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Agranulocytosis After Consumption of Cocaine Adulterated With Levamisole
- Nancy Y. Zhu, MD;
- Donald F. LeGatt, PhD; and
- A. Robert Turner, MD
- From the University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
Background: Levamisole is a veterinary antihelminthic previously used as an immunomodulator in rheumatoid arthritis and as adjuvant therapy in the treatment of colorectal cancer. It is no longer available in North America for human use but is available in the United States and South America for veterinary administration.
Since 2004, pharmaceutical agents have been found in cocaine supplies in North America and Europe (1). Levamisole contaminated 30% of cocaine seized by the U.S. Drug Enforcement Agency from July to September 2008 (U.S. Department of Justice, Drug Enforcement Administration. Cocaine Signature Program Report. January–October 2008. Internal document.) and 11% of cocaine samples tested in Alberta, Canada, from April to December 2008 (Office of Research and Surveillance, Health Canada. Personal communication.). Levamisole causes reversible agranulocytosis in up to 20% of cases (2), but the clinical effects of cocaine adulterated with levamisole have not been described.
Objective: To describe 5 patients with severe agranulocytosis after exposure to cocaine and levamisole.
Case Report: Between July and November 2008, …
