Difference between revisions of "Levamisole toxicity"

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*an antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects  
 
*an antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects  
 
*Increasingly used as a cutting agent in cocaine sold around the globe
 
*Increasingly used as a cutting agent in cocaine sold around the globe
 +
**69% of DEA seized cocaine contained levamisole (2009)
 
*Results in Levamisole induced necrosis syndrome<ref>http://www.ncbi.nlm.nih.gov/pubmed/20668440</ref>
 
*Results in Levamisole induced necrosis syndrome<ref>http://www.ncbi.nlm.nih.gov/pubmed/20668440</ref>
  

Revision as of 01:38, 16 December 2014

Background

  • an antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects
  • Increasingly used as a cutting agent in cocaine sold around the globe
    • 69% of DEA seized cocaine contained levamisole (2009)
  • Results in Levamisole induced necrosis syndrome[1]

Clinical Features

  • agranulocytosis
    • neutropenia
  • levamisole induced necrosis syndrome
    • Necrotic patches anywhere on skin (especially ears and legs)

Differential Diagnosis

Workup

  • CBC

Management

  • Neutropenia
  • Necrosis
    • Aggressive supportive care
    • Burn care if significant necrosis
  • Avoid cocaine re-exposure
    • 27% of pts had symptom recurrence with cocaine re-exposure[2]

Disposition

Admission

See Also

External Links

Sources

  1. http://www.ncbi.nlm.nih.gov/pubmed/20668440
  2. Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234