Levamisole: A Dangerous New Cocaine Adulterant

  title={Levamisole: A Dangerous New Cocaine Adulterant},
  author={Aimee Chang and John D. Osterloh and J. Thomas},
  journal={Clinical Pharmacology \& Therapeutics},
Levamisole has increasingly been discovered in street cocaine as an adulterant. Recent reports have linked levamisole in street cocaine to agranulocytosis in cocaine users. It is well known that agranulocytosis is associated with therapeutic use of levamisole, and this may have led to the withdrawal of the drug from the US market. Levamisole was a US Food and Drug Administration–approved drug that has been used as an immunomodulator, a chemotherapy adjuvant, and anthelmintic medication. The… 
Levamisole in cocaine: Unexpected news from an old acquaintance
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Adverse effects of levamisole in cocaine users: a review and risk assessment
A risk assessment is provided based on the current level of levamisole adulteration in street cocaine, the dose range calculated per gram and the pattern of chronic exposure in heavy or dependent users.
Letter to the Editor—Consumption of Levamisole in Cocaine Preparations
The presented study revealed that levamisole is present in the majority of cocaine consumed in Lower Saxony, and the obtained prevalence was comparable with the data presented by Lynch et al. for cocaine samples in North America.
Agranulocytosis and other consequences due to use of illicit cocaine contaminated with levamisole
More than three fourths of cocaine users in the United States are exposed to levamisole; a significant minority of these individuals will develop autoimmune-mediated neutropenia, cutaneous vascular complications, and/or leukoencephalopathy.
Levamisole in Illicit Trafficking Cocaine Seized: A One-Year Study
The study of the presence of levamisole, over other adulterants in seized cocaine samples, due to its recognized human toxicity should be performed in routine toxicological analysis in deaths due to cocaine use.
Levamisole - A Toxic Adulterant in Illicit Drug Preparations: A Review.
Both the medical and forensic communities need to be aware of levamisole and its potential impact on toxicological investigations, because of its varying presence in illicit drug markets.
Aminorex poisoning in cocaine abusers.
Cutaneous Necrotizing Vasculitis and Leukopenia in a Cocaine User: Is Levamisole the Culprit?
A 23-year-old female cocaine user that presented with purpuric rash and skin necrosis, found to have positive c-ANCA and anti-proteinase 3 antibodies is reported, diagnosed with levamisole-induced vasculitis and successfully treated with withdrawal of cocaine use and local wound care.


Cocaine adulterants used as marker compounds.
The determination of cocaine content and adulterants in street samples is important not only from the clinical and toxicological points of view, but also for forensic purposes, related to the determination of geographical origin, comparison of various street samples for intelligence purposes and route of synthesis of the drugs.
The formation of aminorex in racehorses following levamisole administration. A quantitative and chiral analysis following synthetic aminorex or levamisole administration vs. aminorex-positive samples from the field: a preliminary report.
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  • 2009
The chiral isomer distribution of aminorex found in samples from the field is significantly different from that arising from the administration of synthetic, racemic am inorex and is similar to that observed from aminorx arising from levamisole administration.
Agranulocytosis associated with cocaine use - four States, March 2008-November 2009.
This report summarizes the investigations in New Mexico and Washington, which suggested that levamisole in cocaine was the likely cause of the agranulocytosis, and health-care providers and public health officials should be aware of cases of agranULocyTosis associated with cocaine use.
Clinical toxicity of cocaine adulterants.
  • M. Shannon
  • Psychology, Biology
    Annals of emergency medicine
  • 1988
Atypical reactions associated with heroin use--five states, January-April 2005.
The investigation by state and local health and law enforcement authorities and CDC into the 26 cases of atypical reactions after heroin use reported in five states during January 28-April 17, 2005 concludes that unintentional or intentional adulteration of illicit drugs such as cocaine or heroin is an additional potential hazard associated with their use.
Levamisole tainted cocaine causing severe neutropenia in Alberta and British Columbia
The findings support a link between neutropenia and levamisole tainted cocaine; particularly from smoking the crack form of cocaine.
Aminorex produces stimulus effects similar to amphetamine and unlike those of fenfluramine
  • R. Young
  • Biology, Psychology
    Pharmacology Biochemistry and Behavior
  • 1992
Modes of action of anthelmintic drugs.