Levamisole in cocaine: Unexpected news from an old acquaintance

Clinical Toxicology

Volumn 50, Issue 4, 2012, Pages 231-241

  Larocque, Alexandre ^a   Hoffman, Robert S ^b  

^a CENTRE HOSPITALIER DE L UNIVERSITÉ DE MONTRÉAL   (Canada)

^b NEW YORK CITY POISON CONTROL CENTER   (United States)

Author keywords

Agranulocytosis; Cutaneous vasculopathy; Leukoencephalopathy; Neutropenia; Vasculitis

Indexed keywords

AMINE OXIDASE (FLAVIN CONTAINING); AMPHETAMINE; ANTINUCLEAR ANTIBODY; CATECHOL METHYLTRANSFERASE; COCAINE; FLUOROURACIL; LEVAMISOLE; LEVOTHYROXINE; MYELOPEROXIDASE; NEUTROPHIL CYTOPLASMIC ANTIBODY; NICOTINIC RECEPTOR; STEROID; TETRAMISOLE;

AGRANULOCYTOSIS; ANOREXIA; ARTHRALGIA; BONE NECROSIS; COLON CANCER; DIARRHEA; DRUG USE; DRUG WITHDRAWAL; EAR LOBE; EMBASE; ERYTHEMA; HUMAN; HYPERSENSITIVITY REACTION; HYPONATREMIA; IMMUNOSUPPRESSIVE TREATMENT; INFLAMMATORY DISEASE; INFLUENZA; LEUKOCYTOCLASTIC VASCULITIS; LEUKOENCEPHALOPATHY; LEUKOPENIA; LUNG EMBOLISM; LUNG HEMORRHAGE; MACULOPAPULAR RASH; MEDICAL LITERATURE; MEDLINE; NAUSEA; NEOPLASM; NEPHROTIC SYNDROME; NEUROTRANSMISSION; NEUTROPENIA; NONHUMAN; POLYARTHRITIS; RECURRENT DISEASE; REVIEW; RHEUMATOID ARTHRITIS; SKIN NECROSIS; THROMBOCYTOPENIA; URTICARIA; VASCULAR DISEASE; VOMITING;

AGRANULOCYTOSIS; ANTIBODIES, ANTINEUTROPHIL CYTOPLASMIC; COCAINE-RELATED DISORDERS; DRUG CONTAMINATION; HUMANS; LEUKOENCEPHALOPATHIES; LEVAMISOLE; VASCULITIS;

ANIMALIA;

EID: 84859124867     PISSN: 15563650     EISSN: 15569519     Source Type: Journal    
DOI: 10.3109/15563650.2012.665455     Document Type: Review

References (131)

