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Zijp TR, Izzah Z, Åberg C, Gan CT, Bakker SJL, Touw DJ, van Boven JFM. Clinical Value of Emerging Bioanalytical Methods for Drug Measurements: A Scoping Review of Their Applicability for Medication Adherence and Therapeutic Drug Monitoring. Drugs 2021; 81:1983-2002. [PMID: 34724175 PMCID: PMC8559140 DOI: 10.1007/s40265-021-01618-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Direct quantification of drug concentrations allows for medication adherence monitoring (MAM) and therapeutic drug monitoring (TDM). Multiple less invasive methods have been developed in recent years: dried blood spots (DBS), saliva, and hair analyses. AIM To provide an overview of emerging drug quantification methods for MAM and TDM, focusing on the clinical validation of methods in patients prescribed chronic drug therapies. METHODS A scoping review was performed using a systematic search in three electronic databases covering the period 2000-2020. Screening and inclusion were performed by two independent reviewers in Rayyan. Data from the articles were aggregated in a REDCap database. The main outcome was clinical validity of methods based on study sample size, means of cross-validation, and method description. Outcomes were reported by matrix, therapeutic area and application (MAM and/or TDM). RESULTS A total of 4590 studies were identified and 175 articles were finally included; 57 on DBS, 66 on saliva and 55 on hair analyses. Most reports were in the fields of neurological diseases (37%), infectious diseases (31%), and transplantation (14%). An overview of clinical validation was generated of all measured drugs. A total of 62 drugs assays were applied for MAM and 131 for TDM. CONCLUSION MAM and TDM are increasingly possible without traditional invasive blood sampling: the strengths and limitations of DBS, saliva, and hair differ, but all have potential for valid and more convenient drug monitoring. To strengthen the quality and comparability of future evidence, standardisation of the clinical validation of the methods is recommended.
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Affiliation(s)
- Tanja R Zijp
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Zamrotul Izzah
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- University of Groningen, Groningen Research Institute of Pharmacy, Department of Pharmaceutical Analysis, Groningen, The Netherlands
| | - Christoffer Åberg
- University of Groningen, Groningen Research Institute of Pharmacy, Department of Pharmaceutical Analysis, Groningen, The Netherlands
| | - C Tji Gan
- University of Groningen, University Medical Center Groningen, Respiratory Diseases and Lung Transplantation, Groningen, The Netherlands
| | - Stephan J L Bakker
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, The Netherlands
| | - Daan J Touw
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.
- University of Groningen, Groningen Research Institute of Pharmacy, Department of Pharmaceutical Analysis, Groningen, The Netherlands.
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands.
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
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Umukoro NN, Aruldhas BW, Rossos R, Pawale D, Renschler JS, Sadhasivam S. Pharmacogenomics of oxycodone: a narrative literature review. Pharmacogenomics 2021; 22:275-290. [PMID: 33728947 DOI: 10.2217/pgs-2020-0143] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oxycodone is a semisynthetic μ- and κ-opioid receptor with agonist with a broad scope of use including postoperative analgesia as well as control of neuropathic and cancer pain. Advantages over other opioids include prolonged duration of action, greater potency than morphine and lack of histamine release or ceiling effect. Individual responses to oxycodone can vary due to genetic differences. This review article aims to summarize the oxycodone literature and provide context on its pharmacogenomics and pharmacokinetics. The evidence for clinical effect of genetic polymorphisms on oxycodone is conflicting. There is stronger evidence linking polymorphic genetic enzymes CYP2D6 and CYP3A with therapeutic outcomes. Further, research is needed to discern all of oxycodone's metabolites and their contribution to the overall analgesic effect.
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Affiliation(s)
- Nelly N Umukoro
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Blessed W Aruldhas
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, India
| | - Ryan Rossos
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA.,Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Dhanashri Pawale
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA.,Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Janelle S Renschler
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA.,Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Bruun LD, Kjeldstadli K, Temte V, Birdal M, Bachs L, Langødegård M, Strand DH, Gaare KI, Øiestad E, Høiseth G. Detection Time of Oxazepam and Zopiclone in Urine and Oral Fluid after Experimental Oral Dosing. J Anal Toxicol 2019; 43:369-377. [DOI: 10.1093/jat/bky083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/16/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Lina Dorthea Bruun
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Kari Kjeldstadli
- Department of Pharmacology, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Vidar Temte
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Morris Birdal
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Liliana Bachs
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Marit Langødegård
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Dag Helge Strand
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Kristin Irene Gaare
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Elisabeth Øiestad
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
- School of Pharmacy, University of Oslo, PO Box 1068, Blindern, Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
- Diakonhjemmet Hospital, Center for Psychopharmacology, Vinderen, Oslo, Norway
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Lu W, Zhao S, Gong M, Sun L, Ding L. Simultaneous determination of acetaminophen and oxycodone in human plasma by LC-MS/MS and its application to a pharmacokinetic study. J Pharm Anal 2018; 8:160-167. [PMID: 29922484 PMCID: PMC6004620 DOI: 10.1016/j.jpha.2018.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/22/2018] [Accepted: 01/26/2018] [Indexed: 01/31/2023] Open
Abstract
A simple and rapid liquid chromatography–tandem mass spectrometry (LC–MS/MS) method was developed and validated for simultaneous determination of acetaminophen and oxycodone in human plasma. Acetaminophen-d4 and oxycodone-d3 were used as internal standards. The challenge encountered in the method development that the high plasma concentration level of acetaminophen made the MS response saturated while the desired lower limit of quantification (LLOQ) for oxycodone was hard to reach was well solved. The analytes were extracted by protein precipitation using acetonitrile. The matrix effect of the analytes was avoided by chromatographic separation using a hydrophilic C18 column coupled with gradient elution. Multiple reaction monitoring in positive ion mode was performed on tandem mass spectrometer employing electrospray ion source. The calibration curves were linear over the concentration ranges of 40.0–8000 ng/mL and 0.200–40.0 ng/mL for acetaminophen and oxycodone, respectively. This method, which could contribute to high throughput analysis and better clinical drug monitoring, was successfully applied to a pharmacokinetic study in healthy Chinese volunteers.
