1
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Willems R, You SJ, Vollmer F, Hattingen E, Weidauer S. Toxic Leukoencephalopathy due to Suspected Levamisole-adulterated Cocaine. Clin Neuroradiol 2024; 34:503-506. [PMID: 37962601 PMCID: PMC11130053 DOI: 10.1007/s00062-023-01358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Rafael Willems
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
| | - Se-Jong You
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Friederike Vollmer
- Clinic of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stefan Weidauer
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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2
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Paz-Ramos MI, Violante-Soria V, Browne T, Cruz SL. Effects of fentanyl and the adulterant levamisole on the rewarding and locomotor effects of methamphetamine in rats. Drug Alcohol Depend 2024; 256:111098. [PMID: 38266573 DOI: 10.1016/j.drugalcdep.2024.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND People who use psychostimulant substances can be exposed to unknown adulterants, such as the synthetic opioid fentanyl (FEN) and the anthelmintic cholinergic agent levamisole (LEV). This work explores the rewarding and locomotor effects of methamphetamine (METH) in combination with FEN or LEV. METHODS We used adult male Wistar rats in the conditioned-place preference (CPP) paradigm (conditioning, extinction, and reinstatement phases) and in the open field test to study effective doses of METH, FEN, or LEV, or ineffective doses of METH+FEN or METH+LEV in combination. RESULTS METH and LEV, at 1mg/kg METH each, and 30µg/kg FEN produced CPP. Extinction to METH- or LEV-induced CPP occurred after eight saline injections, but it took 8-26 sessions to extinguish FEN-induced CPP. A challenge dose of 0.5mg/kg METH reinstated CPP. The same occurred with 15µg/kg FEN but not with 0.5 or 1mg/kg LEV. Training animals with ineffective doses of METH (0.01mg/kg) combined with either FEN (0.3µg/kg) or LEV (0.01mg/kg) produced CPP. Sub-effective doses of METH or FEN alone did not induce reinstatement after extinction. However, animals challenged with LEV, METH+FEN, or METH+LEV mixtures did it. Combining FEN (3µg/kg) with 0.1mg/kg METH increased locomotor activity. CONCLUSION Ineffective FEN and LEV doses mixed with METH produce effects larger than would be expected based on the effects of either drug alone. This outcome suggests a supra-additive interaction, which could increase the risk of developing a METH use disorder.
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Affiliation(s)
| | | | - Thom Browne
- Colombo Plan Secretariat, Drug Advisory Program, Colombo, Sri Lanka
| | - Silvia L Cruz
- Center for Research and Advanced Studies, Mexico City, Mexico.
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3
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Attia KAM, El-Desouky EA, Abdelfatah AM, Abdelshafi NA. Simultaneous analysis of the of levamisole with triclabendazole in pharmaceuticals through developing TLC and HPLC-PDA chromatographic techniques and their greenness assessment using GAPI and AGREE methods. BMC Chem 2023; 17:163. [PMID: 37996961 PMCID: PMC10668390 DOI: 10.1186/s13065-023-01087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Two simple and rapid chromatographic methods were developed and validated for the analysis of levamisole and triclabendazole simultaneously in pure and pharmaceutical products. The first method is thin-layer chromatography (TLC) with densitometry, and the second method is high-performance liquid chromatography with PDA detection (HPLC-PDA). A Hypersil BDS C18 column with dimensions of 4.6 × 150 mm and a particle size of 5 µm was used in the HPLC-PDA method. An isocratic condition was used to carry out the separation, and the mobile phase was made up of acetonitrile and a 0.03 M potassium dihydrogen phosphate buffer in double-distilled water. The ratio of the mobile phase preparation was 70:30 (v/v), and the flow rate was 1 mL/min. A wavelength of 215 nm was employed for analyte detection. Precoated silica gel 60 F254 aluminium plates were used for the TLC method's separation. Mobile phase was made of ethyl acetate, hexane, methanol, and ammonia (69:15:15:1) for the separation. The detection wavelength selected was 215 nm. According to the International Council for Harmonization (ICH) guidelines, the proposed methods were validated and it was found that the two chromatographic methods are accurate, precise, and linear for both compounds in the range of 3.75-37.5 and 6-60 mg/L for the HPLC method for levamisole and triclabendazole, respectively and in the range of 2-14 µg/spot for the TLC method. The developed methods greenness profile was assessed using AGREE and ComplexGAPI tools.
