Difference between revisions of "Levamisole toxicity"

(Text replacement - "Category:Tox" to "Category:Toxicology")
(Text replacement - " pts" to " patients")
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**Burn care if significant necrosis
 
**Burn care if significant necrosis
 
*Avoid cocaine re-exposure
 
*Avoid cocaine re-exposure
**27% of pts had symptom recurrence with cocaine re-exposure<ref>Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234</ref>
+
**27% of patients had symptom recurrence with cocaine re-exposure<ref>Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234</ref>
  
 
==Disposition==
 
==Disposition==

Revision as of 16:50, 21 June 2016

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  • an antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects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)[1]
  • Results in Levamisole induced necrosis syndrome[2]

Clinical Features

  • agranulocytosis/thrombocytopenia
    • typically neutropenia
    • tends to reverse spontaneously when discontinued
  • levamisole induced necrosis syndrome
    • Necrotic patches anywhere on skin (especially ears and legs)
  • leukoencephalopathy
    • seen when used as a pharmaceutical in past
    • no cases described associated with cocaine adulteration

Differential Diagnosis

Workup

  • CBC

Management

  • Neutropenia
  • Necrosis
    • Aggressive supportive care
    • Burn care if significant necrosis
  • Avoid cocaine re-exposure
    • 27% of patients had symptom recurrence with cocaine re-exposure[3]

Disposition

Admission

See Also

External Links

Sources

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