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Vieira Diniz ML, Batista JM, da Silva PHR, Fernandes C. Microextraction by packed sorbent and high-performance liquid chromatography for determination of benznidazole in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1219:123640. [PMID: 36867997 DOI: 10.1016/j.jchromb.2023.123640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/20/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
Benznidazole is the main drug used in Chagas disease and its determination in plasma samples is useful in several situations. Hence, robust and accurate bioanalytical methods are needed. In this context, sample preparation deserves special attention, as it is the most error-prone, labor-intensive and time-consuming step. Microextraction by packed sorbent (MEPS) is a miniaturized technique, developed to minimize the use of hazardous solvents and sample amount. In this context, this study aimed to develop and validate a MEPS coupled to high performance liquid chromatography method for the analysis of benznidazole in human plasma. MEPS optimization was performed by a 24 full factorial experimental design, which resulted in about 25 % of recovery. The best condition was achieved when 500 µL of plasma,10 draw-eject cycles, sample volume drawn of 100 µL, and desorption with three times of 50 µL of acetonitrile were used. The chromatographic separation was performed with a C18 (150 × 4.5 mm, 5 µm) column. The mobile phase was composed of water:acetonitrile (60:40) at a flow rate of 1.0 mL min-1. The developed method was validated and proved to be selective, precise, accurate, robust and linear in the range from 0.5 to 6.0 µg mL-1. The method was applied to three healthy volunteers that made use of benznidazole tablets and showed to be adequate to assess this drug in plasma samples.
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Affiliation(s)
- Melina Luiza Vieira Diniz
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos 6627, 31270-901 Belo Horizonte, MG, Brazil
| | - Jessica Mauricio Batista
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos 6627, 31270-901 Belo Horizonte, MG, Brazil
| | - Pedro Henrique Reis da Silva
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos 6627, 31270-901 Belo Horizonte, MG, Brazil
| | - Christian Fernandes
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos 6627, 31270-901 Belo Horizonte, MG, Brazil.
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Benznidazole in Cerebrospinal Fluid: a Case Series of Chagas Disease Meningoencephalitis in HIV-Positive Patients. Antimicrob Agents Chemother 2021; 65:AAC.01922-20. [PMID: 33361290 DOI: 10.1128/aac.01922-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/08/2020] [Indexed: 11/20/2022] Open
Abstract
Chagas disease reactivation in HIV-positive people is an opportunistic infection with 79 to 100% mortality. It commonly involves the central nervous system (CNS). Early treatment with trypanocidal drugs such as benznidazole (BNZ) is crucial for this severe manifestation of Trypanosoma cruzi infection. However, limited BNZ clinical pharmacology data are available, especially its concentration in the CNS. We report a series of HIV-positive patients undergoing treatment for T. cruzi meningoencephalitis, their clinical response, and cerebrospinal fluid (CSF) and plasma BNZ concentrations. Measurements were carried out using leftover samples originally obtained for routine medical care. A high-performance liquid chromatography/tandem mass spectrometry bioanalytical method designed for BNZ plasma measurements was adapted and validated for CSF samples. Six patients were enrolled in this study from 2015 to 2019. A total of 6 CSF and 19 plasma samples were obtained. Only three of the CSF samples had detectable BNZ levels, all under 1 µg/ml. Fifteen plasma samples had detectable BNZ, and 13 were above 2 µg/ml, which is the putative trypanocidal level. We observed BNZ concentrations in human CSF and plasma. CSF BNZ concentrations were low or not measurable in all patients, suggesting that the usual BNZ doses may be suboptimal in HIV-positive patients with T. cruzi meningoencephalitis. While drug-drug and drug-disease interactions may be in part responsible, the factors leading to low CSF BNZ levels remain to be studied in detail. These findings highlight the potential of therapeutic drug monitoring in BNZ treatment and suggest that the use of higher doses may be useful for Chagas disease CNS reactivations.
