Usage
Albendazole + Ivermectin is a combination anthelmintic medication prescribed for the treatment of various parasitic worm infections. These include:
- Soil-transmitted helminth infections: Such as roundworm (Ascaris lumbricoides), hookworm (Ancylostoma duodenale, Necator americanus), whipworm (Trichuris trichiura), and Strongyloides stercoralis.
- Lymphatic filariasis: This combination is frequently used in mass drug administration programs to eliminate lymphatic filariasis.
- Other parasitic infections: It is sometimes used for other specific parasitic infections like scabies, onchocerciasis (river blindness), and certain types of cysticercosis (tissue infection with larval stage of pork tapeworm) but typically not as first-line therapy.
Pharmacological Classification: Anthelmintic (antiparasitic)
Mechanism of Action: Albendazole inhibits tubulin polymerization in parasites, disrupting their glucose uptake and leading to their death. Ivermectin binds to glutamate-gated chloride channels in invertebrate nerve and muscle cells, resulting in paralysis and death of the parasites. The combined action of these drugs broadens the spectrum of activity against a wide range of helminths.
Alternate Names
There is no formally recognized alternate name for this combination product. It is commonly referred to by the generic names of its components (Albendazole and Ivermectin). Brand names vary depending on the manufacturer and country of origin.
How It Works
Pharmacodynamics: Albendazole disrupts microtubule formation in helminths, thus impairing glucose uptake and leading to their death. Ivermectin increases the permeability of cell membranes to chloride ions in nematodes and some insects, leading to hyperpolarization, paralysis, and death of the parasite.
Pharmacokinetics:
- Albendazole: Poorly absorbed orally; absorption enhanced with fatty meals. Metabolized in the liver to the active metabolite albendazole sulfoxide. Excreted in bile and urine.
- Ivermectin: Readily absorbed orally. Metabolized in the liver (primarily CYP3A4). Excreted primarily in feces; minimal urinary excretion.
Mode of Action: Albendazole acts on the parasite’s cytoskeleton while Ivermectin targets its neuromuscular system. This combined action provides a broader antiparasitic effect.
Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: Albendazole inhibits tubulin polymerization. Ivermectin interacts with glutamate-gated chloride channels.
Elimination Pathways: Albendazole is eliminated primarily through biliary excretion (feces) and to a lesser extent in urine. Ivermectin is primarily eliminated through fecal excretion.
Dosage
Standard Dosage
Adults: For soil-transmitted helminths, a single oral dose of 400 mg albendazole with 150-200 mcg/kg ivermectin is typically administered. For mass drug administration in lymphatic filariasis, the same dose is generally given annually.
Children: Dosage is based on weight for Ivermectin component and age and weight for Albendazole (see below). Pediatric safety should be carefully considered, especially in younger children. Use in children under 5 years old or weighing less than 15 kg needs to be done with caution, following weight-based dosing for Ivermectin and professional guidelines.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on renal or hepatic function.
- Patients with Renal Impairment: Monitor renal function. Dosage adjustments might be necessary for Albendazole.
- Patients with Hepatic Dysfunction: Close monitoring is essential, and dose adjustments may be required for both drugs.
- Patients with Comorbid Conditions: Consider potential drug interactions and the patient’s overall health status.
Clinical Use Cases
The combination Albendazole + Ivermectin is not typically indicated for the specified clinical settings (Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, Emergency Situations). Its primary use is in the outpatient setting for the treatment and control of parasitic infections.
Dosage Adjustments:
Dose adjustments are often necessary for individuals with hepatic or renal dysfunction based on the severity of impairment. Always follow clinical guidelines and consult with a specialist.
Side Effects
Common Side Effects:
Headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, fatigue, weakness, itching, rash, fever.
Rare but Serious Side Effects:
Liver damage (hepatitis), bone marrow suppression, seizures, allergic reactions (including angioedema, Stevens-Johnson syndrome), encephalopathy (in patients with Loa loa infection), ocular cysticercosis complications.
Long-Term Effects: With appropriate dosing for approved indications, long-term effects are rare. However, prolonged or high-dose use of Albendazole may increase the risk of liver toxicity and bone marrow suppression.
Adverse Drug Reactions (ADR):
Severe liver toxicity, Stevens-Johnson syndrome, bone marrow failure, anaphylactic reactions.
Contraindications
- Pregnancy: Contraindicated, particularly in the first trimester. Use only if benefits clearly outweigh risks.
