skip to main content

How to find us

Phone: 206-296-4600
TTY Relay: 711

Toll-free: 800-325-6165

Click here to email us

Instructions to submit a Public Records Request

Health advisory: Agranulocytosis Caused by Levamisole-Contaminated Cocaine

July 15, 2009

ACTION REQUESTED:

Clinicians should continue to consider agranulocytosis secondary to levamisole-contaminated cocaine when evaluating suspected or known cocaine users and other patients with agranulocytosis and infectious syndromes. Testing for levamisole is available from Harborview Medical Center, see below for details. A recent levamisole alert from Washington Poison center is attached.

Background:

Levamisole-associated agranulocytosis with serious infections and hospitalizations has been reported among cocaine users in several states, including locally. Since June, 2009, Public Health has become aware of at least three cases admitted to King County hospitals as well as cases at hospitals in Snohomish County and one earlier death in Spokane. The cost of treatment of these cases has been high.

Several of the cases had prior admissions for this potentially lethal complication of their illicit drug use, but the cause was often not recognized by clinicians or communicated to the patients. We remind you to consider this cause of neutropenic fever, and consider testing suspected cases for cocaine and levamisole. Patients with levamisole-associated neutropenia should be counseled about the potentially life-threatening danger of continued cocaine exposure, and helped to access some form of drug treatment.

Testing for levamisole: Most laboratories are NOT currently offering testing for levamisole. The toxicology lab at Harborview Medical Center (contact: Dr. Jeff Baird, pager 206-540-6630) can perform qualitative testing for levamisole in urine but testing needs to be done promptly (within 24-48 hours of use) as Levamisole has a short half-life. Clinicians should use the required lab requisition form available online from UW’s Laboratory Medicine web site to order a comprehensive urine drug screen and be sure to write on the form "look for levamisole" so the lab staff can be alert for the levamisole signal on gas chromatography/mass sprectrometry results. The UW toxicology lab requisition form is available at: http://depts.washington.edu/labweb/referencelab/clinical/forms.htm.

Please report cases of agranulocytosis in cocaine users to Public Health by calling 206-296-4774 or faxing 206-296-4803.

For more information on levamisole-associated agranulocytosis, see article from the Annals of Internal Medicine.

To subscribe to receive e-mail and/or fax health alerts from Public Health, contact Maybelle Tamura at 206-296-4774 or Maybelle.Tamura@kingcounty.gov