Can levamisole-contaminated cocaine cause pulmonary hypertension?

May 30, 2013, 4:09 pm

★★★☆☆

Aminorex poisoning in cocaine abusers. Karch SB et al. Int J Cardiol 2012 Jul 26;158:344-346.

Abstract

The drug aminorex was introduced in several European countries as an appetite suppressant in 1965, but quickly withdrawn when its use was associated with cases of pulmonary hypertension (PH) and a high fatality rate.

Starting in 2004, a large percentage of cocaine batches tested have been shown to contain levamisole. Recent investigations have demonstrated that levamisole is metabolized to aminorex in humans.

In the European experience, onset of symptoms of PH began after six to nine months of aminorex use, with average daily doses of 10 -40 mg. Although it is not know how much aminorex would be produced after exposure to cocaine contaminated with levamisole, the authors of this article speculate that cocaine users may be at increased risk for PH. Although PH has been associated with cocaine use, the literature on this predates 2004.

Because the symptoms of PH are nonspecific and develop slowly, the diagnosis can be difficult to make. This article is valuable in alerting clinicians cocaine users may be at risk for the condition. I expect future studies will determine just how much aminorex is produced from exposure to typical amounts of contaminated cocaine.

Remember, there are two known conditions that can be caused by levamisole-tainted cocaine: agraulocytosis and necrotizing vasculitis.

Tip o’ the hat to Dr. Jerry Hoffman, who alerted me to this possible connection. I had not heard of it before.

Related posts:

Cocaine-associated hyponatremia: is levamisole the culprit?

Levamisole-adulterated cocaine: an excellent review

Cocaine, levamisole, and the white blood count 

Dramatic pictures: vasculitis caused by levamisole-contaminated cocaine

Scrotal gangrene after smoking crack

Unusual complication of cocaine abuse

Case reports: neutropenia associated with levamisole-adulterated cocaine

Why is the antihelminthic drug levamisole used to adulterate cocaine?

Cocaine adulterated with levamisole implicated in 21 cases of agranulocytosis

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