发现于1960年代,常见的抗蠕虫左旋咪唑已广泛用于兽医应用。此后,其用途迅速扩展,包括各种急性和慢性疾病的人类医学治疗。由于严重不良反应的报告,美国食品和药物管理局于2000年撤回了左旋咪唑用于人类的批准;然而,美国以外的医疗选择和世界范围内的非法选择允许左旋咪唑继续获得。这种化合物在体内迅速代谢,至少有2种已知的活性代谢物。左旋咪唑具有广泛的免疫调节作用,包括对免疫反应的刺激和抑制作用。通常在治疗浓度下耐受性良好,尽管已经报道了各种与自身免疫相关的不良反应,包括粒细胞缺乏症,白细胞减少症,紫癜,可见坏死的皮肤组织。左旋咪唑免疫系统受损的个体更容易受到感染,包括COVID-19。自2000年初以来,左旋咪唑经常被用作非法街头毒品的掺假剂,尤其是可卡因,芬太尼,和海洛因。尽管它的流行程度随着时间和地理而变化,在高达79%的街头可卡因供应中检测到左旋咪唑,其含量按重量计高达74%。它在非法药物市场的存在也引起了人们对儿童和新生儿接触的可能性的关注,尽管这只有有限的轶事证据支持。左旋咪唑目前不包括在常规药物测试小组中,尽管在一系列的死前和死后标本选项中存在多种验证性测试技术。由于它在非法药物市场上的存在各不相同,医学界和法医界都需要了解左旋咪唑及其对毒理学研究的潜在影响.
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.