapy for neurocysticercosis, the patient should be examined for retinal lesions (retinal cysticercosis). The benefits of starting albendazole therapy should be weighed against the possibility of retinal damage caused by albendazole-induced changes to existing ocular lesions. Patients being treated for neurocysticercosis should receive appropriate corticosteroid therapy (e.g., dexamethasone) and anticonvulsant therapy. Experts state that antiparasitic drugs are contraindicated in patients with cerebral edema (cysticercal encephalitis).
Albendazole may cause bone marrow suppression and should be used cautiously in any patient predisposed to leukopenia or neutropenia or other bone marrow suppression (e.g., recent chemotherapy). A complete blood cell count with differential should be performed at the start of each 28-day treatment cycle and every 2 weeks during each 28-day cycle. Albendazole may be continued if the total white blood cell count and absolute neutrophil count decrease is modest and does not progress. Rare fatalities associated with the use of albendazole have been reported due to granulocytopenia, agranulocytosis, and pancytopenia (see Adverse Reactions).
In patients receiving albendazole for hookworm infection, iron-deficiency anemia is common. Patients should receive iron supplementation as needed.
Experience with albendazole use in children < 6 years of age is limited; data are even more rare for infants. Safe and effective use of albendazole has not been established in children and infants < 24 months of age. In hydatid disease, infection in young children is uncommon, but no problems have been encountered in those who have been treated. Neurocysticercosis infections in children are more frequently encountered. In five published studies involving pediatric patients as young as 1 year of age, no significant problems were encountered, and the efficacy appeared similar to the adult population.
Albendazole is classified as FDA pregnancy risk category C; however, due to concerns over teratogenesis, most infectious disease experts consider the drug contraindicated during pregnancy, particularly in the first trimester. Albendazole has not been studied in pregnant women and published human gestational data are sparse. In animal studies, albendazole (at 0.1 - 0.6 times the recommended human dose based on body surface area in mg/m2 ) has been shown to be embryotoxic and has caused skeletal malformations in rabbits and rats. The manufacturer states that albendazole may cause fetal harm. Females of childbearing age should begin to take albendazole after a negative pregnancy test; adequate birth control must be used during treatment and for 1 month post albendazole therapy and should be advised against becoming pregnant during treatment and for 1 month following treatment. Albendazole should be used during pregnancy only if the potential benefits outweigh the potential risk to the fetus; first trimester exposure should be avoided.
Albendazole is distributed into the milk of lactating animals. It is not known whether albendazole is distributed into human breast milk, but distribution of albendazole sulfoxide may occur. Use with caution in lactating mothers. In general, patients are advised to discontinue breast-feeding during albendazole therapy.
[ Last revised: 9/19/2003 6:13:00 AM ]
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