Transcript LEVAMISOLE於牙科的使用

LEVAMISOLE於牙科的使用
傅任巧
藥劑科
20041123
Levamisole藥理生理學
• immunomodulatory activity
• T-cell activity and to have enhancing
effects on the functions of B-lymphocytes
and macrophages
Levamisole使用方向
• 健保: 抗蛔蟲及鉤蟲病
• At present, the primary indication
of levamisole is as adjunctive
treatment of stage C colon
cancer, in combination with
fluorouracil.
• mood-elevating effects in humans and
convulsant effects at high doses
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AIDS
AMYOTROPHIC LATERAL SCLEROSIS
APHTHOUS STOMATITIS
BAYLIS ASCARIASIS
BILIARY CIRRHOSIS
BREAST CANCER
COLON CANCER (HAVE FDA CHECKED)
CROHN'S DISEASE
HELMINTHIASIS
HEPATITIS
LEUKEMIA- ACUTE NONLYMPHOCYTIC LEUKEMIA
LUNG CANCER
MALIGNANT MELANOMA
NEPHROTIC SYNDROME
ONCHOCERCIASIS
ORAL ULCERS, CHRONIC
PULMONARY TUBERCULOSIS
RHEUMATOID ARTHRITIS
SOLID TUMORS
SYSTEMIC LUPUS ERYTHEMATOSUS
ULCERATIVE COLITIS
ONCHOCERCIASIS
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1. OVERVIEW:
FDA APPROVAL: Adult, no; pediatric, no
EFFICACY: Adult, ineffective
DOCUMENTATION: Adult, fair
2. SUMMARY: - LEVAMISOLE is not effective therapy for
the treatment of onchocerciasis
• 3. ADULT:
– a. Levamisole 150 milligrams orally weekly for 5 weeks
was reported ineffective in the treatment of onchocerciasis
in a randomized study. In this trial, the combination of
levamisole plus mebendazole appeared to offer no
significant advantage over mebendazole alone (RivasAlcala et al, 1981).
ORAL ULCERS, CHRONIC
• 1. OVERVIEW:
• FDA APPROVAL: Adult, no; pediatric,
no
• EFFICACY: Adult, possibly effective
• DOCUMENTATION: Adult, fair
• 2. SUMMARY: - The combination of
levamisole and low-dose prednisolone is
effective and relatively safe, compared to
high-dose prednisolone
• 3. ADULT:
– a. Results of an open clinical trial indicate that
addition of levamisole to low-dose
prednisolone is beneficial for controlling such
MUCOCUTANEOUS DISEASE as oral
lichen planus (OLP), erythema multiforme
(EM), mucous membrane pemphigoid (MMP),
and early pemphigus vulgaris (PV) (Lu et al,
1998). In a study population of 41 patients (30
with OLP, 6 with EM, 3 with MMP, and 2 with
early PV), levamisole 50 milligrams (mg) and
prednisolone 5 mg, each given 3 times per
day for 3 consecutive days each week and used
either alone or in combination with topical
dexamethasone, were used until no evidence
of OLP, EM, MMP, or PV was found.
– The time to response after start of therapy ranged
from 1 to 4 weeks, and all patients showed marked
improvement. Of the 30 patients with OLP, 29
remained free of symptoms for 4 to 6 months.
Although neither OLP nor EM were eradicated,
recurrences were mild, and continued to respond to
the drug regimen whenever it was reinstated. Of the
remaining patients, all 6 with EM, all 3 with MMP,
and both with early PV remained completely free of
disease symptoms without additional medication for
the 3 years of follow-up. Patients showing an
excellent response had all medication stopped in
cases of EM, 2 weeks of maintenance in cases of
OLP, and 4 weeks of maintenance in cases of MMP
and PV. One patient with OLP reported a minor skin
rash.
Dental
The leukopenic effects of levamisole may
result in an increased incidence of
microbial infection, delayed healing, and
gingival bleeding. If leukopenia occurs,
dental work should be deferred until blood
counts have returned to normal and
patients should be instructed in proper oral
hygiene, including caution in use of regular
toothbrushes, dental floss, and toothpicks.
LEVAMISOLE於牙科牙蟲病的用法
• levamisole 50 mg(1 TAB) TID
and
prednisolone 5 mg TID
• levamisole 150 mg(3 TAB) QD