Levamisole

Levamisole is a synthetic compound derived from imidazothiazole and was originally used as an anthelmintic in veterinary medicine. Due to its immunomodulatory properties, it was also previously used in humans as an oncologic and various autoimmune diseases. In 1999, reports of severe neutropenia led to the withdrawal of the drug from the market.

About 70-80% of cocaine is "stretched" with levamisole, which is added to increase volume and stimulant properties. Levamisole is used for this purpose because it has a similar white, powdery consistency to cocaine and cannot be detected in common impurity tests such as the 'bleach test', a popular street test used to check cocaine purity. In addition, levamisole enhances the addictive effects of cocaine by acting as a nicotine antagonist and prolonging and enhancing the release of glutamate.

The spectrum of autoimmune manifestations caused by cocaine and levamisole can be summarized in three overlapping clinical pictures:

Cocaine-induced midline destructive lesions (CIMDL)

Levamisole-adulterated cocaine (LAC) vasculopathy/vasculitis

Cocaine-induced vasculitis (CIV).

Exanthema, nervousness, sleep disturbances, depression, nausea, vomiting, loss of appetite, diarrhea, constipation, stomatitis; altered perception of taste, flu-like symptoms, thrombocytopenia; agranulocytosis, myalgia or athralgia, encephalopathy-like syndromes, neurologic abnormalities, multifocal leukoencephalopathy or demyelinating processes; elevation of triglycerides and cholesterol.