Generic Dicaris ( Levamisole )

Buy Generic Dicaris (Levamisole) without prescription in Canada

Dicaris (Levamisole 50 mg): Comprehensive Patient Information for Canada

Basic Product Information

Mechanism of Action

In simple terms: Levamisole is an anthelmintic deworming medication that paralyzes parasitic worms in the body. Once the worms are paralyzed, they cannot maintain their position in the intestines and are expelled naturally through normal bowel movements, usually within 24 hours. Levamisole also has immune-stimulating properties that were historically used in cancer treatment and certain immune conditions.

For specialists: Levamisole is a synthetic imidazothiazole derivative that acts as a fast-acting anthelmintic. It acts as an agonist at L-subtype nicotinic acetylcholine receptors on nematode muscle cells, causing sustained depolarization and spastic paralysis of the parasite musculature. This paralysis prevents the helminth from maintaining its position, leading to expulsion by normal peristaltic movement, typically within 24 hours of administration. Levamisole also inhibits alkaline phosphatase and possesses immunomodulatory properties, including stimulation of antibody formation, enhancement of T-cell responses, and potentiation of monocyte and macrophage functions. The levo-isomer is the active anthelmintic component, while the dextro-isomer inhibits tissue non-specific alkaline phosphatase.

Pharmacokinetics

• Absorption: Levamisole is rapidly absorbed after oral administration, with a time to peak plasma concentration of approximately 1.3 to 1.9 hours. The oral bioavailability is approximately 62 to 70 percent in healthy adults. Food may impair absorption, so administration after meals is generally recommended.
• Metabolism: Levamisole undergoes extensive hepatic metabolism. The primary metabolite is aminorex, which was developed in the 1970s as an appetite suppressant but was discontinued after pulmonary hypertension-related deaths.
• Elimination: Levamisole is eliminated primarily via renal excretion, with approximately 46 percent excreted in urine within 24 hours and 32 percent in feces. The elimination half-life is approximately 2.6 to 5.6 hours.
• Onset of Action: Anthelmintic effect occurs within seconds of contact with the parasite; expulsion of worms typically occurs within 24 hours.
• Duration of Action: The anthelmintic effect is generally a single-dose treatment. Immunomodulatory effects may persist with repeated dosing.

Uses in Daily Life and Best Practice Advice

Levamisole is used in jurisdictions where it is approved for the treatment of specific parasitic worm infections. In Canada, levamisole is not approved for human use and is available only as a veterinary product or through compounding pharmacies for specific indications. Your physician will determine whether levamisole is appropriate for your condition.

• Typical Uses: Treatment of infections caused by Ascaris lumbricoides (roundworm), Necator americanus (hookworm), Strongyloides stercoralis, Trichostrongylus colubriformis, and Ancylostoma duodenale (hookworm).
• Administration: Tablets are taken orally, preferably after a meal with a sufficient amount of liquid, and preferably in the evening.
• Monitoring: A follow-up stool examination is recommended 3 weeks after treatment to confirm eradication. If the result is positive, a second course of treatment should be administered.
• Local Policy: In Canada, levamisole is not available as a human prescription drug. It may be obtained through veterinary channels or compounding pharmacies under specific circumstances. The drug remains on the WHO Model List of Essential Medicines.

Morning vs. Evening Dosing

Levamisole is typically administered as a single dose in the evening after a meal. There is no specific clinical recommendation for morning versus evening dosing, but evening administration is generally preferred to minimize the risk of gastrointestinal upset and to align with the parasite's activity cycle. Always follow the advice of your physician.

• Evening Use: Recommended for single-dose anthelmintic treatment to be taken after the evening meal with a sufficient amount of liquid.
• Morning Use: Not specifically recommended for anthelmintic treatment.
• Immunomodulatory Use: When used for immunomodulatory purposes, not approved in Canada, dosing may involve intermittent administration over a longer period.
• Regularity: For anthelmintic treatment, levamisole is typically given as a single dose. Do not repeat unless advised by a healthcare professional.

Administration With or Without Food

Levamisole should be taken after a meal with a sufficient amount of liquid. Taking it with food may help reduce the risk of stomach upset. Food may also affect the absorption of levamisole, so consistent administration after meals is recommended.