1. United Nations Office on Drugs and Crime. World Drug Report 2011. New York: United Nations Publication, 2011.
2. United Nations Office on Drugs and Crime. World Drug Report 2010. New York: United Nations Publication, 2010.
3. Hoffman RS, Kirrane BM, Marcus SM. A descriptive study of an outbreak of clenbuterol-containing heroin. Ann Emerg Med 2008; 52:548-553.
4. Shannon M. Clinical toxicity of cocaine adulterants. Ann Emerg Med 1988; 17:1243-1247.
5. Rosenthal M, Trabert U, Muller W. Letter: Leucocytotoxic effect of levamisole. Lancet 1976; 1:369.
6. Sany J, Morlack G, Kalfa G, Serre H. Letter: Agranulocytosis during treatment with levamisole. Nouv Presse Med 1976; 5:1148.
7. Leca AP, Le PM, Prier A, Camus JP. Letter: Agranulocytosis during rheumatoid arthritis treated by levamisole. Nouv Presse Med 1976; 5:1212.
8. Ruuskanen O, Remes M, Makela AL, Isomaki H, Toivanen A. Levamisole and agranulocytosis. Lancet 1976; 2:958-959.
9. Graber H, Takacs L, Vedrody K. Agranulocytosis due to levamisole. Lancet 1976; 2:1248.
10. Valentino A, Fuentecilla K. Levamisole: an analytical profile. Microgram Journal 2005; 3:134-137.
11. Center for Disease Control and Prevention (CDC). Agranulocytosis associated with cocaine use-four States, March 2008-November 2009. MMWR Morb Mortal Wkly Rep 2009; 58:1381-1385.
12. Zhu NY, Legatt DF, Turner AR. Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Intern Med 2009; 150: 287-289.
13. Thienpont D, Vanparijs OF J, Raeymaekers AH M, Vandenberk J, Demoen PJA, Allewijn FTN, et al. Tetramisole (R 8299), a new, potent broad spectrum anthelmintic. Nature 1966; 209:1084-1086.
14. Amery WK, Bruynseels JP. Levamisole, the story and the lessons. Int J Immunopharmacol 1992; 14:481-486.
15. Mielants H, Veys EM. A study of the hematological side effects of levamisole in rheumatoid arthritis with recommendations. J Rheumatol Suppl 1978; 4:77-83. (Pubitemid 9068469)
16. Drew SI, Carter BM, Nathanson DS, Terasaki PI. Levamisole-associated neutropenia and autoimmune granulocytotoxins. Ann Rheum Dis 1980; 39:59-63. (Pubitemid 10169238)
17. Vogel CL, Silverman MA, Mansell PW, Miller AM, Thompson JS, Herbick JM, et al. Mechanisms of levamisole-induced granulocytopenia in breast cancer patients. Am J Hematol 1980; 9: 171-183. (Pubitemid 11199274)
18. Vanholder R, Van HW. Recurrent agranulocytosis after levamisole. Lancet 1977; 1:100.
19. Schmidt KL, Mueller-Eckhardt C. Agranulocytosis, levamisole, and HLA-B27. Lancet 1977; 2:85.
20. Veys EM, Mielants H, Verbruggen G. Levamisole-induced adverse reactions in HLA B27-positive rheumatoid arthritis. Lancet 1978; 1:148. (Pubitemid 8264245)
21. El-Ghobarey AF, Capell HA. Levamisol-induced thrombocytopenia. Br Med J 1977; 2:555-556.
22. Winquist EW, Lassam NJ. Reversible thrombocytopenia with levamisole. Med Pediatr Oncol 1995; 24:262-264.
23. Macfarlane DG, Bacon PA. Levamisole-induced vasculitis due to circulating immune complexes. Br Med J 1978; 1:407-408. (Pubitemid 8318798)
24. Scheinberg MA, Bezerra JB, Almeida FA, Silveira LA. Cutaneous necrotising vasculitis induced by levamisole. Br Med J 1978; 1:408. (Pubitemid 8318799)
25. Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies. Arch Dis Child 1996; 75:355-356. (Pubitemid 26354616)
26. Menni S, Pistritto G, Gianotti R, Ghio L, Edefonti A. Ear lobe bilateral necrosis by levamisole-induced occlusive vasculitis in a pediatric patient. Pediatr Dermatol 1997; 14:477-479. (Pubitemid 28012032)
27. Rongioletti F, Ghio L, Ginevri F, Bleidl D, Rinaldi S, Edefonti A, et al. Purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children. Br J Dermatol 1999; 140:948-951. (Pubitemid 29238474)