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Affiliation(s)
- Khalid A M Attia
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, 11751, Egypt
| | - Ebrahim A El-Desouky
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, 11751, Egypt
| | - Amr M Abdelfatah
- Department of Pharmaceutical Analytical Chemistry, School of Pharmacy, Badr University in Cairo, Badr City, Cairo, 11829, Egypt.
| | - Nahla A Abdelshafi
- Department of Pharmaceutical Analytical Chemistry, School of Pharmacy, Badr University in Cairo, Badr City, Cairo, 11829, Egypt.
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4
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Hamad AA. Facile utility of felumin, a biological dye for the first fluorimetric determination of l-tetramisole drug through an "on-off fluorescence" strategy. RSC Adv 2023; 13:9361-9369. [PMID: 36959881 PMCID: PMC10029856 DOI: 10.1039/d2ra08183k] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
l-Tetramisole is an anti-nematode and immunomodulating agent employed medically to treat diseases caused by worms. It is also used as an immune system-modifying agent in rheumatoid arthritis and as assistant therapy in treating cancers in the colorectal, head, and neck regions. Felumin is a safe food dye used in feed additives, flavors, biostaining, and recently, in analytical tracking. This is the first innovative spectrofluorimetric approach to l-Tetramisole drug analysis. It is both efficient and environmentally benign and was evaluated and validated in this investigation using a green, one-pot, and direct spectrofluorimetric technique. Instant complexes were created by combining l-Tetramisole and Felumin in an acidic solution. The fluorometric investigation was performed based on the off-effect strategy of l-Tetramisole on the emission amplitude of a biological dye (Felumin) at 557.5 nm. The linear range was from 0.1 to 1.7 μg mL-1, with sensitivity limits of 0.020 and 0.061 μg mL-1, respectively. Analytical modulation of l-Tetramisole-Felumin complexes was done for all system parameters. The system was found to meet ICH criteria. Moreover, this technique successfully recovered the substance in the prescribed medicinal dosage forms. The created fluorimetric technique was also successfully employed to track the drug of interest in human biofluids, which was a major accomplishment. The kinetics of the reaction system was also studied further. Finally, the proposed method's environmental friendliness was evaluated on the eco-scale.
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Affiliation(s)
- Ahmed Abdulhafez Hamad
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University, Assiut Branch Assiut 71524 Egypt
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5
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Hamad AA, Haredy AM. Designing a unique molecular size-dependent approach for determining levamisole via synergizing Rayleigh Scattering response of Cilefa Pink B dye; Application to bulk, dosage forms, and biofluids; method greenness evaluation. TALANTA OPEN 2023. [DOI: 10.1016/j.talo.2023.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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6
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Ruiz‐Quiñonez AK, Espinosa‐Riquer ZP, Carranza‐Aguilar CJ, Browne T, Cruz SL. Co-administration of morphine and levamisole increases death risk, produces neutropenia and modifies antinociception in mice. Addict Biol 2022; 27:e13166. [PMID: 35470549 DOI: 10.1111/adb.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
Levamisole is a veterinary anthelmintic drug and a common adulterant of misused drugs. This study analyses the lethal, antinociceptive and haematological effects produced by acute or repeated levamisole administration by itself or combined with morphine. Independent groups of male Swiss Webster mice were i.p. injected with 100 mg/kg morphine, 31.6 mg/kg levamisole (lethal doses at 10%, LD10 ) or the same doses combined. Naloxone pretreatment (10 mg/kg, i.p.) prevented morphine-induced death, as did 2.5 mg/kg, i.p. mecamylamine with levamisole. Co-administration of levamisole and morphine (Lvm + Mor) increased lethality from 10% to 80%. This augmented effect was prevented by 30 mg/kg, i.p. naloxone and reduced with 10 mg/kg naloxone plus 2.5 mg/kg, i.p. mecamylamine. In independent groups of mice, 17.7 mg/kg, i.p. levamisole antagonized the acute morphine's antinociceptive effect evaluated in the tail-flick test. Repeated 17.7 mg/kg levamisole administration (2×/day/3 weeks) did not affect tolerance development to morphine (10 mg/kg, 3×/day/1 week). Blood samples obtained from mice repeatedly treated with levamisole showed leukopenia and neutropenia. Morphine also produced neutropenia, increased erythrocyte count and other related parameters (e.g. haemoglobin). Lvm + Mor had similar effects on leukocyte and neutrophil counts to those seen with levamisole only, but no erythrocyte-related alterations were evident. Blood chemistry analysis did not indicate liver damage but suggested some degree of electrolyte balance impairment. In conclusion, Lvm + Mor increased death risk, altered morphine-induced antinociceptive effects and produced haematologic abnormalities. The importance of studying combinations of drugs of abuse lies in the fact that drug users frequently combine drugs, which are commonly adulterated.
