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dc.contributor.authorBrunt, Tibor Markus
dc.contributor.authorvan den Berg, Jorrit
dc.contributor.authorPennings, Ed
dc.contributor.authorVenhuis, Bastiaan
dc.date.accessioned2018-04-30T09:28:41Z
dc.date.available2018-04-30T09:28:41Z
dc.date.issued2017-06
dc.identifier.citationAdverse effects of levamisole in cocaine users: a review and risk assessment. 2017, 91 (6):2303-2313 Arch. Toxicol.en
dc.identifier.issn1432-0738
dc.identifier.pmid28314885
dc.identifier.doi10.1007/s00204-017-1947-4
dc.identifier.urihttp://hdl.handle.net/10029/621862
dc.description.abstractThe immunomodulatory adjuvant and antihelminth levamisole is increasingly used as an adulterant in cocaine worldwide. An accumulating body of clinical and toxicological literature has appeared since 2010 describing neutropenia, agranulocytosis, leukoencephalopathy and vasculitis in cases associated with levamisole-adulterated cocaine. Mostly, neutropenia and agranulocytosis were reported, characterized by a decimation of neutrophils. A large proportion of cases also involved vasculopathy, characterized by pronounced black and purple skin purpura with cutaneous necrosis. Females are more susceptible for both agranulocytosis and vasculitis. Another complication reported with levamisole-adulterated cocaine is leukoencephalopathy, a disabling and potentially fatal neurological disorder caused by cerebral demyelination. In this review, all adverse effects associated with therapeutic levamisole and levamisole-adulterated cocaine are described. In addition, this review provides an update of the pharmacology of levamisole, its metabolism, including toxic metabolites and metabolites that are relevant for levamisole's addition to cocaine. Special emphasis is put on the immunopathology and the dose-effect relationship of chronic levamisole exposure. Finally, a risk assessment is provided based on the current level of levamisole adulteration in street cocaine, the dose range calculated per gram and the pattern of chronic exposure in heavy or dependent users.
dc.language.isoenen
dc.rightsinfo:eu-repo/semantics/closedAccessen
dc.subject.meshCocaine
dc.subject.meshCocaine-Related Disorders
dc.subject.meshDrug Contamination
dc.subject.meshDrug-Related Side Effects and Adverse Reactions
dc.subject.meshHumans
dc.subject.meshLevamisole
dc.subject.meshMolecular Structure
dc.subject.meshRisk Assessment
dc.titleAdverse effects of levamisole in cocaine users: a review and risk assessment.en
dc.typeArticleen
dc.identifier.journalArch Toxicol 2017; 91(6):2303-13en
html.description.abstractThe immunomodulatory adjuvant and antihelminth levamisole is increasingly used as an adulterant in cocaine worldwide. An accumulating body of clinical and toxicological literature has appeared since 2010 describing neutropenia, agranulocytosis, leukoencephalopathy and vasculitis in cases associated with levamisole-adulterated cocaine. Mostly, neutropenia and agranulocytosis were reported, characterized by a decimation of neutrophils. A large proportion of cases also involved vasculopathy, characterized by pronounced black and purple skin purpura with cutaneous necrosis. Females are more susceptible for both agranulocytosis and vasculitis. Another complication reported with levamisole-adulterated cocaine is leukoencephalopathy, a disabling and potentially fatal neurological disorder caused by cerebral demyelination. In this review, all adverse effects associated with therapeutic levamisole and levamisole-adulterated cocaine are described. In addition, this review provides an update of the pharmacology of levamisole, its metabolism, including toxic metabolites and metabolites that are relevant for levamisole's addition to cocaine. Special emphasis is put on the immunopathology and the dose-effect relationship of chronic levamisole exposure. Finally, a risk assessment is provided based on the current level of levamisole adulteration in street cocaine, the dose range calculated per gram and the pattern of chronic exposure in heavy or dependent users.


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