左旋咪唑
Levamisole
Levamisole hydrochloride / Levamisole phosphate
別名: Levasole · Amtech · Ascaridil · Decaris · Ergamisol · Immunol · Ketrax · Meglum · Prohibit · Solaskil · Vermisol · Vizole · cloridrato de levamizol · ICI-59623 · levamisoli hydrochloridum · NSC-177023 · R-12564 · RP-20605 · l-tetramisole hydrochloride
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
2.2 mg/kg PO every other day, with appropriate antimicrobial therapyPO· q48h
— 🐕
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For recurrent cutaneous infections (immune stimulant) | 2.2 mg/kg PO every other day, with appropriate antimicrobial therapy | PO | q48h | — | 🌎 NA |
| As an immune stimulant | 0.5-2 mg/kg PO 3 times a week | PO | 3 times a week | — | 🌎 NA |
| For adjunctive therapy in dogs with chronic pyoderma | 0.5-1.5 mg/kg PO 2-3 times a week | PO | 2-3 times a week | — | 🌎 NA |
| For adjunctive therapy in dogs with chronic pyoderma | 2.2 mg/kg PO every other day | PO | q48h | — | 🌎 NA |
| As an alternative treatment for SLE | 3-7 mg/kg PO every other day for 4 months; alone or in combination with corticosteroids | PO | q48h | 4 months | 🌎 NA |
| As a microfilaricide | 11 mg/kg PO for 6-12 days. Examine for microfilaria within 7-10 days and at weekly intervals until eliminated or treatment is halted. | PO | q24h | 6-12 days | 🌎 NA |
| For treatment of Angiostrongylus vasorum | 7.5 mg/kg (route not specified) for two consecutive days, followed by 10 mg/kg for 2 days; if the infection is not cleared, the regimen is repeated. | Not specified | q24h | 4 days | 🌎 NA |
| For Crenosoma vulpis (lungworms) | 8 mg/kg once | PO | Once | 1 dose | 🌎 NA |
| For Capillaria (lungworms) | 7-12 mg/kg once daily PO for 3-7 days | PO | q24h | 3-7 days | 🌎 NA |
| For Filaroides osleri (lungworms) | 7-12 mg/kg once daily PO for 20-45 days | PO | q24h | 20-45 days | 🌎 NA |
| For Filaroides osleri (lungworms) | 7.5 mg/kg PO twice daily or 25 mg/kg PO every other day for 10 days | PO | q12h or q48h | 10 days | 🌎 NA |
| For Capillaria aerophilia (lungworms) | 10 mg/kg PO once daily for 5 days; repeat in 9 days | PO | q24h | 5 days | 🌎 NA |
- For adjunctive therapy in dogs with chronic pyoderma: Efficacy not established
- For adjunctive therapy in dogs with chronic pyoderma: May only be efficacious in 10% of cases
- As a microfilaricide: Rarely recommended today. Retching and vomiting are common. Avoid giving on an empty stomach or immediately after drinking water. A 'conditioning' dose of 5 mg/kg PO once a day may be necessary. Stop therapy if abnormal behavior or ataxia develops.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For the treatment of lungworms | 20-40 mg/kg PO every other day for 5-6 treatments | PO | q48h | 5-6 treatments | 🌎 NA |
| 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 | 🌎 NA |
| 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 | 🌎 NA |
| For the treatment of lungworms | 25 mg/kg every other day for 10-14 days | PO | q48h | 10-14 days | 🌎 NA |
| For Capillaria aerophilia (lungworms) | 10 mg/kg PO once daily for 5 days; repeat in 9 days | PO | q24h | 5 days | 🌎 NA |
