Levamisole 50 Mg Medically reviewed by Sanjay Gangani, B.Pharm, CMO & Pharmacist
Active Ingredient Levamisole Indication Worm infections Manufacturer Glowderma Lab Ltd Strength:- 50 mg Packaging 10 x 10 Tablets / Box Dosage Form:- Tablet Country of Origin India
INQUIRE ABOUT Levamisole 50 Mg
What is Levamisole 50 Mg Levamisole 50 is an oral tablet containing levamisole hydrochloride 50 mg.
Levamisole is unusual: it has two entirely separate actions.
First, it paralyses certain intestinal worms, so the body expels them.
Second, at low doses it modifies the immune system.
These two actions are used for two completely different purposes.
It is a prescription-only medicine.
Levamisole 150 mg can destroy the white cells that fight infection.
This reaction is called agranulocytosis.
It is unpredictable, and it can be fatal.
It is the reason the drug was withdrawn from human use in Western markets.
Anyone on long-term levamisole needs regular blood counts.
Any fever, mouth ulcer or sore throat during treatment is urgent.
A single-dose worm treatment carries a far smaller risk than months of therapy.
Important point about regulatory status Levamisole was marketed for human use in the USA as Ergamisol.
It was withdrawn there in 2000, principally because of agranulocytosis.
It was also withdrawn in Canada, the UK and most of Europe.
It remains very widely used in veterinary medicine worldwide.
It remains licensed for human use in India and some other countries.
In the UK, 50 mg tablets are now obtained only as an unlicensed special order.
They are used there by paediatric nephrologists for nephrotic syndrome.
The evidence for that specific use is genuinely good.
The withdrawal reflected the risk-benefit balance of its broader uses.
How It Works (Mechanism of Action) As an antiworm drug Nematode muscle cells carry nicotinic acetylcholine receptors.
Levamisole binds and activates a specific subtype of those receptors.
The receptor opens and positive ions flood into the muscle cell.
The cell depolarises and cannot reset.
This causes a sustained, continuous muscle contraction.
The worm becomes rigidly paralysed, not killed.
It can no longer hold its position in the gut.
Normal intestinal movement then expels the paralysed worm.
Levamisole also inhibits the worm enzyme fumarate reductase.
That blocks the worm’s energy production.
As an immunomodulator At low doses levamisole acts on T-lymphocytes.
It restores depressed T-cell function towards normal.
It increases T-cell proliferation and interleukin-2 production.
It stimulates monocyte and macrophage activity.
It improves neutrophil movement towards infection (chemotaxis).
It enhances phagocytosis, the engulfing of microbes.
Its action has been compared to that of a thymic hormone.
It appears to normalise an immune system that is out of balance.
In nephrotic syndrome it is also thought to act on podocytes.
It may increase glucocorticoid receptor expression in those cells.
That would make the kidney more responsive to a lower steroid dose.
Key pharmacokinetic points Absorption from the gut is rapid and nearly complete.
Peak blood levels occur within about 1.5 to 2 hours.
The half-life is short, about 3 to 6 hours.
It is extensively metabolised by the liver.
Metabolites are excreted mainly in the urine.
The short half-life is why alternate-day dosing is used for immune effects.
A single dose is enough to paralyse worms because the effect is immediate.
In nephrotic syndrome it is not a quick fix.
The aim is fewer relapses over a year, not immediate remission.
Dosage Guide Worm infections Infection Group Dose Ascariasis (roundworm) Adults 150 mg as a single dose Ascariasis Children 2.5 to 3 mg per kg as a single dose Hookworm Adults 150 mg single dose, repeated after 7 days Hookworm Children 2.5 mg per kg single dose, repeated after 7 days Heavy or mixed infection All A second course after 7 days, as directed
Childhood nephrotic syndrome Parameter Detail Dose 2 to 2.5 mg per kg body weight Frequency On alternate days , once in the morningMaximum Usually 150 mg per dose Duration Commonly 12 to 24 months Steroid dose Tapered in parallel, as directed by the nephrologist Review Regular clinic review with urine and blood tests
Dosing in special groups Group Guidance Children under 1 year Data are limited. Specialist decision only. Pregnancy Avoid. Safety has not been established. Breastfeeding Avoid. Liver disease Avoid in active liver disease. Monitor closely otherwise. Kidney disease Used in nephrotic syndrome, but monitor. Pre-existing low white cell count Contraindicated. Anyone using cocaine Contraindicated in practice. Compounds the risk. Older adults Limited data. Use with caution and monitor.
