Levamisole: A Dangerous New Cocaine Adulterant

@article{Chang2010LevamisoleAD,
  title={Levamisole: A Dangerous New Cocaine Adulterant},
  author={Aimee Chang and John D. Osterloh and J. Thomas},
  journal={Clinical Pharmacology \& Therapeutics},
  year={2010},
  volume={88}
}
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… 
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131 Citations
Highly Influential Citations
6
Background Citations
50
Methods Citations
2

131 Citations

Levamisole in cocaine: Unexpected news from an old acquaintance
TLDR
The importance of accurately identifying levamisole-induced complications is therefore critical for symptomatic patients as discontinuation of exposure is fundamental and as a correct diagnosis prevents unnecessary and potentially dangerous use of other treatment modalities like powerful immunosuppressive therapy.
Adverse effects of levamisole in cocaine users: a review and risk assessment
TLDR
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
TLDR
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.
Levamisole and cocaine synergism: A prevalent adulterant enhances cocaine's action in vivo
Agranulocytosis and other consequences due to use of illicit cocaine contaminated with levamisole
TLDR
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
TLDR
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.
TLDR
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.
[Agranulocytosis and vasculitis in a cocaine addict: levamisole, the hidden culprit].
Aminorex poisoning in cocaine abusers.
Cutaneous Necrotizing Vasculitis and Leukopenia in a Cocaine User: Is Levamisole the Culprit?
TLDR
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.
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