| For treatment of Ollulanus tricuspis | 5 mg/kg SC | SC | Once | 1 dose | 🌎 NA |
| As a microfilaricide | 10 mg/kg PO for 7 days | PO | q24h | 7 days | 🌎 NA |
| For adjunctive therapy of feline plasma-cell gingivitis/pharyngitis (immune-stimulant) | 25 mg PO every other day for 3 doses | PO | q48h | 3 doses | 🌎 NA |
小型哺乳類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For nematodes in Rabbits | 12.5-20 mg/kg PO (for gastric nematodes) or SC (for extragastric nematodes) | PO/SC | Once | — | 🌎 NA |
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For intestinal nematodes | 5-15 mL/gallon of drinking water for 1-3 days; repeat in 10 days. If birds refuse to drink, withhold water prior to treating. | PO | Daily | 1-3 days | 🌎 NA |
| For gavage in Australian Parakeets (or desert species that refuse to drink water) | 15 mg/kg; repeat in 10 days | PO | Once | — | 🌎 NA |
| For parenteral use | 4-8 mg/kg IM or SC; repeat in 10-14 days. | IM/SC | Once | — | 🌎 NA |
| For immunostimulation | 0.3 mL/gallon of water for several weeks | PO | Continuous | Several weeks | 🌎 NA |
| As a parenteral immunostimulant | 2 mg/kg IM or SC. 3 doses at 14 day intervals | IM/SC | q14d | 3 doses | 🌎 NA |
| As a nebulized immunostimulant | 1 mL (of 13.65% levamisole phosphate) in 15 mL saline | Inhalation | — | — | 🌎 NA |
| For Capillaria infections | 15-30 mg/kg orally as a single bolus or through a crop tube; or 2.25 mg/gallon of drinking water for 4-5 days. Repeat treatment in 10-14 days. | PO | Varies | 1 or 4-5 days | 🌎 NA |
| Poultry nematodes | 18-36 mg/kg, PO | PO | Once | — | 🌎 NA |
| For Libyastrongylus douglassi in Ratites | Give 30 mg/kg PO or IM at one month of age, then once a month for 7 treatments, then 4 times yearly | PO/IM | Monthly then quarterly | Ongoing | 🌎 NA |
- For intestinal nematodes: Using 13.65% injectable
- For gavage in Australian Parakeets (or desert species that refuse to drink water): Using 13.65% injectable
- For parenteral use: Using 13.65% injectable. May cause vomiting, ataxia, or death. Do not use in debilitated birds.
- For immunostimulation: Using 13.65% injectable
- As a parenteral immunostimulant: Using 13.65% injectable
爬蟲類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an anthelmintic (Nematodes, Acanthocephalans, or Pentastomes) | Nematodes: 5-10 mg/kg PO; repeat in two weeks followed by a fecal exam 14 days after the second dose. If positive, a third dose is given. Acanthocephalans, or Pentastomes: as above, but may also be given SC or ICe. | PO/SC/ICe | q14d | 2-3 doses | 🌎 NA |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an immunostimulant | Dosages have ranged from 2.5 mg/kg injected at 7 day intervals, and 2.2 mg/kg PO every 24 hours for 3 days, then off for 4 days for a period of 4-6 weeks. | Injection/PO | Varies | 4-6 weeks | 🌎 NA |
| As adjunctive therapy for EPM | 1-2 mg/kg per day PO | PO | q24h | — | 🌎 NA |
- As an immunostimulant: Anecdotal reports of beneficial effects in the treatment of nasal viral papillomas, COPD, and EPM have been suggested.
