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Granulomatous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Albert Alhatem, Robert A. Schwartz, Muriel W. Lambert, W. Clark Lambert
Overview: Levamisole is a drug formerly approved for human use by the Food and Drug Administration and now withdrawn. It continues to be approved for veterinary use. Because it is widely used as a filler with illegal heroin and cocaine, such users are at risk for developing this reaction.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Three RCTs have shown levamisole alone, or with placebo, to be superior to steroids in preventing relapse in steroid dependent children; a meta-analysis has shown a lower relative risk for relapse at 6 to 12 months, RR 0.6 (95% Cl 0.45–0.79%) [16]. Following the induction of remission with steroids, levamisole is commenced at a dose of 2.5 mg/kg on alternate days. This allows the tapering and possible discontinuation of concomitant alternate day steroids. The efficacy of levamisole is dependent upon its continuous administration, with a substantial risk of relapse occurring upon stopping therapy. When remission is successfully maintained, levamisole is typically continued for a period of up to 12–24 months, though there are no theoretical reasons why longer courses cannot be used.
Control of Human Intestinal Nematode Infections
Published in Max J. Miller, E. J. Love, Parasitic Diseases: Treatment and Control, 2020
Levamisole, an isomer of tetramisole, has been effectively used in human patients harboring A. lumbricoides in a single dose of 150 mg for adults and 40 to 80 mg for children.16,17 It also has some effect on hookworms and S. stercoralis. This substance, soluble in water, is readily absorbed. The drug is well tolerated. A few cases of intestinal symptoms and dizziness have been reported as the only side effects. This drug is, at the moment, under clinical trials for diseases due to immunodeficiencies and for some malignancies,18 based on the findings that it enhances the immunological defense of the patients, probably by stimulating the production of T lymphocytes. In these cases, levamisole has been administered at the dose of 300 mg daily for 3 d weekly and for several months with good tolerance.
Combining locoregional CAR-T cells, autologous + allogeneic tumor lysate vaccination and levamisole in treatment of glioblastoma
Published in Immunopharmacology and Immunotoxicology, 2022
Meric A. Altinoz, Alp Ozpinar, Emily Hacker, Aysel Ozpinar
The addition of levamisole to 5-fluorouracil (5-FU) decreases clinical recurrence and total mortality by 41% and 33%, respectively, in stage III colon cancer [35]. Today, the 5-FU-levamisole combination is still being used in the clinical treatment of colon cancer in Israel [36] and Norway [37,38]. There are very few studies on the clinical effects of levamisole on GBM, including combinations with chemotherapy or radiotherapy. Further, levamisole has not yet been tested in combination with immunostimulant protocols in GBM. For the first time in 1981, 2.5 mg/kg levamisole was administered to patients with GBM in combination with chemotherapy after radiotherapy [39]. The longest surviving patients were in the levamisole group, but no significant prolongation of the mean survival was observed [39]. The same group reported that levamisole was ineffective in the rat glioma model induced by Rous sarcoma virus but increased survival if administered with BCG vaccine [39]. In 1985, another group applied levamisole to GBM patients after radiotherapy under the same dose regimen. The longest surviving patient was 17 months in the levamisole group and 13 months in the radiotherapy group alone [40]. In 1989, researchers from Russia administered levamisole to GBM patients with an anticancer antibiotic called reumycin and observed significant clinical improvement and tumor regression in a group of patients [41]. A very prominent feature of levamisole is its potency to augment vaccine-induced immune responses.
A severe case of Levamisole-induced vasculitis
Published in Clinical Toxicology, 2022
Austin Ambur, Timothy Nyckowski
Levamisole is a commonly utilized adulterant for illicit drugs such as cocaine because of its low cost and weak amphetamine properties. In 2019, United States Drug Enforcement Administration reported that 17% of seized and analyzed cocaine contained levamisole [1]. It has been connected with ANCA-associated retiform purpura in cocaine users and the pathogenesis unclear [2]. Skin lesions affect 83 to 91% of patients and classically present as a retiform eruption affecting the ears, face, and extremities [3]. Levamisole is often associated with neutropenia and agranulocytosis in severe cases [4]. If clinical suspicion is present, work up should include a toxicology screen, skin biopsy, and full vasculopathy laboratory evaluation [5]. No specific therapy as been shown to be effective, however systemic steroids may be considered in severe cases.
Recurrent noninfectious preseptal cellulitis secondary to cocaine use and levamisole-associated vasculitis
Published in Baylor University Medical Center Proceedings, 2022
Wesley M. Gillette, Sonali Singh
Levamisole is an antihelminthic pharmaceutical that was developed in the 1960s. Due to its immunomodulatory effects including induction of interferon synthesis, it was also used to treat certain cancers but was withdrawn by the Food and Drug Administration in 1999 due to various toxicities, including vasculitis and agranulocytosis syndromes.1 However, levamisole is still available to veterinarians, and it is estimated that approximately 70% of street cocaine is adulterated with levamisole, which acts as a bulking agent and may also enhance the euphoric effects of cocaine.2 Patients affected by levamisole-induced vasculitis (LIV) often present with purpuric lesions involving the ears and lower extremities as well as constitutional symptoms and arthralgias. Ophthalmic or ocular adnexal involvement in these patients is rare. To our knowledge, only three cases of LIV associated with ophthalmic or ocular adnexal disease have been reported in the literature.3–5 Herein, we present a case of recurrent preseptal cellulitis secondary to LIV associated with cocaine use.