Usage
Albendazole + Levamisole is prescribed for the treatment of various parasitic worm infections, including hookworm, roundworm, tapeworm, pinworm, threadworm, whipworm infections, hydatid disease, and neurocysticercosis. Its pharmacological classifications are anthelmintic and immunomodulator.
Albendazole inhibits tubulin polymerization in parasites, disrupting their metabolism and leading to immobilization and death. Levamisole, an immunomodulator, suppresses enzyme activity in the worm’s muscles, causing paralysis and death, and also potentially stimulates the host’s immune response against the parasites.
Alternate Names
No widely recognized alternate names exist for this specific combination. However, the individual drugs are known by their generic names: Albendazole and Levamisole. Brand names vary depending on the manufacturer and region.
How It Works
Pharmacodynamics: Albendazole disrupts microtubule formation in helminths, leading to impaired glucose uptake, reduced energy production, and ultimately, parasite death. Levamisole causes paralysis of susceptible nematodes through a cholinergic agonist effect, leading to their expulsion from the gastrointestinal tract. It may also have immunostimulatory effects.
Pharmacokinetics: Albendazole is poorly absorbed orally but its primary metabolite, albendazole sulfoxide, is the active anthelmintic. Albendazole sulfoxide’s bioavailability increases when co-administered with levamisole. Albendazole sulfoxide is metabolized in the liver and excreted in bile. Levamisole is well-absorbed orally, metabolized in the liver and excreted primarily in urine.
Mode of Action: Albendazole binds to β-tubulin, preventing its polymerization into microtubules. Levamisole acts as a cholinergic agonist, causing persistent stimulation of nicotinic receptors at the neuromuscular junction of susceptible nematodes, leading to paralysis.
Elimination Pathways: Albendazole is primarily eliminated via biliary excretion after hepatic metabolism, while Levamisole is predominantly excreted renally.
Dosage
Standard Dosage
Adults: A single dose of Albendazole 400 mg + Levamisole (dosage varies, typically 150 mg for adults) is usually recommended for intestinal infections. For systemic infections like hydatid disease or neurocysticercosis, higher doses and longer treatment durations are necessary.
Special Cases:
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Elderly Patients: Use with caution in elderly patients with hepatic dysfunction. Dosage adjustments may be necessary.
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Patients with Renal Impairment: Dosage adjustments are not typically required, but careful monitoring is necessary.
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Patients with Hepatic Dysfunction: Dosage adjustments may be necessary. Close monitoring of liver function is required.
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Patients with Comorbid Conditions: Use with caution in patients with pre-existing blood disorders, epilepsy, rheumatoid arthritis, Sjogren’s syndrome or any other conditions affecting the immune system.
Clinical Use Cases
The use of Albendazole + Levamisole in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergencies is not indicated. It is specifically used for the treatment of parasitic worm infections.
Dosage Adjustments
Dose modifications might be needed in patients with hepatic or renal impairment.
Side Effects
Common Side Effects
Nausea, vomiting, abdominal pain, headache, dizziness, diarrhea, temporary hair loss, metallic taste.
Rare but Serious Side Effects
Liver dysfunction, bone marrow suppression (leukopenia, agranulocytosis, thrombocytopenia), Stevens-Johnson syndrome, severe skin rash, seizures (with prolonged Levamisole use).
Long-Term Effects
Chronic complications are rare but can include blood disorders with prolonged Levamisole use.
Adverse Drug Reactions (ADR)
Agranulocytosis, aplastic anemia, hepatotoxicity.
Contraindications
Pregnancy (especially the first trimester), hypersensitivity to Albendazole or Levamisole, pre-existing blood disorders.
Drug Interactions
Albendazole + Levamisole may interact with:
- Cimetidine, Praziquantel, Dexamethasone (increase albendazole levels)
- Phenytoin, Ritonavir, Levamisole (decrease albendazole effectiveness)
- Alcohol (disulfiram-like reaction with Levamisole)
- Anti-helminthics (albendazole, ivermectin)
- Anti-cancer drugs (doxifluridine, capecitabine)
- Antiepileptics (phenytoin)
- Anticoagulants (warfarin)
- Corticosteroids
- Live vaccines
Pregnancy and Breastfeeding
Albendazole + Levamisole is contraindicated in pregnancy, especially during the first trimester. Use during breastfeeding is generally not recommended. Consult your doctor for further advice.
Drug Profile Summary
- Mechanism of Action: Albendazole inhibits microtubule formation; Levamisole is a cholinergic agonist causing paralysis and has potential immunomodulatory effects.
- Side Effects: Nausea, vomiting, abdominal pain, headache, dizziness; rarely, liver dysfunction, bone marrow suppression.
- Contraindications: Pregnancy, hypersensitivity.
- Drug Interactions: Cimetidine, praziquantel, dexamethasone, phenytoin, ritonavir.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy; use with caution during breastfeeding.
- Dosage: Varies according to infection; typically 400mg Albendazole with Levamisole dosing (often 150mg for adults).
- Monitoring Parameters: Liver function tests, complete blood count.
Popular Combinations
While Albendazole and Levamisole are combined, there aren’t other commonly used drug combinations with this specific mix.
Precautions
- General Precautions: Baseline liver function tests and complete blood counts are recommended. Monitor during therapy, especially with long-term use. Screen for allergies.
- Pregnant Women: Contraindicated.
- Breastfeeding Mothers: Not recommended.
- Children & Elderly: Use with caution in children under 6 years of age and in elderly patients, especially with liver dysfunction.
- Menstruating Individuals: Effective contraception must be used.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Albendazole + Levamisole?
A: The standard dosage varies according to the infection. It is usually 400 mg of Albendazole given with Levamisole which varies typically 150mg for adults. However, for systemic infections, the dosages and duration will change as per requirement. Pediatric dosages are weight-based.
Q2: What are the most common side effects?
A: The most common side effects are gastrointestinal: nausea, vomiting, abdominal pain, and diarrhea. Headache and dizziness may also occur.
Q3: Can Albendazole + Levamisole be used in pregnancy?
A: No, it is contraindicated in pregnancy, especially the first trimester, due to potential teratogenic effects.
Q4: What are the potential drug interactions with this combination?
A: Several drug interactions exist; some increase albendazole levels (e.g., cimetidine, dexamethasone), while others decrease its effectiveness (e.g., phenytoin, ritonavir). Levamisole interacts with alcohol and other anthelmintics. It is crucial to review the patient’s medication history.
Q5: Are there any specific monitoring parameters required during treatment?
A: Yes, periodic monitoring of liver function tests and complete blood counts, especially during long-term treatment, is recommended due to the potential for liver toxicity and bone marrow suppression.
Q6: What is the mechanism of action of this combination therapy?
A: Albendazole disrupts microtubule formation in parasites, while Levamisole causes neuromuscular paralysis and might exert immunomodulatory effects.
Q7: What are the contraindications to using Albendazole + Levamisole?
A: Contraindications include pregnancy (especially first trimester), hypersensitivity to either drug, and pre-existing blood disorders.
Q8: Can this combination be used in patients with liver or kidney disease?
A: Use with caution in patients with hepatic dysfunction. Dosage adjustments may be necessary. Patients with renal impairment should be carefully monitored though no dose adjustment is usually necessary.
Q9: How should patients be counseled regarding the administration of this medicine?
A: Patients should be advised to take the medication with food to enhance albendazole absorption. They should also be informed about potential side effects and instructed to report any concerning symptoms promptly. Women of childbearing age should be counseled on the importance of contraception during treatment and for a period after the last dose.