28. Barbano G, Ginevri F, Ghiggeri GM, Gusmano R. Disseminated autoimmune disease during levamisole treatment of nephrotic syndrome. Pediatr Nephrol 1999; 13:602-603. (Pubitemid 29403481)
29. Menkes CJ, Feldmann JL, Baptiste GJ, Delbarre F. Nephrotic syndrome through extramembranous glomerulonephritis induced by levamisole in a patient with rheumatoid arthritis. Nouv Presse Med 1978; 7:2654-2655. (Pubitemid 9008307)
30. Hansen TM, Petersen J, Halberg P, Permin H, Ullman S, Brun C, et al. Levamisole-induced nephropathy. Lancet 1978; 2(8092 Pt 1):737. (Pubitemid 9040757)
31. Shearn MA, Tu WH. Proliferative glomerulonephritis associated with levamisole therapy of rheumatoid arthritis. J Rheumatol 1981; 8:522-523.
32. Hook CC, Kimmel DW, Kvols LK, Scheithauer BW, Forsyth PA, Rubin J, et al. Multifocal inflammatory leukoencephalopathy with 5-fluorouracil and levamisole. Ann Neurol 1992; 31:262-267.
33. Kimmel DW, Wijdicks EF, Rodriguez M. Multifocal inflammatory leukoencephalopathy associated with levamisole therapy. Neurology 1995; 45:374-376.
34. Wu VC, Huang JW, Lien HC, Hsieh ST, Liu HM, Yang CC, et al. Levamisole-induced multifocal inflammatory leukoencephalopathy: clinical characteristics, outcome, and impact of treatment in 31 patients. Medicine (Baltimore) 2006; 85:203-213.
35. Xu N, Zhou W, Li S, Zhou G, Zhang N, Liang J. Clinical and MRI characteristics of levamisole-induced leukoencephalopathy in 16 patients. J Neuroimaging 2009; 19:326-331.
36. Segal AW, Pugh SF, Levi AJ, Loewi G. Levamisole-induced arthritis in Crohn's disease. Br Med J 1977; 2:555.
37. Siklos P. Levamisole-induced arthritis. Br Med J 1977; 2:773.
38. Pinals RS. The non-hematological side effects of levamisole in the treatment of rheumatoid arthritis-a review. J Rheumatol Suppl 1978; 4:71-75. (Pubitemid 9068468)
39. Yust I, Vardinon N, Fiersteter E, Avramov LA. Levamisole-induced allergy. Lancet 1977; 2:457. (Pubitemid 8167968)
40. Christiansen FT, Ng KC, Zilko PJ, Dawkins RL. Levamisole-induced hypersensitivity. Lancet 1977; 1:1112.
41. Secher L, Permin H, Skov PS, Ullmann S, Halberg P. Levamisole-induced hypersensitivity. Lancet 1977; 2:932.
42. Secher L, Permin H, Skov PS, Ullman S, Halberg P. Levamisole-induced hypersensitivity. Acta Derm Venereol 1978; 58:372-374. (Pubitemid 9008712)
43. Hodinka L, Meretey K, Bozsoky S. Skin manifestations and serum IgE levels in levamisole-treated rheumatoid arthritis patients. Int Arch Allergy Appl Immunol 1979; 58:362-364. (Pubitemid 9127687)
44. Knowles S, Shear N. Levamisole causing a fixed drug eruption. Can J Hosp Pharm 1994; 47:65-66. (Pubitemid 24176110)
45. Parkinson DR, Cano PO, Jerry LM, Capek A, Shibata HR, Mansell PW, et al. Complications of cancer immunotherapy with levamisole. Lancet 1977; 1:1129-1132. (Pubitemid 8111079)
46. Tweedy CR, Silverberg DA, Scott L. Levamisole-induced syndrome of inappropriate antidiuretic hormone. N Engl J Med 1992; 326:1164.
47. P avenski K, Vandenberghe H, Streutker C, Adam D, Jakubovic H. Role of plasmapheresis in the treatment of levamisole-induced skin necrosis in crack/cocaine users [abstract]. Transfusion 2010; 50(Suppl.):83A.
48. Ullrich KR, West SG, High W, Koval RJ, Koval E, Bapoje S, Hirsh JM. Clinical and autoimmune manifestations of levamisole-adulterated cocaine abuse [abstract]. Arthritis Rheum 2010; 62(Suppl. 10):2013.
49. Han C, Dutz J. Antiphospholipid antibody syndrome triggered by levamisole-tainted cocaine: case report and review of the literature [abstract]. J Am Acad Dermatol 2011; 64(2 Suppl. 1):AB12.
