Aminorex poisoning in cocaine abusers

• Published in: International journal of cardiology Vol. 158; no. 3; pp. 344 - 346
• Main Authors: Karch, Steven B, Mari, Francesco, Bartolini, Viola, Bertol, Elisabetta
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 26.07.2012; Elsevier
• Subjects: aminorex; Aminorex - metabolism; Aminorex - poisoning; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiparasitic agents; Antirheumatic Agents - pharmacokinetics; Antirheumatic Agents - poisoning; Appetite Depressants - metabolism; Appetite Depressants - poisoning; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; cocaine; Cocaine-Related Disorders - epidemiology; Drug Contamination; Epidemics - statistics & numerical data; Familial Primary Pulmonary Hypertension; Humans; Hypertension, Pulmonary - chemically induced; idiopathic pulmonary hypertension; levamisole; Levamisole - pharmacokinetics; Levamisole - poisoning; Medical sciences; Pharmacology. Drug treatments; Pneumology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; cocaine; levamisole; aminorex; idiopathic pulmonary hypertension; Respiratory disease; Aminorex; Idiopathic; Levamisole; Cardiovascular disease; Parasiticide; Cocaine; Poisoning; Cardiology; Pulmonary hypertension
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2011.06.105

Abstract Levamisole is found in more than 80% of illicit cocaine seized within United States borders. Percentages are somewhat lower in Europe. In 2009, controlled in vivo studies demonstrated that horses metabolize levamisole to aminorex. Earlier this year our laboratory demonstrated that the same conversion occurs in man. Levamisole itself causes aplastic anemia and numerous reports have begun to appear in the literature, but the conversion of levamisole to aminorex is of much more concern. Aminorex ingestion was responsible for a five-year epidemic (1967–1972) of idiopathic pulmonary hypertension (IPH) confined to Switzerland, Austria, and Germany, the only countries where aminorex had been marketed as an anorectic. The incidence of IPH reverted to normal levels as soon as aminorex was withdrawn. In most cases onset of symptoms in IPH began after six to nine months of aminorex use, with average dosage ranges of 10 to 40 mg per day. The outcome was almost uniformly fatal. The conversion rate of levamisole to aminorex has not been established, but given the high daily intake of cocaine by many abusers, it seems likely that many of them will have ingested enough contaminated cocaine to ultimately cause IPH. Until the disease is well established, the symptoms of IHP are vague, and existing drug registries specifically exclude drug abusers, making it difficult to track these cases. This review is intended to draw attention to what may be a slowly emerging new epidemic.