Levamisole

Levamisole is prescribed along with other agents for the treatment of certain types of colon cancer. It may also be prescribed to help treat other conditions as determined by your physician.

Ergamisol, Decaris, Ketrax

Levamisole

Dicaris

30

Janssen-Cilag, Janssen Pharmaceuticals, Khandelwal Laboratories

Tablets

50 mg, 150 mg

India

Levamisole

I. Introduction

A. Brief Overview of Levamisole

Levamisole is a medication used to treat infections caused by parasitic worms. Its immune-modulating abilities make it useful for more than getting rid of parasites. This drug, which belongs to the imidazothiazoles family, addresses public health challenges associated with parasitic diseases.

B. Historical Background and Development

Levamisole was first introduced in the 1960s to treat worm infections in animals. However, its potential as an agent for human use was soon realized. Over time researchers also discovered that the drug has properties which widened its range of medical applications.

II. Composition of Levamisole

A. Chemical Structure and Properties

Levamisole has a formula of C11H12N2S and is known for its imidazothiazole ring. It is a compound that can easily be absorbed from the gut due to its nature. Because of its ability to bind strongly to proteins and its lipophilicity, it can effectively penetrate tissues and have a wide range of effects.

B. Different Formulations and Brand Names

Levamisole is sold under brand names globally, such as Ergamisol and Ketrax. It is predominantly available in tablet form. It can also be obtained as a liquid for oral consumption or as an injectable version making it versatile for different medical and veterinary applications.

III. Uses of Levamisole

A. Approved Medical Uses

Levamisole is an anthelmintic medication used to treat parasitic worm infections such as ascariasis and hookworm infections1It works as a nicotinic acetylcholine receptor agonist that causes continued stimulation of the parasitic worm muscles, leading to paralysis1Levamisole has also been used alongside fluorouracil as an adjuvant treatment for colon cancer in some patients23However, its application in cancer therapy has declined because of adverse reactions2.

Here are the references:

1Levamisole - Wikipedia 

2Levamisole: Uses, Interactions, Mechanism of Action | DrugBank Online 

3Levamisole and 5-fluorouracil therapy for resected colon cancer: A new …

B. Veterinary Uses

Levamisole is an anthelmintic drug widely used in veterinary medicine to treat nematode infections in animals such as cattle, sheep, pigs, goats, poultry, and pets. It is effective against both mature and developing stages of nematodes12Levamisole is commonly administered orally or subcutaneously1.

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C. Recent Research and Potential Future Applications

Levamisole is being investigated for its potential use in immunomodulation for HIV/AIDS and autoimmune diseases12However, it is essential to note that these applications are still being experimented with and require research3.

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IV. Off-label Use of Levamisole

A. Off-label Uses in Medical Settings

Levamisole has been used off-label to treat conditions such as recurrent mouth ulcers and pediatric nephrotic syndrome12However, it is important to highlight that these applications lack approval from regulatory authorities, and the decision to use Levamisole in such cases relies solely on the discretion of individual healthcare providers1.

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B. Off-label Uses in Veterinary Medicine

Levamisole has been used in an unofficial capacity to address issues like parasitic skin infestations and certain immune-mediated diseases. However, it is essential to note that these applications are not officially endorsed and should be approached with care as they lack approval from regulatory authorities.

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C. Risks and Controversies Surrounding Off-label Use

Levamisole has been used off-label to treat conditions such as parasitic skin infestations and certain immune-mediated diseases12However, it is important to highlight that these applications are not officially endorsed and should be approached carefully as they lack approval from regulatory authorities3The side effects of Levamisole can be quite unpredictable and serious13Therefore it’s crucial to approach off-label use cautiously and carefully consider the advantages versus the associated risks3.

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V. How Levamisole Works

A. Mechanism of Action

Levamisole functions as a ranging deworming agent by activating nicotinic acetylcholine receptors in the parasite's body. This results in muscle contraction, paralysis, and, ultimately, the removal of the parasite. Additionally, Levamisole impacts the immune system, boosting both cellular and antibody-based immune responses. As a result, it improves the body's capacity to combat infections and diseases.

B. Interaction with Other Drugs and Substances

Levamisole can interact with different drugs and substances like any other medication, which might change its effectiveness or cause adverse reactions. For example, if taken together with anticoagulants there could be a chance of bleeding due to Levamisole's potential to cause agranulocytosis. Similarly, when combined with medications processed by the liver, it could increase the amount of those drugs in the bloodstream, potentially leading to toxicity.

VI. Dosage and Administration of Levamisole

A. Standard Dosage Guidelines

The recommended amount of Levamisole will differ depending on the treated condition. A typical dosage for parasitic infections in adults would be around 100 to 200 mg per day, for one or two consecutive days. If needed, this dosage can be repeated after a week.

B. Variations in Dosage for Specific Conditions

The treatment of hookworm and ascariasis often requires a dose of 150 mg, which is typically adequate. However, when used as part of cancer therapy, the dosage may need to be higher. In these cases, it can take up to 50 mg three times a day for three days, followed by rest. In practice, the dosage varies significantly depending on the species, age, and condition of the animal being treated.

C. Route of Administration

Levamisole is usually taken by mouth, although it can also be given through injections into the muscles or, under the skin in veterinary medicine.

VII. Side Effects of Levamisole

A. Common Side Effects and Their Management

Levamisole can sometimes lead to common effects like feeling nauseous, vomiting, having diarrhea experiencing abdominal pain and tiredness. Most of these symptoms can be handled with care and might not require stopping the medication. However, patients must be aware of these side effects before starting the treatment.

