Effect of halothane anaesthesia on salivary elimination of paracetamol

Standards of laboratory practice: analgesic drug monitoring

Analgesics are the most commonly consumed over-the-counter preparations in the United States. They are used in the treatment of various pain syndromes and other medical conditions. Although analgesics are generally perceived to be safe agents, serious toxicity may occur in the setting of acute overdose, chronic abuse, or overuse. The indications for therapeutic drug monitoring in patients using these medications appropriately is as yet not well defined. The emphasis of this discussion, therefore, is on recommendations for monitoring in situations where toxicity is suspected. Preanalytical, analytical, and practice issues including drug interactions, frequency of monitoring, pertinent ancillary tests, reporting, and special patient groups at risk for toxicity are reviewed. Recent information from a major manufacturer of evacuated tubes arguing against the use of gel tubes for blood collection for drug monitoring is included. Colorimetric/enzymatic/immunoassays for the routine/stat monitoring of acetaminophen and salicylate and diflunisal cross-reactivity with most of the currently used salicylate assays are presented. Achiral and chiral chromatographic assays and newly introduced columns such as restricted access media and/or automated chromatographic systems are reviewed for the analysis of ibuprofen, naproxen, and the recently introduced tramadol. Finally, concepts regarding future directions including drug chirality and chiral analysis are presented.

Effect of diabetes mellitus on salivary paracetamol elimination

1. Salivary elimination of paracetamol was studied in nine type I and ten type II diabetics. Ten healthy volunteers served as a control group. 2. A significant increase in the elimination half-life (t1/2) and apparent volume of distribution was observed in type I diabetics compared with controls. Clearance rate (CL) was not significantly altered. 3. In type II diabetics paracetamol elimination t1/2 was significantly increased with a corresponding decrease in CL. Apparent volume of distribution of the drug was not significantly different. 4. Paracetamol elimination t1/2 had significant correlation with fasting blood sugar values.

Salivary paracetamol elimination in patients with congestive cardiac failure

1. Salivary paracetamol elimination was studied in nine patients with congestive cardiac failure (CCF). Six healthy volunteers served as the control group. 2. Paracetamol elimination t1/2 and apparent volume of distribution were significantly higher in patients with CCF compared with controls. There was no significant change in the clearance rate. 3. Drug therapy of failure for a period of 15 days returned the t1/2 and V values to normality.