50. Friend K, Milone M, Perrone J. Hyponatremia associated with levamisole-adulterated cocaine [abstract]. Clin Toxicol (Phila) 2011; 49:207-208.
51. Wei J, Kneeland PP, Dhaliwal G. Cracking the case. J Hosp Med 2011; 6:489-493.
52. John S, Manda S, Hamrock D. Cocaine-induced thrombotic vasculopathy. Am J Med Sci 2011; 342:524-526.
53. Jacob RS, Silva CY, Powers JG, Schieke SM, Mendese G, Burlingame RW, et al. Levamisole-Induced Vasculopathy: A Report of 2 Cases and a Novel Histopathologic Finding. Am J Dermatopathol 2011; [Epub ahead of print].
54. Jinjolava N, Jariwala S, Rosenstreich D, Verulashvili M. An unusual case of levamisole-adulterated cocaine-induced vasculitis [abstract]. Ann Allergy Asthma Immunol 2011; 107(5 Suppl.):A61.
55. Matthews A, Oladapo O, Morgan B. A cocaine death with concomitant adulterant-induced toxicity [abstract]. Clin Toxicol (Phila) 2009; 47:761.
56. Knowles L, Buxton JA, Skuridina N, Achebe I, Legatt D, Fan S, et al. Levamisole tainted cocaine causing severe neutropenia in Alberta and British Columbia. Harm Reduct J 2009; 6:30.
57. Wiens MO, Son WK, Ross C, Hayden M, Carleton B. Cases: Cocaine adulterant linked to neutropenia. CMAJ 2010; 182:57-59.
58. Tadmor T, Vadasz Z, Polliack A, Attias D. Two cases of agranulocytosis associated with cocaine use: is this phenomenon becoming more prevalent? Eur J Haematol 2010; 84:458-459.
59. Czuchlewski DR, Brackney M, Ewers C, Manna J, Fekrazad MH, Martinez A, et al. Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 2010; 133:466-472.
60. Lynch K, Dominy S, Graf J. Prevalence and correlation of levamisole-adulterated cocaine and severe agranulocytosis/vasculitis [abstract]. Clin Toxicol (Phila) 2010; 48:291.
61. Buchanan JA, Oyer RJ, Patel NR, Jacquet GA, Bornikova L, Thienelt C, et al. A confirmed case of agranulocytosis after use of cocaine contaminated with levamisole. J Med Toxicol 2010; 6:160-164.
62. Bradford M, Rosenberg B, Moreno J, Dumyati G. Bilateral necrosis of earlobes and cheeks: another complication of cocaine contaminated with levamisole. Ann Intern Med 2010; 152:758-759.
63. Buchanan JA, Vogel JA, Eberhardt AM. Levamisole-induced occlusive necrotizing vasculitis of the ears after use of cocaine contaminated with levamisole. J Med Toxicol 2011; 7:83-84.
64. Ganje T, Hurley W. Testing the pipe: neutropenia from levamisole-adulterated cocaine [abstract]. Clin Toxicol (Phila) 2010; 48:617.
65. Waller JM, Feramisco JD, Alberta-Wszolek L, McCalmont TH, Fox LP. Cocaine-associated retiform purpura and neutropenia: is levamisole the culprit? J Am Acad Dermatol 2010; 63:530-535.
66. Van Wieren A, Kapoor M, Rao P, Gardner R. A new low for an old high: neutropenia induced by levamisole-adulterated cocaine. Med Health R I 2010; 93:320-321.
67. Farhat EK, Muirhead TT, Chaffins ML, Douglass MC. Levamisole-induced cutaneous necrosis mimicking coagulopathy. Arch Dermatol 2010; 146:1320-1321.
68. Walsh NM, Green PJ, Burlingame RW, Pasternak S, Hanly JG. Cocaine-related retiform purpura: evidence to incriminate the adulterant, levamisole. J Cutan Pathol 2010; 37:1212-1219.
69. Click J. Levamisole-induced retiform purpura. J Drugs Dermatol 2011; 10:217.
70. Geller L, Whang TB, Mercer SE, Phelps R. Retiform purpura: a new stigmata of illicit drug use? Dermatol Online J 2011; 17:7.
71. Pavenski K, Vandenberghe H, Jakubovic H, Adam D, Garvey B, Streutker C. Levamisole-induced vasculopathy and associated skin necrosis in crack/cocaine users [abstract]. Lab Investigation 2011; 91(Suppl.):122A-123A.
72. Jang D, Hoffman R, Nelson L, Stajic M, Smith S. Levamisole-induced occlusive necrotizing vasculitis in a pregnant woman after use of cocaine contaminated with levamisole [abstract]. Clin Toxicol (Phila) 2011; 49:216.
