Case Report: Panic attack induced by albendazole in a post-PCI patient

Albendazole is a widely used broad-spectrum anthelmintic whose recognized neuropsychiatric adverse effects are largely limited to encephalitis and demyelinating encephalopathy. Panic attack has not been previously reported as an adverse reaction to albendazole.

A 59-year-old Chinese man with recent percutaneous coronary intervention for coronary artery disease was prescribed albendazole (600 mg/day for 7 days) for an incidentally detected Clonorchis sinensis infection. Within hours of his first dose, he developed recurrent, unpredictable panic attacks characterized by palpitations, chest pain, dyspnea, derealization, fear of dying, and a sense of losing control. These episodes met DSM-5 diagnostic criteria for panic attack (11 of 13 core symptoms) and were graded as Grade 2 according to the Common Terminology Criteria for Adverse Events version 5.0. Extensive cardiac, pulmonary, and psychiatric workup excluded alternative causes. The panic attacks resolved following albendazole discontinuation and combination anxiolytic-antidepressant therapy. The Naranjo adverse drug reaction probability score was 8, indicating a probable causal relationship.

This case suggests that albendazole can probably induce acute panic attacks, expanding its neuropsychiatric adverse effect spectrum. In patients with heightened central nervous system vulnerability-such as those recovering from major cardiovascular procedures-the risk may be increased. For non-urgent anthelmintic indications in such patients, deferring treatment until clinical stabilization may be prudent.