레바미솔

항기생충제(항선충제) / 면역 자극제

레바미솔은 이미다조티아졸 유도체로서 주로 대동물에서 항선충 구충제로 사용되며, 과거에는 소동물에서 미세사상충 구제제 및 면역 자극제로 사용되었습니다. **임상 요점:** * **소동물 사용 감소:** 치료 지수가 좁고 더 안전하고 효과적인 구충제(예: 매크로라이드계, 벤즈이미다졸계)가 등장함에 따라 현대 개와 고양이 임상에서는 거의 사용되지 않습니다. * **대동물에서의 유용성:** 소, 양, 돼지에서 여전히 가치 있는 광범위 구충제이며 위장관 및 폐 선충에 특히 효과적이지만, 기생충 내성이 전 세계적으로 증가하는 추세입니다. * **면역 조절:** 세포 매개 면역을 자극하는 독특한 능력으로 인해, 특히 면역이 저하된 환자에서 만성 감염, 면역 매개 질환 및 특정 종양의 보조 요법으로 허가 외(off-label) 사용되기도 합니다.

작용 기전: **Antiparasitic Action:** Levamisole acts as a cholinergic agonist at **nicotinic acetylcholine receptors** on the nematode muscle. * Receptor activation → continuous depolarization → **spastic paralysis** of the worm. * The paralyzed nematodes are subsequently expelled alive from the host's gastrointestinal or respiratory tract. * At higher concentrations, it interferes with nematode carbohydrate metabolism by blocking **fumarate reduction** and **succinate oxidation**. **Immunostimulant Action:** The exact mechanism is not fully elucidated. It is believed to: * Restore cell-mediated immune function in peripheral **T-lymphocytes**. * Stimulate phagocytosis and chemotaxis by **monocytes and macrophages**. * Effects are generally more pronounced in immunocompromised animals rather than healthy ones.

동물 종별 용량

Sheep

For removal of mature and immature Dictyocaulus vivapurus · 8 mg/kg PO · PO · Once
For treatment of susceptible nematodes · 7.5 mg/kg PO · PO · Once

Goats

For removal of mature and immature Dictyocaulus vivapurus · 8 mg/kg PO · PO · Once
For treatment of susceptible nematodes · 7.5 mg/kg PO · PO · Once

Cats

For the treatment of lungworms · 20-40 mg/kg PO every other day for 5-6 treatments · PO · q48h · 5-6 treatments
For Aelurostrongylus abstrusus (lungworms) · 100 mg PO daily every other day for 5 treatments; give atropine (0.5 mg SC, 15 minutes before administering); or 15 mg/kg PO every other day for 3 treatments, then 3 days later: 30 mg/kg PO, then 2 days later: 60 mg/kg. · PO · Varies · Varies
For Capillaria aerophilia (lungworms) · 4.4 mg/kg SC for 2 days, then 8.8 mg/kg once 2 weeks later; or 5 mg/kg PO once daily for 5 days, followed by 9 days of no therapy, repeat two times · SC/PO · Varies · Varies
For the treatment of lungworms · 25 mg/kg every other day for 10-14 days · PO · q48h · 10-14 days
For Capillaria aerophilia (lungworms) · 10 mg/kg PO once daily for 5 days; repeat in 9 days · PO · q24h · 5 days

투여 경로

POSCIMTopical

금기

Lactating dairy animals (not approved)
Severely debilitated animals
Patients with significant renal or hepatic impairment
Cats with FIV or FIP (and likely ineffective in FeLV)
Use as a dirofilarial adulticide
Intravenous (IV) administration (never recommended)
Intramuscular (IM) administration in birds (avoid if possible)

이상반응

Cattle: Muzzle foaming, hypersalivation, excitement, trembling, lip-licking, head shaking, injection site swelling
Sheep/Goats: Transient excitability, depression, hyperesthesia, salivation, stinging upon SC injection
Swine: Salivation, muzzle foaming, coughing/vomiting (especially if infected with lungworms)
Dogs: GI disturbances (vomiting, diarrhea), neurotoxicity (panting, shaking, agitation), immune-mediated anemia, agranulocytosis, dyspnea, pulmonary edema, immune-mediated skin eruptions (erythema multiforme, toxic epidermal necrolysis), lethargy
Cats: Hypersalivation, excitement, mydriasis, vomiting

약물 상호작용

Aspirin · Levamisole may increase salicylate levels
Chloramphenicol · Fatalities have been reported after concomitant administration; avoid using these agents together
Cholinesterase-inhibiting drugs (e.g., organophosphates, neostigmine) · Could theoretically enhance the toxic effects of levamisole; use together with caution
Nicotine-like compounds (e.g., pyrantel, morantel, diethylcarbamazine) · Could theoretically enhance the toxic effects of levamisole; use together with caution
Warfarin · Increased risk for bleeding

모니터링

Clinical efficacy (fecal exams, resolution of clinical signs)
Adverse effects/toxicity observation

과용량

Signs of levamisole toxicity often mimic those of **organophosphate toxicity** due to its cholinergic effects. * **Clinical Signs:** Hypersalivation, hyperesthesias, irritability, clonic seizures, CNS depression, dyspnea, defecation, urination, and collapse. Acute overdosage can result in death due to respiratory failure. Cardiac arrhythmias may also be seen. * **Avian Toxicity:** In pet birds, 40 mg/kg SC is reported as a toxic dose. IM injections may cause more severe toxicity. Signs include depression, ataxia, leg/wing paralysis, mydriasis, regurgitation, and death. * **Treatment:** Primarily supportive, as animals generally recover within hours of dosing. If respiratory failure occurs, institute artificial ventilation with oxygen until recovery. For recent oral ingestion, emptying the gut and/or administering activated charcoal with cathartics may be indicated. * **Warning:** Intravenous (IV) administration is particularly hazardous and is never recommended.

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