Cocaine Adulterated with Levamisole Implicated in 21 Cases of Agranulocytosis

December 19, 2009, 1:53 pm

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AGRANULOCYTOSIS ASSOCIATED WITH COCAINE USE — FOUR STATES, MARCH 2008 – NOVEMBER 2009 MMWR Dec 18, 2009;58:1381-1385.

A must-read report in the current issue of MMWR presents 21 cases of agranulocytosis in cocaine users, apparently caused by adulteration of the drug with levamisole, a veterinary anihelminthic also used infrequently in humans to treat certain types of cancer.  The DEA has reported that as of July 2009, 69% of cocaine samples seized at U.S. borders contained levamisole, with average concentrations of approximately 10%. While it is not clear why that drug is being used as an adulterant, a recent letter in Annals of Internal Medicine cited evidence that levamisole increases central dopamine levels and suggested that it may potentiate cocaine’s euphoric effects. MMWR points out that agranulocytosis is a recognized idiosyncratic reaction in up to 13% of persons taking levamisole. A careful illicit drug history should be taken in any patient presenting with unexplained agranulocytosis.  Since the half-life of levamisole is approximately 5 hours, the drug will be undetectable beyond 48 hours of last use.

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  1. Why is the antihelmintic drug levamisole used to adulterate cocaine? » The Poison Review Says:

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