UMEM Educational Pearls

Category: Toxicology

Title: Levamisole Toxicity from Adulterated Cocaine and Heroin

Keywords: levamisole, cocaine, vasculitis, agranulocytosis, heroin (PubMed Search)

Posted: 6/23/2011 by Bryan Hayes, PharmD (Emailed: 7/14/2011) (Updated: 7/14/2011)
Click here to contact Bryan Hayes, PharmD

Levamisole is an antihelminthic agent used in humans to treat certain parasitic infections and cancers.  It is more commonly used for veterinary purposes.  It has recently seen increasing use as a cutting agent for cocaine and heroin, found in up to 70% of cocaine sample seized by the DEA.  It adds bulk and weight to powdered cocaine and is even theorized to increase the stimulant effects.

Toxicity of levamisole includes agranulocytosis and vasculitis (see attached document for recent image from NEJM).

Trivia: Levamisole was found in DJ AM and Andrew Koppel (Ted Koppel’s son), who both died of drug overdoses.


  • Zhu NY, et al. Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Intern Med 2009;150(4):287.
  • Centers for Disease Control and Prevention (CDC). Agranulocytosis associated with cocaine use - four States, March 2008-November 2009. MMWR Morb Mortal Wkly Rep 2009;58(49):1381.
  • Muirhead TT, et al. Toxic effects of levamisole in a cocaine user. N Engl J Med 2011;364:e52.


1106231638_levamisole.doc (526 Kb)