• Take levamisole after a meal, preferably in the evening.
• Swallow the tablet whole with a full glass of water or other liquid.
• Avoid taking on an empty stomach to minimize gastrointestinal discomfort.
• Avoid alcohol during treatment and for 24 hours after the last dose, as alcohol may cause a disulfiram-like reaction.

Interaction Warnings

Indications for Levamisole

"Off-label" means use outside the official approved indication, usually based on current medical guidelines and scientific evidence. Levamisole is not approved for human use in Canada.

Dosing According to Clinical Indication

Doses should always be adjusted according to the advice of your physician and depending on your health condition. A second course of treatment may be recommended in severe hookworm infections or if the infection is not resolved after a single dose. Follow-up stool examination is recommended 3 weeks after treatment.

Side Effects and Safety Profile

Guidelines for Correct Use

• Take levamisole exactly as directed by your physician. The dose and duration depend on the type of infection being treated.
• Take the tablet after a meal, preferably in the evening, with a sufficient amount of liquid.
• Do not crush, chew, or split the tablet unless directed by your physician or pharmacist.
• Do not share this medication with others, even if they have the same symptoms.
• Avoid alcohol during treatment and for 24 hours after the last dose.
• Follow-up stool examination is recommended 3 weeks after treatment to confirm that the infection has been cleared.
• Seek immediate medical attention if you experience signs of leukoencephalopathy, agranulocytosis, or severe allergic reactions.
• Inform your physician if you have a history of blood disorders, liver disease, kidney disease, or if you are pregnant or breastfeeding.
• Keep out of reach of children. Store at room temperature in a dry place.

Alternative Treatment Options

• Albendazole: A broad-spectrum anthelmintic effective against a wide range of intestinal nematodes, including Ascaris lumbricoides, hookworm, and Strongyloides stercoralis. Available in Canada as a prescription medication. Unlike levamisole, albendazole is generally well tolerated with a favorable safety profile.
• Mebendazole: A commonly used anthelmintic in Canada for ascariasis, hookworm, and other intestinal worm infections. Available over the counter in some provinces for pinworm treatment and by prescription for other indications.
• Pyrantel pamoate: An over-the-counter anthelmintic effective against pinworm and roundworm. Also acts as a nicotinic acetylcholine receptor agonist, similar to levamisole.
• Ivermectin: The treatment of choice for strongyloidiasis. Available by prescription in Canada. More effective than levamisole for Strongyloides stercoralis infection.
• Nitazoxanide: A broad-spectrum antiparasitic agent effective against various intestinal protozoa and helminths. Available by prescription in Canada.

Comparison: Levamisole was historically used as a single-dose anthelmintic but has been largely replaced by safer and more effective alternatives such as albendazole, mebendazole, and ivermectin. The serious risk of leukoencephalopathy, which can occur after a single dose and may be irreversible, has led regulatory authorities to recommend withdrawal of levamisole-containing human medications from the market. In Canada, levamisole is not approved for human use and is available only as a veterinary product or through compounding pharmacies. Your physician will determine the most appropriate and safest treatment for your specific infection.

Legal Status, Registration, and Coverage in Canada

• Registration: Levamisole is not approved by Health Canada for human use. It was withdrawn from the Canadian market for patient use around 2003 after reports of vasculitis, leukopenia, and agranulocytosis. Veterinary levamisole products are authorized for veterinary use and classified as prescription drugs under the Food and Drug Regulations.
• Prescription Status: Not available as a human prescription drug in Canada. May be obtained through veterinary channels or compounding pharmacies under specific circumstances.
• Coverage: Not covered by provincial or territorial drug plans for human use. Veterinary products are not covered by human drug plans.
• Pharmacovigilance: Adverse reactions to veterinary levamisole products in humans should be reported to Health Canada's MedEffect Canada program and local poison control centres.
• International Status: In February 2026, the European Medicines Agency's Pharmacovigilance Risk Assessment Committee recommended the withdrawal of levamisole-containing human medicines from the EU market due to the risk of leukoencephalopathy, concluding that the benefits no longer outweigh the risks. Levamisole remains on the WHO Model List of Essential Medicines.

