Determination of clozapine, and five antidepressants in human plasma, serum and whole blood by gas chromatography-mass spectrometry: A simple tool for clinical and postmortem toxicological analysis

Chromatographic Methods for the Analysis of the Antipsychotic Drug Clozapine and Its Major Metabolites: A Review

Clozapine (CLZ), a second-generation antipsychotic, can effectively reduce schizophrenia, bipolar disorder and major depression symptoms. This review provides an overview of all reported chromatographic methods (62 references) for the quantification of CLZ and its two main metabolites, norclozapine and clozapine N-oxide in pharmaceutical formulations, biological matrices and environmental samples.

Preparation of Ferrofluid from Adipic Acid Coated Magnetic Nanoparticles and Hydrophobic Deep Eutectic Solvent Used in Dispersive Micro-Solid-Phase Extraction: Application for the Pre-Concentration and Determination of Clozapine in Biological Samples

The aim of the present study is the preparation of a novel magnetic ferrofluid (FF) based on a hydrophobic deep eutectic solvent (DES), which is used for the extraction of trace quantities of clozapine from biological samples. For this purpose, a highly stable FF was prepared through the combination of adipic acid-coated magnetic nanoparticles (MNPs) plus tetraethylammonium chloride/thymol hDES without an additional stabilizer. These solvents were synthesized by the available and less-toxic materials, which is the appropriate option to support the solvents for the preparation of FF. In this study, a water-immiscible DES acts simultaneously as a carrier and stabilizer for the MNPs. In addition, the strong interactions between clozapine and magnetic FF could increase the extraction efficiency. The fractional factorial design was used for screening the experimental parameters. Then, the effective factors were optimized using the Box-Behnken design. The optimum extraction conditions were the following: pH of the sample solution: 8, the volume of the desorption solvent: 200 μL and desorption time: 5 min. Moreover, the suggested method exhibited low limits of detection in the range of 2.8-3.1 μg L-1. The linear range was 10.0-500.0 μg L-1 for human plasma and urine samples with acceptable recoveries greater than 91.4%. In addition, the proposed method is convenient, sensitive, effective, rapid and environmentally friendly.

Recent Advances in Analytical Techniques for Antidepressants Determination in Complex Biological Matrices: A Review

Depression is one of the most prevalent but severe of mental disorders, affecting thousands of individuals across the globe. Depression, in its most extreme form, may result in self-harm and an increased likelihood of suicide. Antidepressant drugs are first-line medications to treat mental disorders. Unfortunately, these medications are also prescribed for other in- and off-label conditions, such as deficit/hyperactivity disorders, attention disorders, migraine, smoking cessation, eating disorders, fibromyalgia, pain, and insomnia. This results in an increase in the use of antidepressant medications, leading to clinical and forensic overdose cases that could be either accidental or deliberate. The findings revealed that people who used antidepressants had a 33% greater chance of dying sooner than expected, compared to those who did not take the medications. Analytical techniques for precisely identifying and detecting antidepressants and their metabolic products in a variety of biological matrices are greatly needed to be developed and made available. Hence, this study attempts to discuss various analytical techniques used to identify and determine antidepressants in various biological matrices, which include urine, blood, oral fluid (saliva), and tissues, which are commonly encountered in clinical and forensic science laboratories.

Novel extraction method using an ISOLUTE PLD+ protein and phospholipid removal column for liquid chromatography-tandem mass spectrometry analysis of 20 psychoactive drugs in postmortem whole blood samples

A novel sample extraction method using an ISOLUTE PLD+ protein and phospholipid removal column was developed for simultaneous quantification of 20 psychoactive drugs, including antidepressants, antipsychotics, sedative-hypnotics, and amphetamines, in postmortem whole blood samples by liquid chromatography-tandem mass spectrometry. The method showed improvement in extract cleanliness compared with traditional protein precipitation and the QuEChERS extraction method. The method was validated for all analytes; the calibration curves showed good linearity, with r² values exceeding 0.991. The intra- and interday accuracies and precisions were 87.6-117.5% and 1.0-18.6%, respectively. The recovery efficiencies were in the range of 64.6-96.8%. Matrix effects were observed in the range of 82.6-116.0%. All analytes were stable under different storage conditions. This method was successfully applied in postmortem forensic sample analysis to quantify psychoactive drugs. The method described in the current study will be useful for forensic toxicological investigations.