Missed dose & Overdose If remembered the following day, take it then and resume alternate days.
Never take two doses together.
Never take it on two consecutive days to catch up.
Tell the clinic if several doses are missed.
Overdose causes nausea, vomiting, abdominal pain and diarrhoea.
Dizziness, headache and confusion follow.
Convulsions can occur, particularly in children.
A cholinergic picture may develop: sweating, salivation, slow pulse.
Fatal overdoses have occurred, including with veterinary preparations.
There is no specific antidote. Treatment is supportive.
Atropine may be used by a doctor for cholinergic features.
Seek emergency care immediately for any suspected overdose.
4. How to Take It Swallow the tablet with water or juice.
Do not chew it.
Take it with or after food to reduce stomach upset.
For alternate-day therapy, take it in the morning.
Mark the dosing days on a calendar and tick them off.
Halve the tablet only if your doctor has told you to.
Complete the full course in nephrotic syndrome.
Do not drink alcohol while taking it.
The tablet may be crushed and mixed with yoghurt or mashed potato.
It may also be dispersed in a small amount of water.
The water will look cloudy. That is normal.
Give the whole amount, then rinse the cup and give the rinse too.
Ask the pharmacist to show you how to measure a half-tablet dose.
Use a tablet cutter rather than breaking it by hand.
Keep a written dosing chart on the fridge.
Why alcohol must be avoided Levamisole can cause a disulfiram-like reaction with alcohol.
Flushing, headache , nausea, vomiting and palpitations follow.
The reaction can be unpleasant and occasionally severe.
Avoid alcohol entirely during a course.
Avoid it for several days after the last dose.
Any fever, however mild
Any sore throat
Any mouth ulcer or gum infection
Unusual bruising or bleeding
Unusual tiredness or paleness
Any new purple, dark or blackened patch of skin
Any seizure
Precautions Absolute Contraindications Do not take levamisole 50 mg if any of the following apply.
You are allergic to levamisole.
You have a low white cell count or a low neutrophil count.
You have had agranulocytosis from any drug.
You have any blood or bone marrow disorder.
You have active liver disease.
You are pregnant, or think you may be pregnant.
You are breastfeeding.
You have had levamisole-induced vasculitis before.
You use cocaine, which is itself often adulterated with levamisole.
Conditions to Disclose to Your Doctor Tell your doctor before use if you have or have had any of the following.
Any blood disorder, anaemia or low platelet count
Any previous drug reaction affecting the blood
Liver disease, or abnormal liver blood tests
Kidney disease
Epilepsy or any seizure
Any autoimmune disease
Rheumatoid arthritis or lupus
Any vasculitis
Any skin ulcer or non-healing wound
Any recurrent infection
Thyroid disease
Any recent vaccination, or one due soon
Pregnancy, planned pregnancy or breastfeeding
Any use of cocaine or other illicit drugs
Also tell your doctor about every medicine you take, including
Warfarin or any blood thinner
Phenytoin or other epilepsy medicines
Steroid tablets
Any other drug that can lower blood counts
Chemotherapy, past or present
Methotrexate, azathioprine or any immunosuppressant
Ibuprofen or other anti-inflammatory painkillers
Herbal products
Any veterinary product in the household
Food and Drink Precautions Item Advice Reason Food with the dose Take with or after food Reduces nausea and stomach upset Alcohol Avoid entirely Disulfiram-like reaction: flushing, vomiting, palpitations Alcohol after the course Avoid for several days The reaction can persist briefly Fluids Drink normally Helps with nausea Grapefruit No specific restriction Not a significant interaction Salt (in nephrotic syndrome) Follow the nephrologist’s advice Fluid balance matters in that condition Protein (in nephrotic syndrome) Follow the dietitian’s advice Part of nephrotic syndrome care Raw or undercooked food Normal hygiene care Reinfection with worms is possible Unwashed vegetables and fruit Wash thoroughly Roundworm eggs are acquired this way
Before-Use Safety Checklist Confirm each point before starting.
A doctor has prescribed levamisole for a named condition.
I know whether this is a single dose or a long course.
I know the exact dose in milligrams and in tablets.