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Letícia Streck, . Doro PNDM, Fernandes-Pedrosa MF, da Silva-Júnior AA. High Performance Liquid Chromatography–Diode Array Detector Method for Benznidazole Quantitation in Lipid Based and Self Assembling Cyclodextrins Drug Delivery Systems. JOURNAL OF ANALYTICAL CHEMISTRY 2020. [DOI: 10.1134/s1061934820070163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Marson ME, Bournissen FG, Altcheh J, Moscatelli G, Moroni S, Mastrantonio GE. Presence of benznidazole conjugated metabolites in urine identified by β-glucuronidase treatment. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000218034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- María Elena Marson
- Universidad Nacional de La Plata, Argentina; Universidad Nacional de La Plata, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - Facundo García Bournissen
- Hospital de Niños Ricardo Gutiérrez, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - Jaime Altcheh
- Hospital de Niños Ricardo Gutiérrez, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | | | | | - Guido Enrique Mastrantonio
- Universidad Nacional de La Plata, Argentina; Universidad Nacional de La Plata, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
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Moroni S, Marson ME, Moscatelli G, Mastrantonio G, Bisio M, Gonzalez N, Ballering G, Altcheh J, García-Bournissen F. Negligible exposure to nifurtimox through breast milk during maternal treatment for Chagas Disease. PLoS Negl Trop Dis 2019; 13:e0007647. [PMID: 31415566 PMCID: PMC6711540 DOI: 10.1371/journal.pntd.0007647] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/27/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment with nifurtimox (NF) for Chagas disease is discouraged during breast-feeding because no information on NF transfer into breast milk is available. NF is safe and effective for paediatric and adult Chagas disease. We evaluated the degree of NF transfer into breast milk in lactating women with Chagas disease. PATIENTS AND METHODS Prospective study of a cohort of lactating women with Chagas disease. Patients were treated with NF for 1 month. NF was measured in plasma and milk by high performance liquid chromatography (HPLC). Breastfed infants were evaluated at admission, 7th and 30th day of treatment (and monthly thereafter, for 6 months). RESULTS Lactating women with chronic Chagas disease (N = 10) were enrolled (median age 28 years, range 17-36). Median NF dose was 9.75 mg/kg/day three times a day (TID). Six mothers had mild adverse drug reactions (ADRs), but no ADRs were observed in any of the breastfed infants. No interruption of breastfeeding was observed. Median NF concentrations were 2.15 mg/L (Inter quartil range (IQR) 1.32-4.55) in milk and 0.30 mg/L (IQR 0.20-0.95) in plasma. Median NF milk/plasma ratio was 16 (range 8.75-30.25). Median relative infant NF dose (assuming a daily breastmilk intake of 150 mL/kg/day) was 6.7% of the maternal dose/kg/day (IQR 2.35-7.19%). CONCLUSIONS The low concentrations of NF in breast milk and the normal clinical evaluation of the breastfed babies imply that maternal NF treatment for Chagas disease during breastfeeding is unlikely to lead to clinically relevant exposures in the breastfed infants. TRIAL REGISTRATION Clinical trial registry name and registration number: ClinicalTrials.gov NCT01744405.