73. Lung D, Lynch K, Agrawal S, Armenian P, Banh K. Images in emergency medicine. Adult female with rash on lower extremities. Vasculopathic purpura and neutropenia caused by levamisole-contaminated cocaine. Ann Emerg Med 2011; 57:307,311.
74. Fthenakis A, Klein PA. Retiform purpura in a patient with a history of cocaine use. Dermatol Online J 2011; 17:12.
75. Mitchell V, Chalfin N. Not your usual suspect: two cases of ANCA vasculitis [abstract]. J Hosp Med 2011; 6(4 Suppl. 2):S218.
76. Perkisas S, Vrelust I, Martin M, Gadisseur A, Schroyens W. A warning about agranulocytosis with the use of cocaine adulterated with levamisole. Acta Clin Belg 2011; 66:226-227.
77. Ullrich K, Koval R, Koval E, Bapoje S, Hirsh JM. Five consecutive cases of a cutaneous vasculopathy in users of levamisole-adulterated cocaine. J Clin Rheumatol 2011; 17:193-196.
78. Zwang NA, Van Wagner LB, Rose S. A case of levamisole-induced systemic vasculitis and cocaine-induced midline destructive lesion: a case report. J Clin Rheumatol 2011; 17:197-200.
79. Chung C, Tumeh PC, Birnbaum R, Tan BH, Sharp L, McCoy E, et al. Characteristic purpura of the ears, vasculitis, and neutropenia-a potential public health epidemic associated with levamisole-adulterated cocaine. J Am Acad Dermatol 2011; 65:722-725.
80. Han C, Sreenivasan G, Dutz JP. Reversible retiform purpura: a sign of cocaine use. CMAJ 2011; 183:E597-E600.
81. Muirhead TT, Eide MJ. Images in clinical medicine. Toxic effects of levamisole in a cocaine user. N Engl J Med 2011; 364:e52.
82. Gross RL, Brucker J, Bahce-Altuntas A, Abadi MA, Lipoff J, Kotlyar D, et al. A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Clin Rheumatol 2011; 30: 1385-1392.
83. Chirinos R, DeWitt C, McKinley-Grant L, Dugan E. Cryoglobulinemic vasculitis secondary to levamisole-adulterated cocaine [abstract]. Am J Dermatopathol 2011; 33:420.
84. Darabi K, Clark S, Roy J, Kowal R, Peters S. Two cases of thrombotic vasculopathy, likely resulting from cocaine adulterated with levamisole [abstract]. Am J Dermatopathol 2011; 33:429.
85. Jenkins J, Babu K, Hsu-Hung E, Robinson-Bostom L, Kroumpouzos G. ANCA-positive necrotizing vasculitis and thrombotic vasculopathy induced by levamisole-adulterated cocaine: a distinctive clinicopathologic presentation. J Am Acad Dermatol 2011; 65:e14-e16.
86. D y I, Pokuri V, Olichney J, Wiernik P. Levamisole-adulterated in cocaine causing agranulocytosis, vasculopathy, and acquired protein S deficiency. Ann Hematol 2011; 91(3):477-478.
87. Baltarowich L. Skin necrosis associated with exposure to cocaine contaminated with levamisole: an emerging phenomenon [abstract]. Clin Toxicol (Phila) 2011; 49:524-525.
88. Chapman D, Khodaee M. Case report: agranulocytosis attributed to levamisole-tainted cocaine. Am Fam Physician 2011; 84:355.
89. de la Hera I, Sanz V, Cullen D, Chico R, Petiti G, Villar M, et a l. Necrosis of ears after use of cocaine probably adulterated with levamisole. Dermatology 2011; 223:25-28.
90. Poon SH, Baliog CR Jr., Sams RN, Robinson-Bostom L, Telang GH, Reginato AM. Syndrome of Cocaine-Levamisole-Induced Cutaneous Vasculitis and Immune-Mediated Leukopenia. Semin Arthritis Rheum 2011; 41:434-444.
91. Herms B, Kaplon M, Baumann M. Agranulocytosis in cocaine users in Ohio: suspected levamisole taint. Leuk Res 2011; 35:e173-e174.
92. Friend K, Milone MC, Perrone J. Hyponatremia Associated With Levamisole-Adulterated Cocaine Use in Emergency Department Patients. Ann Emerg Med 2011; [Epub ahead of print].
