Adverse effects of levamisole in cocaine users: a review and risk assessment View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-06

AUTHORS

Tibor Markus Brunt, Jorrit van den Berg, Ed Pennings, Bastiaan Venhuis

ABSTRACT

The immunomodulatory adjuvant and antihelminth levamisole is increasingly used as an adulterant in cocaine worldwide. An accumulating body of clinical and toxicological literature has appeared since 2010 describing neutropenia, agranulocytosis, leukoencephalopathy and vasculitis in cases associated with levamisole-adulterated cocaine. Mostly, neutropenia and agranulocytosis were reported, characterized by a decimation of neutrophils. A large proportion of cases also involved vasculopathy, characterized by pronounced black and purple skin purpura with cutaneous necrosis. Females are more susceptible for both agranulocytosis and vasculitis. Another complication reported with levamisole-adulterated cocaine is leukoencephalopathy, a disabling and potentially fatal neurological disorder caused by cerebral demyelination. In this review, all adverse effects associated with therapeutic levamisole and levamisole-adulterated cocaine are described. In addition, this review provides an update of the pharmacology of levamisole, its metabolism, including toxic metabolites and metabolites that are relevant for levamisole's addition to cocaine. Special emphasis is put on the immunopathology and the dose-effect relationship of chronic levamisole exposure. Finally, 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. More... »

PAGES

2303-2313

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00204-017-1947-4

DOI

http://dx.doi.org/10.1007/s00204-017-1947-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1084019441

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28314885


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