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Affiliation(s)
- Samanta Moroni
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
| | - Maria Elena Marson
- Toxicology Area, Biological Sciences Department / PlaPiMu-LaSeISiC, Faculty of Exact Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina
- PlaPiMu–LaSeISiC, Buenos Aires Committee for Scientific Research, La Plata, Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
- National Research Council of Argentina (CONICET), Buenos Aires Argentina
| | - Guido Mastrantonio
- Toxicology Area, Biological Sciences Department / PlaPiMu-LaSeISiC, Faculty of Exact Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina
- PlaPiMu–LaSeISiC, Buenos Aires Committee for Scientific Research, La Plata, Buenos Aires, Argentina
| | - Margarita Bisio
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
- National Research Council of Argentina (CONICET), Buenos Aires Argentina
| | - Nicolas Gonzalez
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
| | - Griselda Ballering
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
| | - Jaime Altcheh
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
- National Research Council of Argentina (CONICET), Buenos Aires Argentina
| | - Facundo García-Bournissen
- Parasitology and Chagas Service, Buenos Aires Children´s Hospital “Dr. Ricardo Gutierrez”, Multidisciplinary Institute for Research in Pediatric Diseases (IMIPP), Buenos Aires Argentina
- National Research Council of Argentina (CONICET), Buenos Aires Argentina
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Santana ACSGV, Danda LJDA, Nunes LCC, Soares Sobrinho JL. Simultaneous Quantification of Benznidazole and Posaconazole by HPLC-DAD Using QbD Approach. J Chromatogr Sci 2019; 57:156-162. [PMID: 30496348 DOI: 10.1093/chromsci/bmy097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/14/2018] [Indexed: 11/14/2022]
Abstract
Objective To develop an analytical method to simultaneous quantification of benznidazole (BNZ) and posaconazole (POS) by high-performance liquid chromatography with diode-array detection (HPLC-DAD) using design of experiments. Methods Percentages of organic phase, buffer pH and flow rates of mobile phase were selected as independent variables by full factorial design (33), totaling 27 experiments. Significant factors were evaluated using factorial analysis of variance with 95% confidence level. Method optimization was performed using desirability profiles, considering BNZ/POS chromatographic resolution and peak areas. Further, the method was evaluated regarding its suitability and properly validated according to the international compendiums using the parameters: specificity, linearity, accuracy, precision, limit of detection and limit of quantification. Results The optimized method was achieved using Discovery® C8 column (250 mm × 4.6 mm; 5 μm particle size), methanol/acetate buffer (pH 3.5)(71:29) and detection at 260 nm. Retention times were 3.6 and 7.6 min for BNZ and POS, respectively, with good suitability of system and it was specific and linear (r2 >0.99) for both drugs, proving the efficiency of the method even in the presence of degradation products of POS. Conclusion This new method is a great alternative to perform reliable, faster and cheaper analysis since the simultaneous quantification of the association BZN/POS is not reported yet in the literature.
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Perin L, Moreira da Silva R, Fonseca KDS, Cardoso JMDO, Mathias FAS, Reis LES, Molina I, Correa-Oliveira R, Vieira PMDA, Carneiro CM. Pharmacokinetics and Tissue Distribution of Benznidazole after Oral Administration in Mice. Antimicrob Agents Chemother 2017; 61:e02410-16. [PMID: 28167558 PMCID: PMC5365712 DOI: 10.1128/aac.02410-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/29/2016] [Indexed: 12/28/2022] Open
Abstract
Specific chemotherapy using benznidazole (BNZ) for Chagas disease during the chronic stage is controversial due to its limited efficacy and toxic effects. Although BNZ has been used to treat Chagas disease since the 1970s, few studies about the biodistribution of this drug exist. In this study, BNZ tissue biodistribution in a murine model and its pharmacokinetic profile in plasma were monitored. A bioanalytical high-performance liquid chromatography method with a UV detector (HPLC-UV) was developed and validated according to the European Medicines Agency for quantification of BNZ in organs and plasma samples prepared by liquid-liquid extraction using ethyl acetate. The developed method was linear in the BNZ concentration, which ranged from 0.1 to 100.0 μg/ml for plasma, spleen, brain, colon, heart, lung, and kidney and from 0.2 to 100.0 μg/ml for liver. Validation assays demonstrated good stability for BNZ under all conditions evaluated. Pharmacokinetic parameters confirmed rapid, but low, absorption of BNZ after oral administration. Biodistribution assays demonstrated different maximum concentrations in organs and similar times to maximum concentration and mean residence times, with means of 40 min and 2.5 h, respectively. Therefore, the biodistribution of BNZ is extensive, reaching organs such as the heart and colon, which are the most relevant organs affected by Trypanosoma cruzi infection, and also the spleen, brain, liver, lungs, and kidneys. Simultaneous analyses of tissues and plasma indicated high BNZ metabolism in the liver. Our results suggest that low bioavailability, instead of inadequate biodistribution, could be responsible for therapeutic failure during the chronic phase of Chagas disease.
