Why is the antihelmintic drug levamisole used to adulterate cocaine?

January 6, 2010, 12:44 am

★★★★☆

THE POSSIBLE ROLE OF LEVAMISOLE IN ILLICIT COCAINE PREPARATIONS Raymon LP, Isenschmid DS. J Anal Toxicol Nov/Dec 2009;33:620-622.

We recently reported on the MMWR notice concerning cases of agranulocytosis linked to cocaine adulterated with the antiparastic and chemotherapeutic agent levamisole. The unanswered question, however, was why this particular drug  — used in both human and veterinary medicine — was being added to cocaine illicitly brought into the U.S.  This “Letter to the Editor” of Journal of Analytical Toxicology suggests several possible explanations.  Levamisole acts as an agonist at nicotinic acetylcholine receptors.  In fact, it is used as a treatment for worms because it causes nicotine-like muscular spasm and paralysis of the worms’ muscles.  This nicotinic effect an ganglia may result in increased release of norepinephrine and dopamine, enhancing sympathomimetic activity and elevating mood.  Other neurotransmitters such as GABA, epinephrine, and glutamate may also be involved.  Although speculative, this relatively short letter makes interesting reading.

Tip o’ the Hat to Mind Hacks and DoseNation for their insights into this issue.

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