 

B. Serious or Rare Side Effects

Some patients might encounter significant side effects such as skin rashes, seizures, inflammation of the lungs, and agranulocytosis. A severe decrease in white blood cells can make one more susceptible to infections. If you notice any indications of these effects, it is essential to seek medical assistance.

C. Factors Influencing Side Effects

Various factors can influence the occurrence of side effects, such, as the patient's health, any existing conditions they may have other medications they are taking, and the dosage and duration of Levamisole therapy. For example, if someone has liver or kidney problems or is using drugs that could potentially harm these organs, they might experience more intense side effects. As a result, it may be necessary for these individuals to undergo monitoring and have their dosage adjusted accordingly.

VIII. Interactions and Contraindications of Levamisole

A. Potential Drug Interactions

Levamisole has the potential to interact with medications, which could affect how well they work or make their side effects more intense. It's important to note that when Levamisole is combined with anticoagulants, it may raise the risk of bleeding. Additionally, Levamisole can also interact with drugs metabolized by the liver, possibly increasing their levels in the bloodstream to an extent.

B. Known Contraindications

Levamisole should not be used if a patient has a known allergy to the drug. Additionally, it is not recommended for patients with liver or kidney problems due to the potential for increased toxicity. Furthermore, it is advised to avoid using Levamisole in situations where stimulating the system could be harmful such as in cases of autoimmune diseases.

C. Potential Food and Lifestyle Interactions

Although there are no food interactions, taking Levamisole with a meal is generally recommended to minimize any potential discomfort in the gastrointestinal system. It's important to consider lifestyle choices such as smoking and alcohol consumption as they can affect how the drug is metabolized, potentially resulting in heightened side effects. Therefore, reducing or abstaining from these substances while undergoing Levamisole treatment might be beneficial.

IX. Special Precautions and Warnings with Levamisole

A. Important Precautions

It is important to exercise caution when administering Levamisole due to the possibility of side effects. Monitoring blood cell counts and liver function is recommended, especially when using higher doses or for an extended period. Patients should also be informed about reporting symptoms that may indicate agranulocytosis, such as fever or a sore throat.

B. Warning Signs of Adverse Reactions

It could be a sign of severe adverse reactions if you experience skin rashes, seizures, difficulty breathing, or signs of infection while taking Levamisole. You must seek medical attention if these symptoms occur during your treatment.

C. Careful Administration Guidelines

It is essential to use Levamisole to ensure it is safe and effective. This involves following the prescribed dosages, not missing any doses, and stopping the medication according to the instructions given by your doctor. If you happen to skip a dose, take it soon as you remember unless it's almost time for your next dose.

X. Administration of Levamisole to Specific Populations

A. Administration to Elderly Patients

Older individuals might experience increased vulnerability to the side effects of Levamisole due to age-related decline in liver, kidney, or heart function. It may be necessary to adjust the dosage and closely monitor this group of patients to minimize any associated risks.

B. Administration to Pregnant Women and Nursing Mothers

Considering the risks, it is advisable only to use Levamisole during pregnancy if the benefits outweigh any potential adverse effects. Similarly, caution should be exercised when using Levamisole while nursing as it may be excreted in breast milk and exposed to it.

C. Administration to Children

Levamisole is commonly prescribed to treat infections in children. However, adjusting the dosage according to their body weight is essential as this can affect the risk of side effects, like agranulocytosis. Therefore it is recommended to monitor children who are given Levamisole.

XI. Overdosage of Levamisole

A. Symptoms and Signs of Overdosage

Taking much Levamisole can lead to increased side effects, including intense nausea, frequent vomiting, diarrhea, and symptoms affecting the central nervous system, like dizziness and confusion. In some cases, there is a possibility of experiencing seizures. In instances, agranulocytosis and related infectious complications may develop.

B. Immediate Actions and Treatments

If someone is thought to have taken much of the medication, seeking immediate medical help is crucial. The usual course of treatment involves providing care for the symptoms and offering support. Sometimes activated charcoal might be given to lower the absorption of the drug if the person seeks attention within a few hours of taking it. It's important to note that there isn't a remedy for an overdose of Levamisole.

C. Long-term Consequences of Overdosage

The long-term effects of taking much Levamisole are mainly connected to its ability to cause agranulocytosis, a severe decrease in white blood cells. This condition can make a person more vulnerable to infections, which, if not treated promptly, could result in considerable illness and even death.

XII. Storage and Handling Precactions for Levamisole

A. Ideal Storage Conditions

Levamisole is best stored at room temperature, between 15°C and 30°C. It should be kept in a dry location shielded from direct sunlight and out of the reach of children and pets.

B. Guidelines for Safe Handling and Disposal

Handle Levamisole tablets with your hands and only remove them from the container when taking your medication. If you have any leftover or expired medication be sure to dispose of it by following the guidelines in your local area or consulting a healthcare professional or pharmacist.

C. What to Do in Case of Spillage or Exposure

If there is a spill, cleaning the area using a wet cloth is essential to minimize any potential exposure. If Levamisole comes into contact with your skin or eyes, rinse the area immediately with plenty of water. If you accidentally ingest or inhale it or experience any reactions, seek immediate medical assistance.

XIII. Conclusion

A. Summary of Key Points about Levamisole

Initially created to treat infections, Levamisole has gained recognition for its strong ability to modulate the immune system. While it is practical, its usage is restricted due to the possibility of adverse reactions and the requirement for precise dosage and administration.

B. Current and Potential Future Role of Levamisole in Medicine

Levamisole is still being utilized to treat infections and as a supplement in cancer treatment. However, ongoing research indicates it may have potential applications, such as addressing immunological disorders and infectious diseases. As we gain an understanding of its intricate workings and effectively manage any associated side effects, there is a possibility that Levamisole could find utility in medicine beyond its current uses leading to benefits for a broader range of patients.

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