Levamisole — Drug Monograph
Brand names: Ergamisol
Drug class: Other
Mechanism of Action
Originally an antihelminthic agent with immunomodulatory properties. Its antitumor mechanism is thought to involve restoration/stimulation of depressed immune function — enhancing T-cell, macrophage, and neutrophil activity — rather than direct cytotoxicity. Historically used to potentiate the immune response as an adjuvant to fluorouracil chemotherapy.
FDA Indications
- Historical: adjuvant treatment of Dukes' stage C (node-positive) colon cancer in combination with fluorouracil (5-FU) after surgical resection
Common Side Effects
- Nausea/vomiting
- Diarrhea
- Dysgeusia (metallic taste)
- Fatigue
- Dermatitis/rash
- Arthralgia
Clinical Pearl
Levamisole plus 5-FU was a landmark adjuvant colon cancer regimen in the 1990s but is now obsolete — replaced by leucovorin-modulated 5-FU and oxaliplatin-containing regimens (FOLFOX/CAPOX). The oral drug was withdrawn from the U.S. market; today levamisole is more often encountered as a cocaine adulterant causing agranulocytosis and retiform purpura.