Recent Research and Clinical Guidelines (2022–2026)

• In February 2026, a European regulatory review concluded a comprehensive assessment of levamisole-containing medicines and recommended the withdrawal of their marketing authorizations across the EU. The review confirmed that leukoencephalopathy is a rare but serious adverse effect of levamisole, that it can occur after a single dose, and that symptoms may develop within one day up to several months after treatment. The review found that the benefits of levamisole for treating mild parasitic infections no longer outweigh the serious, unpredictable, and potentially life-threatening risk of leukoencephalopathy.
• The scientific conclusions of the European review noted that leukoencephalopathy had already been identified as a potential risk of levamisole, but further data from literature and spontaneous reports confirmed a causal relationship. The review found no measures that could reduce the risk and no patient groups at higher or lower risk.
• Levamisole remains a frequent adulterant in cocaine supplies. Approximately 5 percent of cocaine and crack samples tested by drug checking services in British Columbia from January 2019 to January 2021 contained levamisole. A survey found that 24.4 percent of urine samples testing positive for cocaine in 2018 also contained levamisole. Healthcare providers should be aware of levamisole toxicity presenting with retiform purpura, neutropenia, and agranulocytosis, particularly involving the ears.
• Research into levamisole's immunomodulatory properties for conditions such as steroid-sensitive idiopathic nephrotic syndrome has been discontinued due to safety concerns.

Availability and Supply in Canada

Prices and availability may vary. Because levamisole is not approved for human use in Canada, it is not available through standard Canadian pharmacies. Any use in humans would require a prescription from a physician and dispensing through a compounding pharmacy or importation through Health Canada's Special Access Programme. Check with your physician for current information.

Frequently Asked Questions (FAQ)

1. Is Dicaris levamisole available in Canada?
   No. Levamisole is not approved by Health Canada for human use. It was withdrawn from the Canadian market for patient use around 2003 after reports of serious side effects including vasculitis, leukopenia, and agranulocytosis. It remains available only as a veterinary product or through compounding pharmacies for specific circumstances.
2. What is the dose of levamisole 50 mg?
   The 50 mg tablet is typically used for pediatric dosing in children 6 to 14 years or for dose titration. For adults, the standard dose for ascariasis is 150 mg as a single dose, which is three 50 mg tablets. For hookworm, the dose is 2.5 mg/kg as a single dose. Always follow your physician's instructions.
3. What are the serious side effects of levamisole?
   The most serious side effect is leukoencephalopathy, a rare but potentially life-threatening brain condition affecting the white matter. Symptoms include confusion, weakness, muscle function impairment, movement coordination difficulties, and speech or vision disturbances. It can occur after a single dose and symptoms may develop within one day up to several months after treatment. Other serious effects include agranulocytosis and vasculitis.
4. Can I drink alcohol while taking levamisole?
   No. Alcohol should be avoided during treatment with levamisole and for 24 hours after the last dose, as it may cause a disulfiram-like reaction.
5. Is levamisole safe for children?
   Levamisole is contraindicated in children under 6 years of age. For children 6 to 14 years, dosing is based on body weight. However, given the serious safety concerns, alternative anthelmintic agents such as albendazole or mebendazole are generally preferred.
6. Why was levamisole withdrawn from the Canadian market?
   Levamisole was withdrawn from the Canadian market for patient use around 2003 after reports of vasculitis, leukopenia, and agranulocytosis. More recently, the risk of leukoencephalopathy has led the European Medicines Agency to recommend withdrawal of all levamisole-containing human medicines from the EU market in 2026.
7. What should I do if I experience neurological symptoms after taking levamisole?
   Seek immediate medical attention if you experience confusion, weakness, difficulty speaking, movement problems, or vision changes. These may be signs of leukoencephalopathy. Do not wait for symptoms to resolve on their own.
8. Are there safer alternatives to levamisole?
   Yes. Safer and more effective alternatives include albendazole, mebendazole, pyrantel pamoate, and ivermectin, depending on the specific infection. These medications are available by prescription in Canada and have more favorable safety profiles. Discuss the best option with your physician.