What is the mode of action of Levamisole (antiparasitic medication)?

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From the Guidelines

Levamisole acts primarily as an immunomodulator, enhancing T-cell function and stimulating both cellular and humoral immune responses in the body. Its mode of action involves increasing T-cell activation and proliferation, restoring depressed T-cell numbers, and improving the function of monocytes and macrophages 1. The drug also increases neutrophil mobility and chemotaxis while stimulating antibody formation.

Key Mechanisms

  • Enhances T-cell function by increasing T-cell activation and proliferation
  • Restores depressed T-cell numbers
  • Improves the function of monocytes and macrophages
  • Increases neutrophil mobility and chemotaxis
  • Stimulates antibody formation In the context of glomerulonephritis, levamisole is suggested to be given at a dose of 2.5 mg/kg on alternate days for at least 12 months, as most children will undergo relapse when levamisole is stopped 1.

Clinical Use

  • Dose: 2.5 mg/kg on alternate days
  • Duration: at least 12 months
  • Indication: glomerulonephritis, particularly in children to prevent relapse.

From the FDA Drug Label

INDICATIONS: LevaMed (levamisole hydrochloride) Soluble Drench Powder is a broad spectrum anthelmintic and is effective against the following adult nematode infections in cattle and sheep: The FDA drug label does not answer the question.

From the Research

Mode of Action of Levamisole

  • Levamisole is a heterocyclic compound that acts as an antihelminthic agent and has immunoregulatory properties 2.
  • Its likely mode of action is by mimicry of the thymic hormone thymopoietin, which affects many components of the immune system, including neutrophils, macrophages, and lymphocytes 2.
  • Levamisole may form a thymopoietin-mimetic tertiary structure, stimulate lymphocytes by its imidazole component, or be metabolized to O.M.P.I., a reducing compound that affects radical scavenging in multiplying lymphocytes 2.

Immunopharmacology of Levamisole

  • Levamisole can act as an immunostimulant or immunosuppressive agent, depending on the dose administered, timing of administration, experimental assay used, and host genetic background 3.
  • The drug's actions are modulated by the interaction between the T-cell recruiting efficacy of the sulphur moiety and the cholinergic effects of the imidazole ring 3.
  • Levamisole's potential for opposite effects explains certain apparent inconsistencies observed in experimental or clinical assays 3.

Clinical Implications of Levamisole

  • The therapeutic usefulness of correctly administered levamisole parallels improvement in tests of cellular immunity 3.
  • Therapy with levamisole must be individualized, with the appropriate agent and dosage chosen according to the immune capabilities of individual patients 3.
  • Levamisole has been used in various clinical settings, including cancer treatment, with some studies showing promise as an adjuvant therapy for resected melanoma and colon carcinoma 4.

Side Effects of Levamisole

  • Levamisole has been associated with agranulocytosis (AGC) in 2.5%-13% of patients, particularly with prolonged high dosage 5.
  • The pathogenesis of levamisole-induced AGC is not fully understood, but it is thought to involve an immune-mediated mechanism 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Mode of action of levamisole.

The Journal of rheumatology. Supplement, 1978

Research

Levamisole: known effects on the immune system, clinical results, and future applications to the treatment of cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1991

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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