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Affiliation(s)
- Wei Lu
- Department of Pharmaceutical Analysis, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, PR China.,Nanjing Clinical Tech Laboratories Inc., 18 Zhilan Road, Jiangning District, Nanjing 211000, PR China
| | - Shunbo Zhao
- Nanjing Clinical Tech Laboratories Inc., 18 Zhilan Road, Jiangning District, Nanjing 211000, PR China
| | - Meng Gong
- Department of Pharmaceutical Analysis, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, PR China.,Nanjing Clinical Tech Laboratories Inc., 18 Zhilan Road, Jiangning District, Nanjing 211000, PR China
| | - Luning Sun
- Research Division of Clinical Pharmacology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, PR China
| | - Li Ding
- Department of Pharmaceutical Analysis, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, PR China.,Nanjing Clinical Tech Laboratories Inc., 18 Zhilan Road, Jiangning District, Nanjing 211000, PR China
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5
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Griswold MK, Chai PR, Krotulski AJ, Friscia M, Chapman BP, Varma N, Boyer EW, Logan BK, Babu KM. A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose. J Med Toxicol 2017; 13:287-292. [PMID: 28971325 PMCID: PMC5711761 DOI: 10.1007/s13181-017-0632-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The adulteration of heroin with non-pharmaceutical fentanyl and other high-potency opioids is one of the factors contributing to striking increases in overdose deaths. To fully understand the magnitude of this problem, accurate detection methods for fentanyl and other novel opioid adulterant exposures are urgently required. The objective of this work was to compare the detection of fentanyl in oral fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose. METHODS This was a prospective observational study of adult Emergency Department patients who presented after a reported heroin overdose requiring naloxone administration. Participants provided paired oral fluid and urine specimens, which were prepared, extracted, and analyzed using a dual LC-QTOF-MS workflow for the identification of traditional and emerging drugs of abuse. Analytical instrumentation included SCIEX TripleTOF® 5600+ and Waters Xevo® G2-S QTOF systems. RESULTS Thirty participants (N = 30) were enrolled during the study period. Twenty-nine participants had fentanyl detected in their urine, while 27 had fentanyl identified in their oral fluid (overall agreement 93.3%, positive percent agreement 93.1%). Cohen's Kappa (k) was calculated and demonstrated moderately, significant agreement (k = 0.47; p value 0.002) in fentanyl detection between oral fluid and urine using this LC-QTOF-MS methodology. Additional novel opioids and metabolites, including norfentanyl, acetylfentanyl, and U-47700, were detected during this study. CONCLUSION In this study of individuals presenting to the ED after reported heroin overdose, a strikingly high proportion had a detectable fentanyl exposure. Using LC-QTOF-MS, the agreement between paired oral fluid and urine testing for fentanyl detection indicates a role for oral fluid testing in surveillance for nonpharmaceutical fentanyl. Additionally, the use of LC-QTOF-MS allowed for the detection of other clandestine opioids (acetylfentanyl and U-47700) in oral fluid.
