Difference between revisions of "Levamisole toxicity"

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==See Also==
 
==See Also==
 
*[[Cocaine]]
 
*[[Cocaine]]
 +
*[[Drug rash]]
  
 
==External Links==
 
==External Links==

Revision as of 17:10, 29 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  • An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects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

Diagnosis

  • 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

References

  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