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Levamisole Disaster

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Carlsson View Drop Down
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    Posted: February 17 2014 at 5:01pm
My tank had a really bad flatworm problem (thousands of those nasty things). I had read about Flatworm Exit, but decided to go "natural" and placed an online order for 2 velvet blue nudis. All the warnings on Flatworm Exit package made me a bit nervous. Last Saturday a member of this forum suggested using Levamisole. He claimed that it was safe for reef aquariums and that he had used it successfully in the past. Based on his experience (I've had my tank up for only 8 months or so), I decided to cancel my order for the two nudis and give Levimasole a try with the sample he gave me.
I found a post on R2R where somebody had treated their 300 gallon tank w/6 grams of Levamisole. To be safe, I mixed just under 2g with 500 cc of RO water and started adding the mixture to my tank a little at a time. Once I noticed a few flatworms releasing and starting to float around, I stopped adding Levamisole. Unfortunatelly, it just kept killing more and more flatworms. Within 30-45 minutes, there was a flatworm blizzard  in the tank. Then, after an hour or so following the death of the fisrt few FW, the water turned yellow-green. I knew it was a bad sign of  toxins being released from the dead flatworms. I turned on my skimmer and put 1/2 gallon of charcoal in the sump. I siphoned out most of the dead FW from my sandbed and changed the filter sock containing hundreds of dead FWs. All my corals (acans, zoas, blastos, and wellso) looked very unhappy. Two clowns and their RBTA didn't seem to mind and neither did my two tangs - naso and sailfin. At that point, I did a 25% water exchange just to be sure. In about two hours, I had 3 cm of bright orange substance in the skimmer cup. I dumped it and continued wet skimming over night. I checked on my tank at 11pm and I could see under my ML that all corals were still mad, but all fish were doing well. I then went to bed.
In the morning, I found in horror that my naso was in really bad shape. Both of his eyes were cloudy and he seemed to be blind - swimming only alongside the tank walls. His color was terrible - pale with white blotches and he was breathing really fast. The sailfin looked OK. I did another 25% water change, pulled two of my Koralias partially above water, so they would help oxygenate the water and rushed to PetSmart to buy a quaratine tank. I set it up with freshly mixed water, small powerhead (with venturi to improve oxygenation) and put the naso in there. At about 1pm, I noticed that the sailfin was becoming blotchy and pale, too. I put him in the QT as well. The naso tang seemed to regain some of his color initially, but died just before 8pm. The sailfin looked simply terrible at that time and died shortly after midnight.
I'm still in a state of disbelief: every time I walk by my tank I expect both tangs to swim up to me and wait to get a treat. They are gone and it hurts really bad. My wife cried when I told her. 
As of now, all zoas seem to have survived just fine. One out of my six acan colonies looks quite bad and may not survive. Red mushrooms are gone and a blasto colony most likely, too. Wellso, RBTA, and clowns are fine. Toadstool has had only few polyps out today, so hopefully it'll come back.
I am not blaming anybody - it was me who made the decision to use Levimasole. I'm sure the person who gave me that stuff meant well, but still can't help but to wish I had stuck with my original plan to buy two nudis. "Safe" is a relative term. Things that have worked in other tanks may not work in yours. Use your own judgement and take everybody else's suggestions with a grain of salt. You are the expert on your own tank.
What went wrong? There is no pharmacodynamic data on Levamisole in flatworms and pharmacokinetics in fish. It is possible that LD50 is very close to LD95 and I have simply overdosed. Quite likely, I had so many flatworms that initial death of only 10-20% with subsequent release of toxins started a chain reaction resulting in a massive die off and toxin release. There is a lesson to be learned from every bad experince, that's why I'm sharing mine.


Edited by Carlsson - February 17 2014 at 5:52pm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ReefdUp Quote  Post ReplyReply Direct Link To This Post Posted: February 17 2014 at 5:16pm
Sorry to hear about your experience/losses. Levamisole is known to have coral mortality rates (especially amongst SPS around 40-60%.) It is usually recommended in a quarantine tank only with coral to treat Acropora-eating flatworms, not red planaria. It was probably a combination of the flatworm toxins and the drug itself.

Just curious - if you didn't want to use Flatworm Exit, then why did you choose to use Levamisole? I usually recommend PraziPro when Flatworm Exit doesn't work (it is fish and coral safe), but the flatworm toxins can still wreak havoc if most are not removed before treatment.

Good luck on the recovery.
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Mike Savage View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mike Savage Quote  Post ReplyReply Direct Link To This Post Posted: February 17 2014 at 5:20pm
I am so sorry to hear that Carlsson. Cry


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Carlsson View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Carlsson Quote  Post ReplyReply Direct Link To This Post Posted: February 17 2014 at 5:50pm

Levamisole was recommended to me by an experienced WMAS member who said that Levamisole was the active ingredient in Flatworm Exit. I didn't verify that as it sounded reasonable - both being anthelminthics. I should have used my own judgement...



Edited by Carlsson - February 17 2014 at 5:51pm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote BobC63 Quote  Post ReplyReply Direct Link To This Post Posted: February 17 2014 at 7:16pm
Sorry to hear about this.
 
I don't have a ton of info to add on the technical side of things; I have been very lucky and never had a severe enough flatworm infestation to need to treat with anything other than a few wrasses.
 
I do, however, believe that Levamisole Hcl is the active ingredient in Flatworm Exit; and I have heard of people using straight Levamisole to treat flatworms. Reading your post, the only thing that may have been in error is it looks like you did not start removing the dead /dying flatworms immediately after dosing the Levamisole; you started removing them after the water turned colors - and that was an hour after the flatworms started dying?
 
I think it tells you to remove the flatworm carcasses immediately on the Flatworm Exit instructions, in order to avoid toxin release.
 
Again, sorry to hear about your losses.
 
 
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Mark Peterson View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mark Peterson Quote  Post ReplyReply Direct Link To This Post Posted: February 17 2014 at 11:07pm
Hello Patrik,

I'm very sorry to hear about this catastrophe.

It sounds like too much Levamisole was added too quickly without waiting for a reaction from the Flatworms.
I would ask if that unknown person using 6 grams in a 300 gal system was using it in the slow dosage way? I suspect not.
As indicated to you, the slow dosing method and procedure is referred to in the Reefkeeping Tips link in my signature line under the title How to eradicate pest Flatworms. In that post, I instruct to start with only 10% of the recommended dosage of Flatworm Exit. That equates to one drop of FWExit per gallon of tank water. Since we are not certain of how much Levamisole is in a drop of Flatworm Exit, it is imperative to dose slowly, wait and watch.

If we were to assume that 6 grams was a full dosage for a 300 gal system, ~3 grams would be a full dosage for your system. Please note that a proper slow dosage would then be 10% of 3 grams. That is only 0.3 grams not 2 grams.

The swift escalation in Flatworm deaths makes me wonder what length of time was waited between doses of the mixture and how many doses were given to deliver 2 grams of Levamisole. If the slow dosage method had been precisely followed, only a small portion of your 2 gram mixture would have been used that day.
The question also comes to mind that if the pumps were off, the Levamisole would not distribute evenly and might have the effect of hitting all at once.

Again, I'm sorry this happened.

Aloha,
Mark Hug

P.S. I sure wish you would have consulted with me after reading online and before beginning the procedure.
Perhaps Levamisole should be given the same way an MD would give a prescription. Wink


Edited by Mark Peterson - February 18 2014 at 12:04am
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