- Breastfeeding: Not recommended. The drugs are excreted in breast milk. Consider interrupting breastfeeding or using an alternative treatment.
- Hypersensitivity: To Albendazole, Ivermectin, or benzimidazoles.
- Loa Loa Infection (Ivermectin): Can cause severe neurological reactions in individuals with high Loa loa microfilaremia.
Drug Interactions
- CYP3A4 Inhibitors/Inducers: May affect Ivermectin metabolism.
- Warfarin: Albendazole may increase the risk of bleeding.
- Antiepileptics (e.g., phenobarbital, valproic acid): May interact with Ivermectin.
- Alcohol: Can increase the risk of side effects with both drugs. Consult product information or drug interaction databases for specific interactions.
Pregnancy and Breastfeeding
- Pregnancy: Contraindicated. Can cause fetal harm.
- Breastfeeding: Not recommended. The drugs can pass into breast milk and potentially affect the infant.
Drug Profile Summary
- Mechanism of Action: Albendazole inhibits tubulin polymerization; Ivermectin potentiates inhibitory neurotransmission.
- Side Effects: Headache, dizziness, nausea, vomiting, abdominal pain; rarely liver damage, bone marrow suppression.
- Contraindications: Pregnancy, breastfeeding, hypersensitivity, Loa loa infection (Ivermectin).
- Drug Interactions: CYP3A4 inhibitors/inducers, warfarin, antiepileptics.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy; not recommended while breastfeeding.
- Dosage: Varies based on indication and patient factors; typically 400 mg albendazole + 150-200 mcg/kg ivermectin as a single dose.
- Monitoring Parameters: Liver function tests, complete blood count (especially with prolonged therapy).
Popular Combinations
Albendazole is often combined with Ivermectin for mass drug administration programs to treat lymphatic filariasis and other helminth infections. It is sometimes used in combination with praziquantel for the simultaneous treatment of multiple parasitic infections.
Precautions
- General Precautions: Assess for pre-existing liver or kidney disease, pregnancy, breastfeeding, Loa loa infection, and allergies. Monitor blood counts with prolonged therapy.
- Pregnant Women: Contraindicated.
- Breastfeeding Mothers: Not recommended.
- Children & Elderly: Weight-based dosing for Ivermectin and age/weight based dosing for Albendazole. Monitor for adverse effects.
- Lifestyle Considerations: Avoid alcohol. Exercise caution while driving or operating machinery due to potential dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Albendazole + Ivermectin for the treatment of soil-transmitted helminths?
A: For adults and children over 5 years old or weighing at least 15 kg, a single dose of 400 mg albendazole and 150-200 mcg/kg ivermectin is typically administered.
Q2: Can Albendazole + Ivermectin be used in pregnant women?
A: No, this combination is contraindicated in pregnancy due to the potential for fetal harm.
Q3: What are the common side effects of Albendazole + Ivermectin?
A: Common side effects include headache, dizziness, nausea, vomiting, abdominal pain, and diarrhea.
Q4: Are there any serious side effects associated with Albendazole + Ivermectin?
A: While rare, serious side effects can include liver damage, bone marrow suppression, and allergic reactions.
Q5: What precautions should be taken before prescribing this medication?
A: Screen for pregnancy, breastfeeding, liver/kidney disease, Loa loa infection, and allergies.
Q6: How does Albendazole + Ivermectin work against parasites?
A: Albendazole disrupts the parasite’s metabolic processes while Ivermectin affects its neuromuscular function.
Q7: What should I do if a patient experiences side effects?
A: Mild side effects are often self-limiting. Discontinue the medication and consult a specialist if side effects are severe or persistent.
Q8: Is there a risk of drug interactions with this combination?
A: Yes. Potentially significant drug interactions can occur with CYP3A4 inhibitors/inducers, warfarin, and some antiepileptics. Review all concomitant medications.
Q9: What are the recommendations for using this combination in children?
A: Ivermectin is dosed by weight. Albendazole dosing depends on age and weight, following pediatric guidelines. Use in children under 5 years old or under 15 kg requires caution and strict adherence to weight-based dosing for Ivermectin.
Q10: How should I counsel patients regarding this medication?
A: Inform patients about potential side effects, drug interactions, and the importance of adherence to the prescribed dosage. Emphasize the contraindication in pregnancy and precautions during breastfeeding. Provide clear instructions on how to take the medication (with food to enhance albendazole absorption).
