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Levamisole + inosine pranobex (isoprinosine) is an investigational combination immunomodulatory therapy that has been evaluated for the treatment and prophylaxis of COVID-19. The combination leverages the synergistic effects of two distinct small molecule immunomodulators. **Levamisole** is a synthetic imidazothiazole derivative that acts as a nicotinic acetylcholine receptor agonist and was originally developed as an anthelmintic; in the context of immunology, it is known to restore T-cell and macrophage functions in immunosuppressed states. **Inosine pranobex** is a complex of inosine and 2-hydroxypropyldimethylammonium 4-acetamidobenzoate that enhances lymphocyte proliferation, natural killer (NK) cell activity, and the production of Th1 cytokines such as interleukin-2 (IL-2) and interferon-gamma (IFN-γ). Clinical trials, primarily conducted by Egyptian institutions like Cairo University, have investigated this combination to bolster the immune response in healthcare workers and patients during the COVID-19 pandemic.
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