Levamisole
Mechanism :
Levamisole can stimulate formation of antibodies to various antigens, enhance T-cell responses by stimulating T-cell activation and proliferation, potentiate monocyte and macrophage functions including phagocytosis and chemotaxis, and increase neutrophil mobility, adherence, and chemotaxis. Besides its immunomodulatory function, levamisole has other pharmacologic activities, including inhibition of alkaline phosphatase and cholinergic activity.
Indication :
- Roundworm infection
- Hookworm infection
- Nephrotic syndrome
Contraindications :
Levamisole hydrochloride is contraindicated in patients with a known hypersensitivity to the drug or its components, in patients with pre-existing blood disorders. Caution in rheumatoid arthritis, Sjogren syndrome, epilepsy and liver disease where dose adjustment may be necessary.
Dosing :
Oral
Roundworm (ascariasis):
<12 years:
2.5-3 mg/kg and 12-18 years 150 mg as single dose.
Hookworm (ankylostomiasis):
<12 years:
2.5 mg/kg and 12-18 years: 150 mg as single dose. Repeat after 7 days if severe infection. Adults 300 mg for 1-2 days.
Nephrotic syndrome:
2.5 mg/kg on alternate days.
Adverse Effect :
Side-effects are generally limited to nausea, vomiting, diarrhea, abdominal pain, dizziness and headache. When given for longer periods for other indications, more serious side effects including hypersensitivity reactions, hematological reactions have been reported.
Interaction :
Alcohol: Levamisole hydrochloride has been reported to produce "ANTABUSE"-like side effects when given concomitantly with alcohol.
Warfarin and Phenytoin: some evidence that levamisole can increase effects of these drugs but clinical importance uncertain.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in normal renal function |
| HD | Unknown dialysability. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
No data in humans is available. In a cirrhosis model of liver insufficiency in rats, levamisole metabolism and biliary excretion was decreased.