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Levamisole is an antihelminthic agent that was voluntarily withdrawn from the market by the manufacturer in 2000 because of toxicity, including agranulocytosis. During the last several years, this agent has been found as an adulterant in up to 70% of cocaine seized in the U.S. In a retrospective study of 95 cocaine-positive patients at a five-hospital system in Rhode Island, researchers compared hematologic characteristics between 47 patients who were levamisole positive and 48 who were levamisole negative.
Total white blood cell count, absolute neutrophil count, and absolute lymphocyte count did not differ significantly between the two groups. A post hoc literature search using the terms levamisole, cocaine, agranulocytosis, and neutropenia…