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Affiliation(s)
- Matthew K Griswold
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alex J Krotulski
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA
| | - Melissa Friscia
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA
| | - Brittany P Chapman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Neha Varma
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Edward W Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry K Logan
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA
| | - Kavita M Babu
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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George R, Haywood A, Good P, Hennig S, Khan S, Norris R, Hardy J. Can Saliva and Plasma Methadone Concentrations Be Used for Enantioselective Pharmacokinetic and Pharmacodynamic Studies in Patients With Advanced Cancer? Clin Ther 2017; 39:1840-1848. [DOI: 10.1016/j.clinthera.2017.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/15/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
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George R, Lobb M, Haywood A, Khan S, Hardy J, Good P, Hennig S, Norris R. Quantitative determination of the enantiomers of methadone in human plasma and saliva by chiral column chromatography coupled with mass spectrometric detection. Talanta 2016; 149:142-148. [DOI: 10.1016/j.talanta.2015.11.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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Heiskanen T, Langel K, Gunnar T, Lillsunde P, Kalso EA. Opioid Concentrations in Oral Fluid and Plasma in Cancer Patients With Pain. J Pain Symptom Manage 2015; 50:524-32. [PMID: 25242020 DOI: 10.1016/j.jpainsymman.2014.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/30/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Measuring opioid concentrations in pain treatment is warranted in situations where optimal opioid analgesia is difficult to reach. OBJECTIVES To assess the usefulness of oral fluid (OFL) as an alternative to plasma in opioid concentration monitoring in cancer patients on chronic opioid therapy. METHODS We collected OFL and plasma samples from 64 cancer patients on controlled-release (CR) oral morphine, CR oral oxycodone, or transdermal (TD) fentanyl for pain. Samples were obtained on up to five separate days. RESULTS A total of 213 OFL and plasma samples were evaluable. All patients had detectable amounts of the CR or TD opioid in both plasma and OFL samples. The plasma concentrations of oxycodone and fentanyl (determination coefficient R(2) = 0.628 and 0.700, respectively), but not morphine (R(2) = 0.292), were moderately well correlated to the daily opioid doses. In contrast to morphine and fentanyl (mean OFL/plasma ratio 2.0 and 3.0, respectively), the OFL oxycodone concentrations were significantly higher than the respective plasma concentrations (mean OFL/plasma ratio 14.9). An active transporter could explain the much higher OFL vs. plasma concentrations of oxycodone compared with morphine and fentanyl. CONCLUSION OFL analysis is well suited for detecting the studied opioids. For morphine and fentanyl, an approximation of the plasma opioid concentrations is obtainable, whereas for oxycodone, the OFL/plasma concentration relationship is too variable for reliable approximation results.
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Affiliation(s)
- Tarja Heiskanen
- Pain Clinic, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
| | - Kaarina Langel
- Alcohol and Drug Analytics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Teemu Gunnar
- Alcohol and Drug Analytics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Pirjo Lillsunde
- Injury Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Eija A Kalso
- Pain Clinic, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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Bista SR, Haywood A, Norris R, Good P, Tapuni A, Lobb M, Hardy J. Saliva versus Plasma for Pharmacokinetic and Pharmacodynamic Studies of Fentanyl in Patients with Cancer. Clin Ther 2015; 37:2468-75. [PMID: 26404396 DOI: 10.1016/j.clinthera.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Fentanyl is widely used to relieve cancer pain. However there is great interpatient variation in the dose required to relieve pain and little knowledge about the pharmacokinetic and pharmacodynamic (PK/PD) relationship of fentanyl and pain control. Patients with cancer are fragile and there is reluctance on the part of health professionals to take multiple plasma samples for PK/PD studies. The relationship between plasma and saliva fentanyl concentrations was investigated to determine whether saliva could be a valid substitute for plasma in PK/PD studies. METHODS One hundred sixty-three paired plasma and saliva samples were collected from 56 patients prescribed transdermal fentanyl (Durogesic, Janssen-Cilag Pty Limited, NSW, Australia) at varying doses (12-200 µg/h). Pain scores were recorded at the time of sampling. Fentanyl and norfentanyl concentrations in plasma and saliva were quantified using HPLC-MS/MS. FINDINGS Saliva concentrations of fentanyl (mean = 4.84 μg/L) were much higher than paired plasma concentrations of fentanyl (mean = 0.877 μg/L). Both plasma and saliva mean concentrations of fentanyl were well correlated with dose with considerable interpatient variation at each dose. The relationship between fentanyl and norfentanyl concentrations was poor in both plasma and saliva. No correlation was observed between fentanyl concentration in plasma and saliva (r(2) = 0.3743) or free fentanyl in plasma and total saliva concentrations (r(2) = 0.1374). Pain scores and fentanyl concentration in either of the matrices were also not correlated. IMPLICATIONS No predictive correlation was observed between plasma and saliva fentanyl concentration. However the detection of higher fentanyl concentrations in saliva than plasma, with a good correlation to dose, may allow saliva to be used as an alternative to plasma in PK/PD studies of fentanyl in patients with cancer.
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Affiliation(s)
- Sudeep R Bista
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Alison Haywood
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross Norris
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Phillip Good
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia; Palliative Care, St Vincent's Private Hospital, Brisbane, Queensland, Australia
| | - Angela Tapuni
- Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia
| | - Michael Lobb
- Mater Pathology Services, South Brisbane, Queensland, Australia
| | - Janet Hardy
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia
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Cone EJ, DePriest AZ, Heltsley R, Black DL, Mitchell JM, LoDico C, Flegel R. Prescription Opioids. III. Disposition of Oxycodone in Oral Fluid and Blood Following Controlled Single-Dose Administration. J Anal Toxicol 2015; 39:192-202. [DOI: 10.1093/jat/bku176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Should the dosage of controlled-release oxycodone in advanced cancer be modified on the basis of patient characteristics? Support Care Cancer 2013; 22:325-30. [DOI: 10.1007/s00520-013-1973-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
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