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Affiliation(s)
- Ana K. Ruiz‐Quiñonez
- Departamento de Farmacobiología Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN) Mexico City Mexico
| | - Zyanya P. Espinosa‐Riquer
- Departamento de Farmacobiología Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN) Mexico City Mexico
| | - César J. Carranza‐Aguilar
- Departamento de Farmacobiología Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN) Mexico City Mexico
| | - Thom Browne
- Colombo Plan Secretariat Drug Advisory Program Colombo Sri Lanka
| | - Silvia L. Cruz
- Departamento de Farmacobiología Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN) Mexico City Mexico
- Faculty of Medicine National Autonomous University of Mexico Mexico City Mexico
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7
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Losacker M, Hundertmark M, Zoerntlein S, Roehrich J, Hess C. Chiral pharmacokinetics of tetramisole stereoisomers – enantioselective quantification of levamisole and dexamisole in serum samples from users of adulterated cocaine. Drug Test Anal 2022; 14:1053-1064. [DOI: 10.1002/dta.3227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Moritz Losacker
- Department of Forensic Toxicology Institute of Legal Medicine, University Medical Center Mainz Mainz Germany
| | - Marica Hundertmark
- Department of Forensic Toxicology Institute of Legal Medicine, University Medical Center Mainz Mainz Germany
| | - Siegfried Zoerntlein
- Forensic Science Institute, Dez. 33 Chemistry/Toxicology, State Office of Criminal Investigation Rhineland‐Palatinate Mainz Germany
| | - Joerg Roehrich
- Department of Forensic Toxicology Institute of Legal Medicine, University Medical Center Mainz Mainz Germany
| | - Cornelius Hess
- Department of Forensic Toxicology Institute of Legal Medicine, University Medical Center Mainz Mainz Germany
- Reference Institute for Bioanalytics Bonn Germany
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8
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Midthun KM, Nelson LS, Logan BK. Levamisole-a Toxic Adulterant in Illicit Drug Preparations: a Review. Ther Drug Monit 2021; 43:221-228. [PMID: 33298746 DOI: 10.1097/ftd.0000000000000851] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
ABSTRACT Discovered in the 1960s, the common anthelminthic levamisole has seen widespread use in veterinary applications. Its use rapidly expanded thereafter to include human medical treatments for a variety of acute and chronic disorders. Because of reports of severe adverse effects, the US Food and Drug Administration withdrew levamisole's approval for human use in 2000; however, medical options outside the United States and illicit options worldwide allow continued accessibility to levamisole. The compound is rapidly metabolized in the body, with at least 2 known active metabolites. Levamisole has a broad range of immunomodulatory effects, including both stimulatory and inhibitory effects on immune responses. It is generally well tolerated at therapeutic concentrations, although a variety of autoimmune-related adverse effects have been reported, including agranulocytosis, leukopenia, purpura, and visible necrotized skin tissue. Individuals with levamisole-compromised immune systems are more susceptible to infections, including COVID-19. Since the early 2000's, levamisole has been frequently used as an adulterating agent in illicit street drugs, especially cocaine, fentanyl, and heroin. Although its prevalence has varied over time and geographically, levamisole has been detected in up to 79% of the street supply of cocaine at levels up to 74% by weight. Its presence in illicit drug markets also raises concern over the potential for exposure of children and neonates, although this is supported by only limited anecdotal evidence. Levamisole is not currently included in routine drug testing panels, although a variety of confirmatory testing techniques exist across a range of antemortem and postmortem specimen options. Because of its varying presence in illicit drug markets, both the medical and forensic communities need to be aware of levamisole and its potential impact on toxicological investigations.