93. Lee KC, Culpepper K, Kessler M. Levamisole-induced thrombosis: Literature review and pertinent laboratory findings. J Am Acad Dermatol 2011; 65:e128-e129.
94. McGrath MM, Isakova T, Rennke HG, Mottola AM, Laliberte KA, Niles JL. Contaminated Cocaine and Antineutrophil Cytoplasmic Antibody-Associated Disease. Clin J Am Soc Nephrol 2011; 6: 2799-2805.
95. Mouzakis J, Somboonwit C, Lakshmi S, Rumbak M, Sinnott J, Cherpelis B, et al. Levamisole induced necrosis of the skin and neutropenia following intranasal cocaine use: a newly recognized syndrome. J Drugs Dermatol 2011; 10:1204-1207.
96. Hezel JPD, Cruz ES. Levamisole-induced transient neuropathy: a case report [abstract]. PM&R 2011; 3(10 Suppl. 1):S292.
97. Ching JA, Smith DJ Jr. Levamisole-Induced Necrosis of Skin, Soft Tissue, and Bone: Case Report and Review of Literature. J Burn Care Res 2012; 33(1):e1-e5.
98. Graf J, Lynch K, Yeh CL, Tartar L, Richman N, Nguyen T, et al. Purpura, cutaneous necrosis, and antineutrophil cytoplasmic antibodies associated with levamisole-adulterated cocaine. Arthritis Rheum 2011; 63:3998-4001.
99. Farmer RW, Malhotra PS, Mays MP, Egger ME, Smith JW, Jortani SA, Spiller H, Bosse GM, Callen JP, Franklin GA. Necrotizing Peripheral Vasculitis/ Vasculopathy Following the Use of Cocaine Laced With Levamisole. J Burn Care Res 2012; 33(1):e6-e11.
100. Khan TA, Cuchacovich R, Espinoza LR, Lata S, Patel NJ, Garcia- Valladares I, et al. Vasculopathy, hematological, and immune abnormalities associated with levamisole-contaminated cocaine use. Semin Arthritis Rheum 2011; 41:445-454.
101. Chai PR, Bastan W, Machan J, Hack JB, Babu KM. Levamisole exposure and hematologic indices in cocaine users. Acad Emerg Med 2011; 18:1141-1147.
102. Dahl O, Fluge O, Carlsen E, Wiig JN, Myrvold HE, Vonen B, et a l. Final results of a randomised phase III study on adjuvant chemotherapy with 5 FU and levamisol in colon and rectum cancer stage II and III by the Norwegian Gastrointestinal Cancer Group. Acta Oncol 2009; 48:368-376.
103. Specks U. The growing complexity of the pathology associated with cocaine use. J Clin Rheumatol 2011; 17:167-168.
104. Wiesner O, Russell KA, Lee AS, Jenne DE, Trimarchi M, Gregorini G, et al. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase as a diagnostic marker for CIMDL but not autoimmune vasculitis. Arthritis Rheum 2004; 50:2954-2965. (Pubitemid 39209534)
105. Savige J, Pollock W, Trevisin M. What do antineutrophil cytoplasmic antibodies (ANCA) tell us? Best Pract Res Clin Rheumatol 2005; 19:263-276. (Pubitemid 40568179)
106. LeGatt D, Boisvert Y, Colbourne P. Cocaine and hog-dewormer: an interesting combination [abstract]. Ther Drug Monit 2007; 29:497.
107. Brugmans J, Van Lommel R, Baro F. Clinical aspects of tetramisole, an anthelminthic with antidepressant activity [abstract]. Psychopharmacology 1972; 26(Suppl.):85.
108. Vanhoutte PM, Van Nueten JM, Verbeuren TJ, Laduron PM. Differential effects of the isomers of tetramisole on adrenergic neurotransmission in cutaneous veins of dog. J Pharmacol Exp Ther 1977; 200:127-140. (Pubitemid 8024140)
109. Shah KK, Gulati OD, Hemavathi KG. Investigation of some effects of levamisole on dog blood pressure. Indian J Physiol Pharmacol 1986; 30:55-62.
110. Pires JG, Futuro-Neto HA, Oliveira AM, Cabral AM. The effect of levamisole on the cardiac responses to sympathomimetics and on the amine uptake process. J Pharm Pharmacol 1979; 31:257-258. (Pubitemid 9148928)
111. Gulati OD, Hemavathi KG, Joshi DP. Interactions of levamisole with some autonomic drugs on guinea-pig vas deferens. J Auton Pharmacol 1985; 5:19-23. (Pubitemid 15117228)
