Plasma quantitation of warfarin and warfarin alcohol by gas chromatography chemical ionization mass spectrometry in patients on warfarin maintenance therapy

Developing a GC-EI-MS/MS method for quantifying warfarin and five hydroxylated metabolites generated by the Fenton reaction

Since the 1950s, Warfarin has been used globally as both a prescription drug and a rodenticide. Research has shown that warfarin and other rodenticides are present in the environment and food chain. However, emerging contaminants are subject to degradation by biotic and abiotic processes and advanced oxidation processes. In some cases, detecting the parent compound may not be possible due to the formation of structurally changed species. This approach aims to identify hydroxylated transformation products of warfarin in a laboratory setting, even after the parent compound has undergone degradation. Therefore, the Fenton reaction is utilized to insert hydroxylation into the parent compound, warfarin, by hydroxyl and hydroperoxyl radicals generated by Fe2+/Fe3+ redox reaction with hydrogen peroxide. Using multiple reaction monitoring, a GC-MS/MS method, incorporating isotopically labeled reference compounds, is used to quantify the expected derivatized species. The analytes are derivatized using trimethyl-3-trifluoromethyl phenyl ammonium hydroxide, and the derivatization yield of warfarin is determined by using isotopically labeled reference compounds. The method has a linear working range of 30 to 1800 ng/mL, with detection limits ranging from 18.7 to 67.0 ng/mL. The analytes are enriched using a C18-SPE step, and the recovery for each compound is calculated. The Fenton reaction generates all preselected hydroxylated transformation products of warfarin. The method successfully identifies that 4'-Me-O-WAR forms preferentially under the specified experimental conditions. By further optimizing the SPE clean-up procedures, this GC-MS-based method will be suitable for detecting transformation products in more complex matrices, such as environmental water samples. Overall, this study provides a better understanding of warfarin's degradation and offers a robust analytical tool for investigating its transformation products.

Assays and applications in warfarin metabolism: what we know, how we know it and what we need to know

INTRODUCTION

Coumadin (R/S-warfarin) is the most widely prescribed oral anticoagulant in the world; nevertheless, its clinical use is complicated by unpredictability in dose requirements to achieve and maintain optimal anticoagulation. Variations in warfarin metabolism among patients contribute to unpredictability in therapeutic responses. Studying the clinical relevance of warfarin metabolism poses a significant analytical challenge. Warfarin is given to patients as an equal mixture of R and S enantiomers. Both drugs undergo extensive metabolism through different pathways to generate > 20 structurally similar isomeric metabolites.

AREAS COVERED

The article discusses how analytical methods have evolved to effectively resolve and quantify individual metabolites. The authors also discuss how the application of these methods has identified clinically relevant metabolic pathways for warfarin and fostered the investigation of clinical biomarkers for patient responses to therapy. The article additionally presents the power of these methods and how aspects of warfarin metabolism have led to the use of warfarin as a phenotyping probe for multiple drug metabolizing enzymes.

EXPERT OPINION

Progress in these areas has been hampered by shortcomings in analytical methods and a narrow focus on one metabolic pathway. Recent advances in liquid chromatographic-mass spectral methods can rapidly analyze most warfarin metabolites. It is now possible to effectively assess alternate metabolic pathways and expand biomarker analyses for clinical and phenotyping applications.

Drug level monitoring: chromatography of some minor groups of drugs

Some important facts about the chromatographic separation of a number of selected categories of drugs are summarized. The data refer to the chromatographic method of choice, stationary phase, mobile phase (carrier gas), detection procedure and (where available) method sensitivity. Also, fundamental instrumental parameters, namely injector, column and detector temperature, carrier gas and mobile phase flow-rate and gradient set-up are reported here. In all cases also the source material used for analysis is specified. The data are presented in table form, each table dealing with a particular category of drugs. The following categories of drugs are being dealt with: anthelmintics, antiarteriosclerotics, antibacterials, anticholinergics and cholinergics, anticoagulants, antidiabetics, antiemetics, antimycotics, antihistamines, antimalarials, antiparasitics, antiparkinsonics, antitussives, antiulcer drugs, antiviral compounds, appetite depressants and immunosuppressives.

Warfarin and warfarin-alcohol levels in anticoagulated patients

The relationship between dosage, prothrombin ratio, and steady-state plasma concentrations of warfarin and warfarin-alcohol, were determined in 43 patients regularly attending an anticoagulant clinic. The warfarin and warfarin-alcohol concentrations were determined by a gas chromatographic mass spectroscopic (GC/MS) method. A significant correlation was found between the dose and the plasma level of warfarin. There was no significant correlation between the prothrombin ratio and the dose of warfarin, the steady-state plasma levels of warfarin or warfarin-alcohol, or the sum of their plasma concentrations. Measurement of the plasma levels of warfarin and warfarin-alcohol is likely to be of little help clinically other than to detect failure of compliance or malabsorption.