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For removal of mature and immature Dictyocaulus vivapurus | 5.5-11 mg/kg PO, either given in feed or as a drench or oral bolus. May also be administered SC at 3.3-8 mg/kg. | PO/SC | Once | — | 🌎 NA |
| For treatment of susceptible nematodes | 7.5 mg/kg PO | PO | Once | — | 🌎 NA |
豬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For removal of mature and immature Metastrongylus | 8 mg/kg PO in feed or water | PO | Once | — | 🌎 NA |
羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For removal of mature and immature Dictyocaulus vivapurus | 8 mg/kg PO | PO | Once | — | 🌎 NA |
| For treatment of susceptible nematodes | 7.5 mg/kg PO | PO | Once | — | 🌎 NA |
山羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For removal of mature and immature Dictyocaulus vivapurus | 8 mg/kg PO | PO | Once | — | 🌎 NA |
| For treatment of susceptible nematodes | 7.5 mg/kg PO | PO | Once | — | 🌎 NA |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
左旋咪唑是一種咪唑並噻唑類衍生物，主要在大型動物中用作抗線蟲寄生蟲藥，過去也曾在小動物中用作殺微絲蟲藥和免疫刺激劑。
臨床要點：
- 在小動物中使用的減少： 由於其治療指數狹窄，加上更安全、更有效的驅蟲藥（如巨環內酯類、苯並咪唑類）的出現，左旋咪唑在現代犬貓臨床中已很少使用。
- 大型動物的應用： 它在牛、羊和豬中仍是一種有價值的廣效驅蟲藥，對胃腸道和肺部線蟲特別有效，儘管寄生蟲抗藥性已成為日益嚴重的全球性問題。
- 免疫調節： 其刺激細胞介導免疫的獨特能力，使其在標示外被用作慢性感染、免疫介導疾病和某些腫瘤的輔助療法，特別是在免疫功能低下的病患中。
作用機制
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.
安全性與警告
禁忌症
- 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)
不良反應
- 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
注意事項
Narrow Margin of Safety: Levamisole has a narrow therapeutic index, especially in small animals and birds. Accurate dosing is critical.
- Stress: Use cautiously or delay use in cattle that are stressed due to vaccination, dehorning, or castration.
- Pregnancy: FDA Category C / Papich Class C. Has been implicated in causing abortion in goats. Use only if potential benefits outweigh risks.
- Nursing: Excreted in cows' milk; use with caution in nursing dams.
藥物相互作用
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
監測
- Clinical efficacy (fecal exams, resolution of clinical signs)
- Adverse effects/toxicity observation
藥物動力學
半衰期
狗1.8-4 hours
吸收
Absorbed from the gut after oral dosing and through the skin after dermal application, although bioavailabilities are variable.
分佈
Reportedly distributed throughout the body.
代謝
Primarily metabolized in the liver.
排除
Metabolites are excreted primarily in the urine (with less than 6% excreted unchanged) and in feces.
過量
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.
可用產品
劑型
- Injection (13.65% levamisole phosphate)
- Water Medication/Soluble Powder (18.15g, 46.8g)
- Oral Tablets/Boluses (184 mg, 2.19 g)
獸醫用
- Levamisole Phosphate Injection: 136.5 mg/mL (13.65%)
- Levamisole Hydrochloride Water Medication: 18.15 grams
- Levamisole Hydrochloride Soluble Drench Powder: 46.8 grams/packet
- Levamisole HCl Oral Tablets/Boluses: 184 mg, 2.19 gram
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Levamisole hydrochloride products should be stored at room temperature (15-30°C); avoid temperatures greater than 40°C. Levamisole phosphate injection should be stored at or below 21°C (70°F); refrigeration is recommended and freezing should be avoided. Compounded oral solution (25 mg/mL) retains >97% potency for 90 days when stored at 4°C and 25°C and protected from light.
飼主須知
- 嚴格給藥： 請完全按照獸醫的指示給藥。左旋咪唑的安全範圍很窄，這意味著有效劑量和中毒劑量之間的差異很小。
- 不良反應： 密切觀察您的寵物是否有中毒跡象，如過度流口水、發抖、喘氣、嘔吐、腹瀉或異常行為。如果出現這些情況，請立即聯繫您的獸醫。
- 給藥方式： 如果用於某些特定疾病的口服治療，請勿在空腹或寵物喝水後立即給藥（請遵循獸醫的具體指示）。
- 食用動物： 左旋咪唑未獲 FDA 批准用於繁殖期的乳用動物。請嚴格遵守屠宰停藥期（例如，牛 48 小時，羊/豬 72 小時）。
- 重複治療： 處於嚴重寄生蟲感染環境中的動物，可能需要在首次治療後 2-4 週進行再次治療。
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