112. Barker SA. The formation of aminorex in racehorses following levamisole administration. A quantitative and chiral analysis following synthetic aminorex or levamisole administration vs. aminorex-positive samples from the field: a preliminary report. J Vet Pharmacol Ther 2009; 32:160-166.
113. Follath F, Burkart F, Schweizer W. Drug-induced pulmonary hypertension? Br Med J 1971; 1:265-266.
114. Ho ENM, Leung DKK, Leung GNW, Wan TSM, Wong ASY, Wong CHF, et al. Aminorex and rexamino as metabolites of levamisole in the horse. Anal Chim Acta 2009; 638:58-68.
115. Gutierrez J, Eisenberg RL, Koval NJ, Armstrong ER, Tharappel J, Hugues CG, Tobin T. Pemoline and tetramisole 'positives' in english racehorses following levamisole administration. Ir Vet J 2010; 63:498-500.
116. Bertol E, Mari F, Milia MG, Politi L, Furlanetto S, Karch SB. Determination of aminorex in human urine samples by GC-MS after use of levamisole. J Pharm Biomed Anal 2011; 55(5):1186-1189.
117. Bunker CF, Johnson M, Gibb JW, Bush LG, Hanson GR. Neurochemical effects of an acute treatment with 4-methylaminorex: a new stimulant of abuse. Eur J Pharmacol 1990; 180:103-111. (Pubitemid 20140995)
118. Hanson GR, Bunker CF, Johnson M, Bush L, Gibb JW. Response of monoaminergic and neuropeptide systems to 4-methylaminorex: a new stimulant of abuse. Eur J Pharmacol 1992; 218:287-293.
119. Russell BR, Beresford RA, Schmierer DM, McNaughton N, Clark CR. Stimulus properties of some analogues of 4-methylaminorex. Pharmacol Biochem Behav 1995; 51:375-378.
120. Meririnne E, Kajos M, Kankaanpaa A, Koistinen M, Kiianmaa K, Seppala T. Rewarding properties of the stereoisomers of 4-methylaminorex: involvement of the dopamine system. Pharmacol Biochem Behav 2005; 81:715-724. (Pubitemid 41187803)
121. Chang A, Osterloh J, Thomas J. Levamisole: a dangerous new cocaine adulterant. Clin Pharmacol Ther 2010; 88:408-411.
122. Karch SB, Mari F, Bartolini V, Bertol E. Aminorex poisoning in cocaine abusers. Int J Cardiol 2011; [Epub ahead of print].
123. Hsu WH. Toxicity and drug interactions of levamisole. J Am Vet Med Assoc 1980; 176(10 Spec No):1166-1169. (Pubitemid 11133195)
124. Raymon LP, Isenschmid DS. Letter to the editor: The possible role of levamisole in illicit cocaine preparations. J Anal Toxicol 2009; 33:620-622.
125. Levandoski MM, Piket B, Chang J. The anthelmintic levamisole is an allosteric modulator of human neuronal nicotinic acetylcholine receptors. Eur J Pharmacol 2003; 471:9-20. (Pubitemid 36694854)
126. Rehni AK, Singh TG. Levamisole-induced reduction in seizure threshold: a possible role of nicotinic acetylcholine receptor-mediated pathway. Naunyn Schmiedebergs Arch Pharmacol 2010; 382:279-285.
127. Spector S, Munjal I, Schmidt DE. Effects of the immunostimulant, levamisole, on opiate withdrawal and levels of endogenous opiate alkaloids and monoamine neurotransmitters in rat brain. Neuropsychopharmacology 1998; 19:417-427. (Pubitemid 28451597)
128. Onuaguluchi G, Igbo IN. Comparative local anaesthetic and antiarrhythmic actions of levamisole hydrochloride and lignocaine hydrochloride. Arch Int Pharmacodyn Ther 1987; 289:278-289. (Pubitemid 18053884)
129. Onuaguluchi G, Igbo IN. Electrocardiographic changes induced by levamisole hydrochloride in the rat. Arch Int Pharmacodyn Ther 1990; 305:55-62. (Pubitemid 20275321)
130. Onuaguluchi G, Igbo IN. Electrocardiographic changes induced by levamisole hydrochloride in the guinea-pig. Afr J Med Med Sci 1990; 19:307-312.
131. Schneider S, Meys F. Analysis of illicit cocaine and heroin samples seized in Luxembourg from 2005-2010. Forensic Sci Int 2011; 212:242-246.