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Affiliation(s)
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | - Barry K Logan
- NMS Labs, Horsham, Pennsylvania
- Center for Forensic Science Research and Education (CFSRE) at the Fredric Rieders Family Foundation, Willow Grove, Pennsylvania
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9
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Lelièvre B, Suply B, Schmitt F, Marcorelles P, Drevin G, Maillart CR. A fatal case after an intravenous injection of levamisole. Forensic Sci Med Pathol 2020; 17:130-135. [PMID: 33180273 DOI: 10.1007/s12024-020-00336-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
Levamisole is a drug originally prescribed as an antihelmintic. Because of the occurrence of severe cases of agranulocytosis and leukoencephalitis it was removed from the French market in 1998 for human use, while it remains available for veterinary use. Nowadays in France its only use in humans is regulated by authorization for temporary use for its immunomodulatory properties in the treatment of nephritic syndrome.A 52-year-old man was found dead at his farm. Injection points were observed on his arm and a syringe containing a dark orange-brown liquid was found near the body. At his home, the discovery of a letter highlighted suicidal intent. Analysis of the aforementioned liquid, peripheral blood and urine confirmed the unique presence of levamisole. The femoral blood concentration of levamisole was of 25 mg/L whereas the femoral blood concentrations reported in cases of fatalities after cocaine use do not exceed 0.0056 mg/L. In humans, levamisole can be detected in biological samples after cocaine use as this drug is also an adulterant and one of its metabolites (aminorex) seems to have amphetamine-like properties. In this case, the man consumed levamisole from time to time for its stimulant and strengthening effects.Cases of fatal poisoning using levamisole are very rare and poorly documented, which makes the interpretation of postmortem blood levamisole concentration difficult.
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Affiliation(s)
- Bénédicte Lelièvre
- Pharmacology-Toxicology Laboratory, CHU Angers, 49933, Angers, France. .,Groupe d'Etude Des Interactions Hôte-Pathogène, UNIV Angers, UNIV Brest, Institut de Biologie en Santé-IRIS, (EA 3142) SFR ICAT 4208 , Angers, France.
| | - Benoit Suply
- Forensic Unit of CHU Brest, Antenne GHBS Lorient, Lorient, France
| | | | | | - Guillaume Drevin
- Pharmacology-Toxicology Laboratory, CHU Angers, 49933, Angers, France
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10
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Effects of cocaine and levamisole (as adulterant) on the isolated perfused Langendorff heart. Int J Legal Med 2020; 134:1741-1752. [PMID: 32377925 PMCID: PMC7417403 DOI: 10.1007/s00414-020-02300-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/14/2020] [Indexed: 01/09/2023]
Abstract
Cocaine-related deaths occur regularly in forensic routine work. In cases in which the detected concentration of cocaine is rather low and other causes of death apart from intoxication can be ruled out, the question arises if adulterants of cocaine might have played a crucial role. In the present study, cardiac effects of cocaine, of the adulterant levamisole and of mixtures of both were evaluated using the isolated perfused Langendorff heart. While exposed to the substances, functional parameters heart rate, left ventricular pressure and coronary flow were documented. Relevant alterations of these parameters were found for cocaine as well as for levamisole. Exposing the hearts to a mixture of both resulted in a combination of these effects; the emergence of new alterations or an obvious aggravation were not detected. Nevertheless, the results imply that the consumption of cocaine adulterated with levamisole bares an increased risk for cardiac complications, especially in the presence of preexisting cardiac pathologies.
