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Levamisole as an adulterant in a cocaine overdose fatality

Johan A Duflou, Issabella G Brouwer and Shane Darke
Med J Aust 2010; 192 (12): . || doi: 10.5694/j.1326-5377.2010.tb03719.x
Published online: 21 June 2010

To the Editor: We present a case of fatal cocaine overdose in which the drug was contaminated with levamisole, a therapeutic agent known to cause reversible agranulocytosis.


  • 1 Department of Forensic Medicine, Sydney South West Area Health Service, Sydney, NSW.
  • 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.


Correspondence: jo.duflou@sswahs.nsw.gov.au

  • 1. Baselt RC. Disposition of toxic drugs and chemicals in man. 8th ed. Foster City, Mich: Biomedical Publications, 2008.
  • 2. Darke S, Degenhardt L, Mattick R. Mortality amongst illicit drug users: epidemiology, causes and intervention. Cambridge: Cambridge University Press, 2006.
  • 3. Centers for Disease Control and Prevention. Agranulocytosis associated with cocaine use — four states, March 2008–November 2009. MMRW Morb Mortal Wkly Rep 2009; 58: 1381-1385.
  • 4. Wiens MO, Son WK, Ross C, et al. Cocaine adulterant linked to neutropenia. CMAJ 2010; 182: 57-59.
  • 5. Zhu NY, Legatt DF, Turner AR. Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Intern Med 2009; 150: 287-289.

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