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Affiliation(s)
- Luísa Perin
- Laboratório de Pesquisas Clínicas, Programa de Pós-Graduação em Ciências Farmacêuticas (CiPHARMA), Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Rodrigo Moreira da Silva
- Núcleo de Pesquisas em Produtos Naturais e Sintéticos, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Kátia da Silva Fonseca
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Jamille Mirelle de Oliveira Cardoso
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Fernando Augusto Siqueira Mathias
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Levi Eduardo Soares Reis
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Israel Molina
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Tropical Medicine and International Health Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Rodrigo Correa-Oliveira
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Paula Melo de Abreu Vieira
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Morfopatologia, Departamento de Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Cláudia Martins Carneiro
- Laboratório de Pesquisas Clínicas, Programa de Pós-Graduação em Ciências Farmacêuticas (CiPHARMA), Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
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Fernández ML, Marson ME, Ramirez JC, Mastrantonio G, Schijman AG, Altcheh J, Riarte AR, Bournissen FG. Pharmacokinetic and pharmacodynamic responses in adult patients with Chagas disease treated with a new formulation of benznidazole. Mem Inst Oswaldo Cruz 2016; 111:218-21. [PMID: 26982179 PMCID: PMC4804505 DOI: 10.1590/0074-02760150401] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
Pharmacological treatment of Chagas disease with benznidazole (BNZ) is effective in children in all stages, but it is controversial in chronically infected adults. We report the pharmacokinetics and pharmacodynamics in six adult patients with Chagas disease treated with the new BNZ formulation (ABARAX®) in doses between 2.5-5.5 mg/Kg/day. All but one patient had plasmatic BNZ concentrations within the expected range. All patients finalised treatment with nondetectable Trypanosoma cruzi quantitative polymerase chain reaction, which remained nondetectable at the six month follow-up. Our data suggests parasitological responses with the new BNZ and supports the hypothesis that treatment protocols with lower BNZ doses may be effective.
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Affiliation(s)
| | - Maria Elena Marson
- Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Juan Carlos Ramirez
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Buenos Aires, Argentina
| | - Guido Mastrantonio
- Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Buenos Aires, Argentina
| | - Jaime Altcheh
- Hospital de Niños Ricardo Gutiérrez, Buenos Aire, Argentina
| | - Adelina Rosa Riarte
- Instituto Nacional de Parasitología Dr M Fatala Chabén, Buenos Aires, Argentina
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Salvador F, Sánchez-Montalvá A, Martínez-Gallo M, Sala-Cunill A, Viñas L, García-Prat M, Aparicio G, Sao Avilés A, Artaza MÁ, Ferrer B, Molina I. Evaluation of cytokine profile and HLA association in benznidazole related cutaneous reactions in patients with Chagas disease. Clin Infect Dis 2015; 61:1688-94. [PMID: 26265500 DOI: 10.1093/cid/civ690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/04/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Benznidazole is the drug of choice for Chagas disease. The major drawback of this drug is the high adverse events rate, being cutaneous reactions the most frequent one, leading to definitive withdrawal of treatment in 15%-30% of patients. METHODS Prospective observational study where adult Chagas disease patients accepting to receive benznidazole (100 mg/8 hours for 60 days) were included. The objective was to characterize the skin toxicity of benznidazole in patients with Chagas disease, determine the serum cytokine profile, and evaluate the potential association with specific HLA alleles and benznidazole concentration. Serum cytokine levels were measured at day 0, 15, and 60 of treatment. Class I and II HLA alleles were determined. When cutaneous reaction was detected, a skin biopsy was performed. Serum benznidazole concentration was determined at the time of cutaneous reaction, or at day 15 of treatment. RESULTS Fifty-two patients were included, 20(38.5%) had cutaneous reaction, and median time of appearance was 9 days. Skin biopsies showed histopathological findings consistent with drug eruption. Patients with cutaneous drug-reaction had higher proportion of eosinophilia during treatment, and higher interleukin (IL)-5 and IL-10 serum concentrations at day 15 of treatment than those without cutaneous reaction. Treatment interruption (that included moderate-severe cutaneous reactions) was more frequent in patients carrying HLA-B*3505 allele (45.5% vs 15.4%, P = .033). No differences in benznidazole serum concentration were found. CONCLUSIONS Benznidazole related cutaneous reaction rate is high, and it was produced by a delayed hypersensitivity reaction with a Th2 response. Carrying HLA-B*3505 allele could be associated with moderate-severe cutaneous reaction.