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11
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Handley SA, Belsey SL, Couchman L, Flanagan RJ. Plasma and Urine Levamisole in Clinical Samples Containing Benzoylecgonine: Absence of Aminorex. J Anal Toxicol 2019; 43:299-306. [PMID: 30590551 DOI: 10.1093/jat/bky102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/24/2018] [Accepted: 12/01/2018] [Indexed: 11/13/2022] Open
Abstract
Aminorex has been reported as a metabolite of levamisole in man, but data on the aminorex concentrations in clinical samples are scant. We thus measured levamisole, aminorex and benzoylecgonine in urine, and levamisole and aminorex in plasma using achiral liquid chromatography-high resolution mass spectrometry. Centrifuged urine (50 μL) was diluted with LC eluent containing internal standard (benzoylecgonine-D3, 25 μg/L) (450 μL). For plasma, sample (200 μL) and Tris solution (2 mol/L, pH 10.6, 100 μL) were added to a 60.5 × 7.5 mm i.d. glass test tube. Internal standard solution (ketamine-D4, 200 μg/L) (10 μL) was added and the tube contents vortex-mixed (5 s). Butyl acetate:butanol (9 + 1, v/v; 200 μL) was added and after vortex-mixing (30 s) and centrifugation (13,680 × g, 4 min), the extract was evaporated to dryness and reconstituted in 10 mmol/L aqueous ammonium formate containing 0.1% (v/v) formic acid (150 μL). Prepared samples and extracts (100 μL) were analyzed using an AccucoreTM Phenyl-Hexyl column (2.6 mm a.p.s., 100 × 2.1 mm i.d.) maintained at 40°C. MS detection was in positive mode using heated electrospray ionization (ThermoFisher Q-ExactiveTM). Intra- and inter-assay accuracy and precision were ±20%, and ≤11%, respectively, for all analytes in both matrices. Lower limits of quantitation were 0.1 and 1 μg/L (all analytes) in plasma and urine, respectively. Of 100 consecutive urine samples submitted for drugs of abuse screening containing benzoylecgonine, levamisole was detected in 72 (median 565, range 4-72,970 μg/L). Levamisole was also measured in eight plasma samples (median 10.6, range 0.9-64.1 μg/L). A number of metabolites of levamisole (4-hydroxylevamisole, levamisole sulfoxide, levamisole glucuronide, and hydroxylevamisole glucuronide) were tentatively identified in urine. Neither aminorex, nor any of its reported metabolites were detected in any sample.
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Affiliation(s)
- S A Handley
- Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - S L Belsey
- Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - L Couchman
- Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - R J Flanagan
- Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
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12
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Stefano JS, Dias AC, Arantes IVS, Costa BMC, Silva LAJ, Richter EM, Banks CE, Munoz RAA. Batch‐Injection Amperometric Analysis on Screen‐Printed Electrodes: Analytical System for High‐Throughput Determination of Pharmaceutical Molecules. ELECTROANAL 2018. [DOI: 10.1002/elan.201800725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Jéssica S. Stefano
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
| | - Aline C. Dias
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
| | - Iana V. S. Arantes
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
| | - Brenda M. C. Costa
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
| | - Luiz A. J. Silva
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
| | - Eduardo M. Richter
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
| | - Craig E. Banks
- Faculty of Science and EngineeringManchester Metropolitan University ce Manchester M1 5GD UK
| | - Rodrigo A. A. Munoz
- Instituto de QuímicaUniversidade Federal de Uberlândia Av. João Naves de Ávila, 2121 38408100 Uberlândia, MG Brazil
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13
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Abstract
Aminorex (5-phenyl-4,5-dihydro-1,3-oxazol-2-amine) and 4-methylaminorex (4-methyl-5-phenyl-4,5-dihydro-1,3-oxazol-2-amine) are psychostimulants that have long been listed in Schedules IV and I of the UN Convention on Psychotropic Substances of 1971. However, a range of psychoactive analogues exist that are not internationally controlled and therefore often classified as new psychoactive substances (NPS). Aminorex analogues encompass failed pharmaceuticals that reemerged as drugs of abuse, and newly synthesized substances that were solely designed for recreational use by clandestine chemists. NPS, sometimes also referred to as "designer drugs" in alignment with a phenomenon arising in the early 1980s, serve as alternatives to controlled drugs. Aminorex and its derivatives interact with monoaminergic neurotransmission by interfering with the function of monoamine transporters. Hence, these compounds share pharmacological and neurochemical similarities with amphetamines and cocaine. The consumption of aminorex, 4-methylaminorex and 4,4'-dimethylaminorex (4-methyl-5-(4-methylphenyl)-4,5-dihydro-1,3-oxazol-2-amine) has been associated with adverse events including death, bestowing an inglorious fame on aminorex-derived drugs. In this Review, a historical background is presented, as well as an account of the pharmacodynamic and pharmacokinetic properties of aminorex and various analogues. Light is shed on their misuse as drug adulterants of well-established drugs on the market. This Review not only provides a detailed overview of an abused substance-class, but also emphasizes the darkest aspect of the NPS market, i.e., deleterious side effects that arise from the ingestion of certain NPS, as knowledge of the pharmacology, the potency, or the identity of the active ingredients remains obscure to NPS users.