Monoclonal Antibodies Application in Lateral Flow Immunochromatographic Assays for Drugs of Abuse Detection

Lateral flow assays (lateral flow immunoassays and nucleic acid lateral flow assays) have experienced a great boom in a wide variety of early diagnostic and screening applications. As opposed to conventional examinations (High Performance Liquid Chromatography, Polymerase Chain Reaction, Gas chromatography-Mass Spectrometry, etc.), they obtain the results of a sample's analysis within a short period. In resource-limited areas, these tests must be simple, reliable, and inexpensive. In this review, we outline the production process of antibodies against drugs of abuse (such as heroin, amphetamine, benzodiazepines, cannabis, etc.), used in lateral flow immunoassays as revelation or detection molecules, with a focus on the components, the principles, the formats, and the mechanisms of reaction of these assays. Further, we report the monoclonal antibody advantages over the polyclonal ones used against drugs of abuse. The perspective on aptamer use for lateral flow assay development was also discussed as a possible alternative to antibodies in view of improving the limit of detection, sensitivity, and specificity of lateral flow assays.

Two-phase agarose gel-electromembrane extraction: Effect of organic solvent as an acceptor phase in electroendosmosis flow phenomenon

In this study, a new mode of gel electromembrane extraction (G-EME) namely as "Two-phase G-EME", is suggested for the sensitive quantification of five basic drugs (desipramine, clomipramine, trimipramine, citalopram and clozapine) in biological samples. Compared to classical G-EME which is based on aqueous-gel-aqueous layout, herein, the aqueous acceptor phase (AP) was replaced with organic solvent. Briefly, negative electrode was immersed into the organic AP (with low conductivity) and positive electrode into the aqueous donor phase (DP). Based on our results, this simple adjustment significantly reduced electroendosmosis (EEO) flow phenomenon which is considered as the main issue in G-EME. In the workflow, target analytes were extracted from the 7.0 mL sample, across the fabricated agarose gel membrane, to the 100 μL of the AP under the optimized extraction conditions (organic solvent type: acetonitrile; pH of gel membrane: 5.0, pH of sample solution: 4.0, voltage: 45 V and extraction time: 22 min). Then, the organic AP with analytes was analyzed by gas chromatography (GC) instrument with flame-ionization detector (FID). The methodology offered limits of detection (LODs) and recoveries in the range of 1.0-1.5 ng mL^-1 and 48.5-89.0 %, respectively. Finally, we note that two-phase G-EME assembly was able to extract analytes-of-interest in the convenient and safe manner from the hazardous and difficult-to-process biological specimens such as human serum and urine.

The systemic inflammatory response syndrome in acute antipsychotic poisoning

The purpose of this study was to investigate the mutual effect of systemic inflammatory response syndrome (SIRS) accompanied with fibrinolysis, endotoxemia, and coagulation in severe cases of antipsychotic poisoning. A total of 199 patients were examined, of which 71 were men and 128 were women. The age of the patients was from 22 to 63 years, (45.3 ± 6.1 years on average). According to the results of the course of therapy, the patients were divided into two groups. In the blood plasma, the content of C-reactive protein, fibrinogen and its proteolysis products (oligopeptides, D-dimers), interleukin-6 were determined. In the first 1 to 3 days, in group 1, the level of interleukin-6 decreased and approached the normal level (P ≤ .05). The opposite trend continued throughout the observation of patients from group 2-their levels of interleukin-6 increased day by day (P ≤ .05). The concentration of D-dimer already in 1 day after admission to intensive care in patients from group 2 exceeded the norm by 14 times (P ≤ .05). The level of D-dimer correlated with the level of oligopeptides in blood plasma upon admission, as well as for 3 and 5 days after admission to intensive care: 0.36, 0.76 at P ≤ .05, 0.94 at P ≤ .01, respectively. Similar correlations were obtained for the content of oligopeptides in urine and the level of D-dimer: 0.55, 0.85 at P ≤ .05, 0.93 at P ≤ .01. In this regard, the most pronounced correlation is that between the SIRS score, plasma D-dimer level, and the plasma level of the D-dimer derivatives, oligopeptides.