For alternate-day therapy, I have marked the days on a calendar.
A baseline full blood count has been done.
A baseline liver function test has been done.
I know when the next blood test is due.
I know the neutrophil count that means stopping.
I have no history of a low white cell count.
I have no active liver disease.
I am not pregnant and not breastfeeding.
My doctor knows every medicine I take.
I am not taking warfarin without close INR monitoring.
I will drink no alcohol during the course.
I know to seek help the same day for fever, sore throat or mouth ulcers.
I know to seek help for any dark or purple skin patch.
This is a human medicine, not a veterinary preparation.
The strip is sealed, undamaged and within its expiry date.
Side Effects Common side effects Side effect What to do Nausea Take with food. Usually mild. Vomiting Report if you cannot keep doses down. Abdominal pain Report if severe. Diarrhoea Keep hydrated. Report if severe. Metallic or altered taste Harmless. Usually settles. Headache Usually mild. Report if persistent. Dizziness Avoid driving until it passes. Tiredness Report if marked. May signal a low blood count. Insomnia Take the dose in the morning. Muscle or joint aches Report if persistent. Flu-like symptoms Report the same day. May signal a blood reaction.
Serious side effects Side effect Frequency What to do Agranulocytosis (severe loss of neutrophils)Uncommon but defining Medical emergency. Stop and seek care.Neutropenia Uncommon Blood test. Stop if below threshold. Leukopenia Uncommon Blood test monitoring. Thrombocytopenia (low platelets) Uncommon Report bruising or bleeding. Anaemia Uncommon Report tiredness and paleness. ANCA-positive vasculitis Rare Medical emergency. See below. Skin necrosis, especially ears and nose Rare Medical emergency. Purpura or retiform purple rash Rare Medical emergency. Leukoencephalopathy Very rare Medical emergency. See below. Seizures Rare Medical emergency. Raised liver enzymes Uncommon Blood test monitoring. Hepatitis Rare Stop and seek review. Lichenoid or fixed drug eruption Uncommon Stop and contact your doctor. Rash or urticaria Uncommon Stop and contact your doctor. Angioedema Rare Medical emergency. Disulfiram-like reaction with alcohol If alcohol is taken Avoid alcohol. Confusion or disorientation Rare Stop and seek review. Peripheral neuropathy Rare Report numbness or tingling.
Agranulocytosis in detail Neutrophils are the white cells that fight bacterial infection.
Levamisole can cause the body to destroy them, through an immune reaction.
The reaction is idiosyncratic: it cannot be predicted from the dose.
It usually appears within weeks to a few months of starting.
It can also appear later.
With no neutrophils, a minor infection can become overwhelming in hours.
The first signs are fever, sore throat and mouth ulcers.
There is no warning in how the person feels beforehand.
This is why scheduled blood counts exist.
It usually reverses within one to three weeks of stopping the drug.
Levamisole must never be restarted after it has happened.
Levamisole-induced vasculopathy Levamisole can trigger antibodies that attack blood vessel walls.
Small vessels in the skin become inflamed and block.
The skin above them dies, leaving purple then black patches.
The ears, nose, cheeks and limbs are classically affected.
It is often accompanied by a low white cell count.
Blood tests show ANCA antibodies, often with other autoantibodies.
It is well described in people using levamisole-adulterated cocaine.
It can also occur with prescribed levamisole.
Any new purple or blackening skin lesion needs same-day assessment.
Leukoencephalopathy This is a rare inflammatory condition of the brain’s white matter.
It presents with confusion, unsteadiness, weakness or speech change.
It has been reported weeks to months after starting levamisole.
It needs urgent neurological assessment and brain imaging.
It is treated by stopping the drug, often with steroids.
Drug Interactions – Avoid With Important interactions Drug or group Interaction Warfarin and other coumarins Levamisole increases the anticoagulant effect; INR rises and bleeding has occurred. Monitor INR closely. Phenytoin Levamisole raises phenytoin blood levels, risking toxicity. Monitor levels. Alcohol Disulfiram-like reaction: flushing, vomiting, palpitations. Avoid.