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Affiliation(s)
- Julian Maier
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| | - Felix P. Mayer
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| | - Simon D. Brandt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Harald H. Sitte
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
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14
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Kunzler D, Lagrimas L, Vo T, DeCrescenzo A, Kaltwasser K, Wilson J. Antineutrophil cytoplasmic antibodies negative levamisole-induced leukocytoclastic vasculitis: a presumed case and literature review. Int J Dermatol 2018; 57:1411-1416. [DOI: 10.1111/ijd.14249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/17/2018] [Accepted: 08/31/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel Kunzler
- School of Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Lauren Lagrimas
- School of Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Thiennga Vo
- School of Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Andrew DeCrescenzo
- Department of Internal Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Kyle Kaltwasser
- Department of Dermatology; University of Texas Medical Branch; Galveston TX USA
| | - Janice Wilson
- Department of Dermatology; University of Texas Medical Branch; Galveston TX USA
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15
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Scherer JN, Fiorentin TR, Sousa TRV, Limberger RP, Pechansky F. Oral Fluid Testing for Cocaine: Analytical Evaluation of Two Point-of-Collection Drug Screening Devices. J Anal Toxicol 2017; 41:392-398. [PMID: 28334841 DOI: 10.1093/jat/bkx018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/13/2017] [Indexed: 12/19/2022] Open
Abstract
The use of point-of-collection testing (POCT) devices for drugs of abuse in oral fluid (OF) is an advantageous tool that has been used for different purposes-particularly traffic enforcement. However, even with the widespread report of cocaine consumption, the reliability of POCT devices has been reported in different magnitudes. This study evaluated the reliability of two POCT devices for the detection of cocaine in OF samples of 110 cocaine users: (i) the DDS2™ (cutoff = 30 ng/mL) and (ii) the Multi-Drugs Multi-Line-Twist Screen Test Device™ (MDML) (cutoff = 20 ng/mL). Results of the screening tests were compared with a Liquid Chromatography-Mass Spectrometry (LC-MS) assay. Sensitivity, specificity and accuracy of DDS2™ were 100, 77.77 and 80% when compared with LC-MS with a cutoff of 30 ng/mL, and 88.89, 89.15 and 89.09% with a cutoff of 10 ng/mL. The MDML™ device achieved sensitivity, specificity and accuracy of 100, 65.6 and 70.9% when compared with LC-MS with a cutoff of 20 ng/mL, and 92.6, 71.1 and 76.6% with a cutoff of 10 ng/mL. When compared with a 10 ng/mL cutoff, the DDS2™ achieved reliability parameters higher than 80%. On the other hand, the MDML™ device did not achieve the minimal recommendation of 80% for all parameters at the same time. Taking into consideration the reliability results showed here, the authors believe that the use of these POCT devices seems to be suitable for cocaine detection in forensic tests only if all positive specimens are further confirmed by a validated method.