Analysis of clozapine in its tablets using two novel spectrophotometric reactions targeting its tertiary amino group

Two simple spectrophotometric methodologies have been proposed and validated for the measurement of an atypical antipsychotic drug Clozapine (CLZ). Method A depends on interaction of CLZ with N-bromosuccinimide(NBS) resulting in formation of a yellowish orange colored product, measured at 320 nm. The linearity range was 5.0-70.0 μg/mL. Method B depends on condensation of the same drug with acetic acid mixed anhydride reagent producing a purple colored product, measured at 319 nm. The linearity range was 8.0-24.0 μg/mL. All parameters affecting the reaction condition (volume of both reagent, temperature, time and the different diluting solvents) were optimized. Both methods were successfully applied to assay CLZ in its pure form and tablets giving mean percentage recoveries of (98.87 ± 1.8 and 100 ± 1.7) for method A, and corresponding values of (98.6 ± 0.96 and 99.5 ± 1) for method B. Besides, the study of reactions stoichiometry was performed and the reaction mechanisms were proposed.

Investigating the Utility of Fabric Phase Sorptive Extraction and HPLC-UV-Vis/DAD to Determine Antidepressant Drugs in Environmental Aqueous Samples

Depression is considered to be one of the most prevalent mental disorders in humans. Antidepressant drugs are released in large concentrations and cause adverse effects on the environment and/or human health. Fabric Phase Sorptive Extraction (FPSE), a contemporary solid sorbent-handling technique, is a quick, sensitive, and simple analytical process. This paper describes a micro-extraction FPSE procedure coupled with High-Performance Liquid-Chromatography–Photodiode Array Detection (FPSE-HPLC–DAD) for the simultaneous extraction and analysis of five antidepressants, namely citalopram, clozapine, mirtazapine, bupropion and sertraline. Three fabric media (Whatman Cellulose filter, Whatman Microfiber Glass filter and Polylactic acid disks) and two different sol–gel sorbents (polyethylene glycol (PEG 300), alongside poly(ethylene glycol)-block-poly(propylene glycol)-block-poly(ethylene glycol) (PEG-PPG-PEG 5.800)) were tested. The best FPSE device was observed to be the microfiber glass filter coated with PEG 300 sol–gel sorbent. In addition, the parameters that affect the efficiency of the process (FPSE media and sorbents, sample pH, extraction time, elution time, etc.) were optimized. The proposed methodology displays a linear range with absolute recovery values higher than 60%, RSD% of less than 13% and LOQs in the range between 1.9–10.7 μg·L−1. Finally, the method was applied in hospital and urban effluents and lake water samples, but none of the analytes were detected.

A Pilot Study of Plasma Antipsychotic Drugs Concentrations of First Episode Patients with Psychosis From Epirus - Greece

Background:

This contribution is a study on plasma antipsychotics concentrations of first episode outpatients with psychosis (FEPs), under antipsychotic treatment; it aims to attract attention to the importance of the drug-driven management of psychiatric patients for improving adherence and clinical efficacy.

Methods:

The plasma antipsychotic concentrations were determined retrospectively (after the completion of selection of all samples) and therefore, they were not used to monitor patients’ response to pharmacotherapy. A total of 120 plasma samples from 35 psychiatric patients were collected and tested for antipsychotics. The concentrations of eight antipsychotic drugs (amisulpride, aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone and paliperidone) and seven of their metabolites were determined.

Results:

Overall, 74% of the samples had therapeutic antipsychotic levels, 19% had subtherapeutic concentrations, while supra-therapeutic concentrations were measured for clozapine (7%). Therapeutic drug concentrations were recorded in 54% of plasma samples from patients being under olanzapine medication and in all patients under long-acting injectables. Sub-therapeutic levels were either attributed to non-adherence, or they reflected residual levels due to medication changes. Supra-therapeutic levels were recorded for clozapine and were not followed by adverse effects.

Conclusion:

This is the first study on antipsychotic plasma levels conducted in Greece. Our results show the importance of performing measurement of plasma antipsychotics levels, at appropriate time intervals, for improving adherence, clinical decision making and thus clinical efficacy. Especially for FEPs, such approach could contribute to early detection of treatment limitations and improve outcome.

