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ANTIPARASITIC PRODUCTS, INSECTICIDES AND REPELLENTS › ANTHELMINTICS › ANTINEMATODAL AGENTS › Imidazothiazole derivatives
levamisole
P02CE01
Adult Dosing
- Ascariasis: 50 mg to 150 mg single oral dose
- Adjuvant therapy for stage III colon cancer (historically with 5-FU): 50 mg orally every 8 hours for 3 days every 2 weeks
Pediatric Dosing
- Ascariasis: 2.5 mg/kg as a single oral dose (maximum 150 mg)
Indications
- Treatment of ascariasis (roundworm infection)
- Historically used as an adjuvant immunotherapy with 5-fluorouracil for resectable stage III colon cancer
- Frequently used as a cutting agent for illicit cocaine, causing severe adulterant-induced syndromes
Mechanism of Action
- Acts as a nicotinic acetylcholine receptor agonist in nematode muscles, causing spastic paralysis and expulsion of the worm
- Immunomodulator that restores depressed T-cell-mediated immune function and enhances macrophage chemotaxis and neutrophil mobility
Contraindications
- Hypersensitivity to levamisole
- Rheumatoid arthritis or concurrent treatment with bone marrow-suppressing agents
- History of agranulocytosis during previous exposure
Adverse Reactions
- Agranulocytosis and severe neutropenia
- Levamisole-induced autoantibody syndrome (LIAS) featuring cutaneous vasculitis, purpura, and retiform purpura on ears and extremities
- Nausea, vomiting, diarrhea, and abdominal pain
- Dizziness, headache, fatigue, and insomnia
- Elevated liver enzymes
Drug Interactions
- Alcohol: May cause a disulfiram-like reaction
- Bone marrow suppressants (e.g., cytotoxic agents, radiation): Increased risk of severe hematologic toxicity and agranulocytosis
- Phenytoin: May increase serum concentration and toxicity of phenytoin
- Warfarin: May enhance the anticoagulant effect leading to increased bleeding risk
Curated Content: Needs Vetting Before Put to Clinical Use