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Affiliation(s)
- Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research, Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020 Porto Alegre, RS, Brazil
| | - Taís Regina Fiorentin
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul, Av. Ipiranga, 2752, 90610-000 Porto Alegre, RS, Brazil
| | - Tanara Rosangela Vieira Sousa
- Center for Drug and Alcohol Research, Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020 Porto Alegre, RS, Brazil
| | - Renata Pereira Limberger
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul, Av. Ipiranga, 2752, 90610-000 Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020 Porto Alegre, RS, Brazil
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Unexpected Complication of Cocaine-Associated Anti-Neutrophil Cytoplasmic Antibody Vasculitis Related to Persistent In-Hospital Cocaine Use. J Addict Med 2017; 11:157-160. [DOI: 10.1097/adm.0000000000000290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Karch SB, Busardò FP, Vaiano F, Portelli F, Zaami S, Bertol E. Levamisole adulterated cocaine and pulmonary vasculitis: Presentation of two lethal cases and brief literature review. Forensic Sci Int 2016; 265:96-102. [DOI: 10.1016/j.forsciint.2016.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
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18
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Jamey C, Kintz P, Raul JS. Lévamisole et cocaïne : une association à surveiller. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Karch SB, Vaiano F, Bertol E. Levamisole, Aminorex, and Pulmonary Arterial Hypertension: A Review. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2015. [DOI: 10.17795/rijm28277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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20
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Eiden C, Peyrière H, Diot C, Mathieu O. Prevalence of levamisole and aminorex in patients tested positive for cocaine in a French University Hospital. Clin Toxicol (Phila) 2015; 53:604-8. [DOI: 10.3109/15563650.2015.1054499] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Kreeftmeijer-Vegter AR, Dorlo TPC, Gruppen MP, de Boer A, de Vries PJ. Population pharmacokinetics of levamisole in children with steroid-sensitive nephrotic syndrome. Br J Clin Pharmacol 2015; 80:242-52. [PMID: 25677380 DOI: 10.1111/bcp.12607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Abstract
AIM The aim was to investigate the population pharmacokinetics of levamisole in children with steroid-sensitive nephrotic syndrome. METHODS Non-linear mixed effects modelling was performed on samples collected during a randomized controlled trial. Samples were collected from children who were receiving 2.5 mg kg(-1) levamisole (or placebo) orally once every other day. One hundred and thirty-six plasma samples were collected from 38 children from India and Europe and included in the analysis. A one compartment model described the data well. RESULTS The apparent clearance rate (CL/F) and distribution volume (V/F) were 44 l h(-1) 70 kg(-1) and 236 l 70 kg(-1) , respectively; estimated interindividual variability was 32-42%. In addition to allometric scaling of CL/F and V/F to body weight, we identified a significant proportional effect of age on CL/F (-10.1% per year). The pharmacokinetics parameters were not affected by gender, tablet strength or study centre. The median (interquartile range) maximum plasma concentration of levamisole was 438.3 (316.5-621.8) ng ml(-1) , and the median area under the concentration-time curve was 2847 (2267-3761) ng ml(-1) h. Median tmax and t½ values were 1.65 (1.32-2.0) h and 2.60 (2.06-3.65) h, respectively. CONCLUSIONS Here, we present the first pharmacokinetic data regarding levamisole in children with steroid-sensitive nephrotic syndrome. The pharmacokinetic profile of levamisole in children was similar to findings reported in adults, although the elimination rate was slightly higher in children.