Other points Drug or group Note Corticosteroids Standard combination in nephrotic syndrome; the steroid is tapered Ibuprofen and other NSAIDs Avoid in children with kidney disease; discuss with the nephrologist Live vaccines Discuss with the specialist before any vaccination Other anthelmintics Do not combine without advice Veterinary levamisole products Never use for a person, at any dose
Why the warfarin interaction matters especially Levamisole raises the INR, sometimes markedly.
Bleeding events have been reported.
Anyone on warfarin needs INR checks within days of starting levamisole.
They also need checks after stopping it.
Do not assume a stable dose will remain stable.
8. Emergency Warning Signs Stop the tablet and get medical help the same day if any of these occur.
Fever, chills or shaking
Severe sore throat
Mouth ulcers, or bleeding gums
Any skin or wound infection
Unusual bruising, or bleeding from the nose or gums
Unusual paleness with tiredness and breathlessness
A new purple, dark red or black patch of skin
A painful skin ulcer, especially on the ear, nose or limb
A seizure
Confusion, unsteadiness, weakness or slurred speech
Numbness or tingling in the hands or feet
Yellowing of the skin or eyes
Severe abdominal pain
Swelling of the lips, tongue, face or throat
Widespread rash with blistering
Sweating, drooling and a very slow pulse
Why fever is the critical symptom Fever on levamisole may mean the neutrophils have collapsed.
A person with no neutrophils can deteriorate within hours.
The fever may be the only sign at first.
Do not treat it at home with paracetamol and wait.
Go to a doctor the same day and say you are taking levamisole.
Ask specifically for an urgent full blood count.
Carry a note or card saying you take levamisole.
It may be the first sign of levamisole-induced vasculitis.
The affected skin can progress to full-thickness necrosis.
Early recognition and stopping the drug limit the damage.
Photograph the lesion and show it to the doctor.
Do not wait for it to spread.
Why Choose This Medicine What levamisole offers as an antiworm drug:
A single oral dose clears most roundworm infections
It works within a day or two
It is extremely cheap, which matters in mass treatment programmes
It needs no refrigeration and has a long shelf life
It is well tolerated as a single dose
A single dose carries very little of the blood-count risk that long courses do
It has a long record of use in community deworming
What levamisole offers in childhood nephrotic syndrome:
It is a genuine steroid-sparing agent, supported by randomised trial evidence
It reduces the relapse rate in frequently relapsing disease
It allows the maintenance steroid dose to be reduced or stopped
That avoids growth suppression, bone loss and Cushingoid features in children
It is taken by mouth, on alternate days, with no injections
It is far cheaper than ciclosporin, tacrolimus or rituximab
It avoids the kidney toxicity of calcineurin inhibitors
It avoids the infertility and cancer concerns of cyclophosphamide
Tolerability is generally good when blood counts are monitored
For many families worldwide it is the only affordable steroid-sparing option
What to weigh before choosing it:
It can cause agranulocytosis, which can be fatal.
That risk is why it was withdrawn from human use in most of the West.
Long-term use requires scheduled blood counts, not occasional ones.
It can cause a destructive skin vasculitis.
It can rarely cause an inflammatory brain condition.
It interacts importantly with warfarin and phenytoin.
It causes a disulfiram-like reaction with alcohol.
It must be avoided in pregnancy and breastfeeding.
It is contraindicated in anyone using cocaine.
It does not cover tapeworm, pinworm or whipworm.
Albendazole or mebendazole cover a broader range of worms.
Veterinary levamisole products must never be used for people.
Storage Instructions Store below 25 °C in a dry place.
Confirm the figure printed on your own carton.
Keep the tablets in their original blister strip until use.
Protect from light, heat and moisture.
Do not store in a bathroom cabinet.
Do not refrigerate or freeze.
Keep out of the sight and reach of children.
A child who swallows these tablets may have a seizure. Seek urgent care.
Keep human and veterinary products completely separate in the home.
Do not use after the printed expiry date.
A long alternate-day course spans several strips, so check each one.
Do not use if the strip is torn, swollen or tampered with.
Do not use a tablet that is cracked, discoloured or crumbling.
Keep the dosing calendar and blood test schedule with the pack.
Return unused or expired tablets to a pharmacy for disposal.
Do not flush them or put them in household waste.
Sanjay Gangani
B.Pharm, CMO & Pharmacist
Licensed pharmacist (B.Pharm) with 12+ years in clinical pharmacy and patient care. Reviews every article for evidence-based accuracy before it is published on ACTIZA Store.
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