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Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Universitat Autònoma de Barcelona, PROSICS Barcelona
| | | | | | | | | | | | | | - Augusto Sao Avilés
- Department of Infectious Diseases, Universitat Autònoma de Barcelona, PROSICS Barcelona
| | - M Ángeles Artaza
- Metabolics Platform, High Technology Unit, Vall d'Hebron Research Institute
| | - Berta Ferrer
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Universitat Autònoma de Barcelona, PROSICS Barcelona
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Martínez N, Elena Marson M, Enrique Mastrantonio G, Raba J, Cerutti S. Development of a LC–MS/MS methodology for the monitoring of the antichagasic drug benznidazole in human urine. Talanta 2015; 131:656-60. [DOI: 10.1016/j.talanta.2014.08.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
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García-Bournissen F, Moroni S, Marson ME, Moscatelli G, Mastrantonio G, Bisio M, Cornou L, Ballering G, Altcheh J. Limited infant exposure to benznidazole through breast milk during maternal treatment for Chagas disease. Arch Dis Child 2015; 100:90-4. [PMID: 25210104 DOI: 10.1136/archdischild-2014-306358] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Benznidazole (BNZ) is safe and effective for the treatment of paediatric Chagas disease. Treatment of adults is also effective in many cases, but discouraged in breastfeeding women because no information on BNZ transfer into breast milk is available. We aimed to evaluate the degree of BNZ transfer into breast milk in lactating women with Chagas disease. PATIENTS AND METHODS Prospective cohort study of lactating women with Chagas disease treated with BNZ administered for 30 days. Patients and their breastfed infants were evaluated at admission, the 7th and 30th day of treatment (and monthly thereafter, for 6 months). BNZ was measured in plasma and milk by high performance liquid chromatography. The protocol was registered in ClinicalTrials.gov (#NCT01547533). RESULTS 12 lactating women with chronic Chagas disease were enrolled (median age 28.5 years, range 20-34). Median BNZ dose was 5.65 mg/kg/day twice daily. Five mothers had adverse drug events (45%), but no adverse drug reactions or any untoward outcomes were observed in the breastfed infants. Median milk BNZ concentration was 3.8 mg/L (range 0.3-5.9) and 6.26 mg/L (range 0.3-12.6) in plasma. Median BNZ milk to plasma ratio was 0.52 (range 0.3-2.79). Median relative BNZ dose received by the infant (assuming a daily breast milk intake of 150 mL/kg/day) was 12.3% of the maternal dose per kg (range 5.5%-17%). CONCLUSIONS The limited transference of BNZ into breast milk and the reassuring normal clinical evaluation of the breastfed babies suggest that maternal BNZ treatment for Chagas disease during breast feeding is unlikely to present a risk for the breastfed infant. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01547533.