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Affiliation(s)
- A R Kreeftmeijer-Vegter
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, P.O. Box 80 082, 3508 TB, Utrecht, the Netherlands.,ACE Pharmaceuticals BV, Schepenveld 41, 3891, ZK, Zeewolde, the Netherlands
| | - T P C Dorlo
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, P.O. Box 80 082, 3508 TB, Utrecht, the Netherlands.,Department Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - M P Gruppen
- Department of Paediatric Nephrology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands
| | - A de Boer
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, P.O. Box 80 082, 3508 TB, Utrecht, the Netherlands
| | - P J de Vries
- ACE Pharmaceuticals BV, Schepenveld 41, 3891, ZK, Zeewolde, the Netherlands.,Department of Internal Medicine, Tergooi Ziekenhuis, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
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22
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Nowak LG, Rosay B, Czégé D, Fonta C. Tetramisole and Levamisole Suppress Neuronal Activity Independently from Their Inhibitory Action on Tissue Non-specific Alkaline Phosphatase in Mouse Cortex. Subcell Biochem 2015. [PMID: 26219715 DOI: 10.1007/978-94-017-7197-9_12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tissue non-specific alkaline phosphatase (TNAP) may be involved in the synthesis of GABA and adenosine, which are the main inhibitory neurotransmitters in cortex. We explored this putative TNAP function through electrophysiological recording (local field potential ) in slices of mouse somatosensory cortex maintained in vitro. We used tetramisole, a well documented TNAP inhibitor, to block TNAP activity. We expected that inhibiting TNAP with tetramisole would lead to an increase of neuronal response amplitude, owing to a diminished availability of GABA and/or adenosine. Instead, we found that tetramisole reduced neuronal response amplitude in a dose-dependent manner. Tetramisole also decreased axonal conduction velocity. Levamisole had identical effects. Several control experiments demonstrated that these actions of tetramisole were independent from this compound acting on TNAP. In particular, tetramisole effects were not stereo-specific and they were not mimicked by another inhibitor of TNAP, MLS-0038949. The decrease of axonal conduction velocity and preliminary intracellular data suggest that tetramisole blocks voltage-dependent sodium channels. Our results imply that levamisole or tetramisole should not be used with the sole purpose of inhibiting TNAP in living excitable cells as it will also block all processes that are activity-dependent. Our data and a review of the literature indicate that tetramisole may have at least four different targets in the nervous system. We discuss these results with respect to the neurological side effects that were observed when levamisole and tetramisole were used for medical purposes, and that may recur nowadays due to the recent use of levamisole and tetramisole as cocaine adulterants.
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Affiliation(s)
- Lionel G Nowak
- Centre de Recherche Cerveau et Cognition (CerCo), Université de Toulouse UPS; CNRS UMR 5549 , Toulouse, France,
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Brandt SD, Baumann MH, Partilla JS, Kavanagh PV, Power JD, Talbot B, Twamley B, Mahony O, O'Brien J, Elliott SP, Archer RP, Patrick J, Singh K, Dempster NM, Cosbey SH. Characterization of a novel and potentially lethal designer drug (±)-cis-para-methyl-4-methylaminorex (4,4'-DMAR, or 'Serotoni'). Drug Test Anal 2014; 6:684-95. [PMID: 24841869 DOI: 10.1002/dta.1668] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/30/2023]
Abstract
During the second half of 2013, a total of 26 deaths involving para-methyl-4-methylaminorex (4,4'-DMAR) were reported to the European Monitoring Centre for Drugs and Drug Addiction. While aminorex and 4-methylaminorex (4-MAR) are known psychostimulants, nothing is known about the comparatively new para-methyl analog. Analytical characterization of two independent samples obtained from online vendors confirmed the presence of the (±)-cis isomer that also appeared to be associated with at least 18 of the 26 deaths. Extensive characterizations included crystal structure analysis, single, tandem, and high-resolution mass spectrometry, liquid and gas chromatography, and nuclear magnetic resonance spectroscopy. For the work described here, both the (±)-cis and (±)-trans racemates were also synthesized, confirming that the differentiation between these two forms was straight-forward. Monoamine transporter activity was studied using rat brain synaptosomes which included the comparison with d-amphetamine, aminorex and (±)-cis-4-MAR. (±)-cis-4,4'-DMAR was a potent, efficacious substrate-type releaser at transporters for dopamine, norepinephrine and serotonin with EC50 values of 8.6 ± 1.1 nM (DAT), 26.9 ± 5.9 nM (NET) and 18.5 ± 2.8 nM (SERT), respectively. The potency of (±)-cis-4,4'-DMAR at DAT and NET rivalled that of other psychomotor stimulant drugs like d-amphetamine and aminorex. However, (±)-cis-4,4'-DMAR had much more potent actions at SERT and activity at SERT varied more than 100-fold across the four drugs. The potent releasing activity of (±)-cis-4,4'-DMAR at all three monoamine transporters predicts a potential for serious side-effects such as psychotic symptoms, agitation, hyperthermia and cardiovascular stimulation, especially after high-dose exposure or following combination with other psychostimulants.
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Affiliation(s)
- Simon D Brandt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
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