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Affiliation(s)
- Facundo García-Bournissen
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Samanta Moroni
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Maria Elena Marson
- Toxicology Area, Biological Sciences Department/PlaPiMu-LaSeISiC, Faculty of Exact Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina PlaPiMu-LaSeISiC, Buenos Aires Committee for Scientific Research, La Plata, Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Guido Mastrantonio
- Toxicology Area, Biological Sciences Department/PlaPiMu-LaSeISiC, Faculty of Exact Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina PlaPiMu-LaSeISiC, Buenos Aires Committee for Scientific Research, La Plata, Buenos Aires, Argentina
| | - Margarita Bisio
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Laura Cornou
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Griselda Ballering
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Jaime Altcheh
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
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Davanço MG, de Campos ML, Peccinini RG. Rapid and sensitive ultra-high-pressure liquid chromatography method for quantification of antichagasic benznidazole in plasma: application in a preclinical pharmacokinetic study. Biomed Chromatogr 2014; 29:1008-15. [DOI: 10.1002/bmc.3386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/25/2014] [Accepted: 10/13/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Marcelo Gomes Davanço
- Department of Natural Active Principles and Toxicology, School of Pharmaceutical Sciences; São Paulo State University; Araraquara São Paulo Brazil
| | - Michel Leandro de Campos
- Department of Natural Active Principles and Toxicology, School of Pharmaceutical Sciences; São Paulo State University; Araraquara São Paulo Brazil
| | - Rosângela Gonçalves Peccinini
- Department of Natural Active Principles and Toxicology, School of Pharmaceutical Sciences; São Paulo State University; Araraquara São Paulo Brazil
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Current bioanalytical methods for pharmacokinetic studies of drugs used in neglected tropical diseases. Bioanalysis 2014; 6:1711-23. [DOI: 10.4155/bio.14.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Neglected tropical diseases are conditions directly associated to poverty and affect millions of people in tropical areas. Considering the necessity of pharmacokinetic and therapeutic drug monitoring studies to assess the disposition of agents clinically employed in the treatment of these diseases, especially in the involved population, this article will overview the current bioanalytical methods developed in the last 10 years, particularly those fully validated and using standard techniques, such as chromatographic procedures combined or not with mass spectrometry. The characteristics of each assay reported will be summarized and critically discussed. Furthermore, emphasis will also be given to the pros and cons in order to highlight the application of each method, especially in routine laboratories.
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Altcheh J, Moscatelli G, Mastrantonio G, Moroni S, Giglio N, Marson ME, Ballering G, Bisio M, Koren G, García-Bournissen F. Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults. PLoS Negl Trop Dis 2014; 8:e2907. [PMID: 24853169 PMCID: PMC4031103 DOI: 10.1371/journal.pntd.0002907] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to long term cardiac morbidity. Treatment of children with benznidazole is effective, but no pediatric pharmacokinetics data are available and clinical pharmacology information on the drug is scarce. PATIENTS AND METHODS Prospective population pharmacokinetic (PK) cohort study in children 2-12 years old with Chagas disease treated with oral benznidazole 5-8 mg/kg/day BID for 60 days. (clinicaltrials.gov #NCT00699387). RESULTS Forty children were enrolled in the study. Mean age was 7.3 years. A total of 117 samples were obtained from 38 patients for PK analysis. A one compartment model best fit the data. Weight-corrected clearance rate (CL/F) showed a good correlation with age, with younger patients having a significantly higher CL/F than older children and adults. Simulated median steady-state benznidazole concentrations, based on model parameters, were lower for children in our study than for adults and lowest for children under 7 years of age. Treatment was efficacious in the 37 patients who completed the treatment course, and well tolerated, with few, and mild, adverse drug reactions (ADRs). DISCUSSION Observed benznidazole plasma concentrations in children were markedly lower than those previously reported in adults (treated with comparable mg/kg doses), possibly due to a higher CL/F in smaller children. These lower blood concentrations were nevertheless associated to a high therapeutic response in our cohort. Unlike adults, children have few adverse reactions to the drug, suggesting that there may be a direct correlation between drug concentrations and incidence of ADRs. Our results suggest that studies with lower doses in adults may be warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT00699387.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guido Mastrantonio
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Norberto Giglio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Maria Elena Marson
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Gideon Koren
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Facundo García-Bournissen
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Identification of N-benzylacetamide as a major component of human plasmatic metabolic profiling of benznidazole. Eur J Drug Metab Pharmacokinet 2014; 40:209-17. [DOI: 10.1007/s13318-014-0195-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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