A Chitosan-Carbon Nanotube-Modified Microelectrode for In Situ Detection of Blood Levels of the Antipsychotic Clozapine in a Finger-Pricked Sample Volume

The antipsychotic clozapine is the most effective medication available for schizophrenia and it is the only antipsychotic with a known efficacious clinical range. However, it is dramatically underutilized due to the inability to test clozapine blood levels in finger-pricked patients' samples. This prevents obtaining immediate blood levels information, resulting in suboptimal treatment. The development of an electrochemical microsensor is presented, which enables, for the first time, clozapine detection in microliters volume whole blood. The sensor is based on a microelectrode modified with micrometer-thick biopolymer chitosan encapsulating carbon nanotubes. The developed sensor detects clozapine oxidation current, in the presence of other electroactive species in the blood, which generate overlapping electrochemical signals. Clozapine detection, characterized in whole blood from healthy volunteers, displays a sensitivity of 32 ± 3.0 µA cm^-2 µmol^-1 L and a limit-of-detection of 0.5 ± 0.03 µmol L^-1 . Finally, the developed sensor displays a reproducible electrochemical signal (0.6% relative standard deviation) and high storage stability (9.8% relative standard deviation after 8 days) in serum samples and high repeatability (9% relative standard deviation for the 5th repetition) in whole blood samples. By enabling the rapid and minimally invasive clozapine detection at the point-of-care, an optimal schizophrenia treatment is provided.

In vitro synergy of sertraline and tetracycline cannot be reproduced in pigs orally challenged with a tetracycline resistant Escherichia coli

Background

Antimicrobial helper-compounds may reverse antimicrobial resistance. Sertraline, a antidepressant drug, has been suggested as a tetracycline helper-compound. Tetracycline is the preferred antimicrobial for treatment of enteric diseases in pigs. This study is the first to evaluate the potency of sertraline as a tetracycline adjuvant in pigs.

Methods

Forty-eight nursery pigs were divided into four treatment groups: Tetracycline, sertraline, tetracycline/sertraline or un-medicated control. Fecal and ileal samples were obtained before treatment, 48 h and nine days after five days of treatment, respectively. Colony forming units (CFU) of tetracycline resistant coliforms in each sample (ileal or fecal) and CFU of an orally inoculated tetracycline-resistant strain of Escherichia coli were determined at each sampling point. The microbiome of fecal and ileal and samples was analyzed by sequencing of the 16S V3-V4 region.

Results

The results did not provide evidence that sertraline in combination with tetracycline has any impact on tetracycline resistant bacteria in either fecal or ileum samples, while in the tetracycline treated group of pigs, an increase in the prevalence of a tetracycline resistant indicator strain of Escherichia coli shortly after ended five-day treatment was observed. The ileal samples obtained shortly after ended treatment showed treatment-associated changes in the composition of the microbiota in the groups of pigs treated with tetracycline (+/−) sertraline. While tetracycline treatment increased the abundance in the reads of E. coli, sertraline/tetracycline treatment led to increased abundances of Streptococcus spp. and decreased abundances of Lactobacillus spp. However, all observed differences (on CFU counts and microbiota composition) between groups shortly after treatment had diminished in less than two weeks after last treatment day.

Conclusions

Sertraline (+/−) tetracycline treatment did not reduce the long-term level of tetracycline-resistant bacteria in the feces or small intestine contents of piglets compared to the un-medicated control group of pigs. The result of this study reflects the importance of in vivo studies for confirmation of the antimicrobial helper-compound potential of an in vitro active compound.

Electronic supplementary material

The online version of this article (10.1186/s12866-018-1383-5) contains supplementary material, which is available to authorized users.

Development and validation of a gas chromatography/tandem mass spectrometry method for simultaneous quantitation of several antipsychotics in human plasma and oral fluid

RATIONALE

Antipsychotic drugs are prescription medications used to treat psychotic disorders, such as schizophrenia, schizoaffective disorder, or psychotic depression. With several antipsychotic drugs currently available all over the world, this class of drugs has quickly gained importance in both the clinical and forensic context. This work describes the development and validation of a methodology for the determination of seven antipsychotic drugs in plasma and oral fluid samples.

METHODS

The antipsychotic drugs (chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, cyamemazine and, levomepromazine) were isolated from 0.2 mL of oral fluid and 0.5 mL of plasma using solid-phase extraction (SPE) following analysis by gas chromatography/tandem mass spectrometry (GC/MS/MS). The method was validated according to the international guidelines in terms of selectivity, linearity, accuracy, precision and recovery.

RESULTS

The procedure was linear within 2-600 ng/mL (plasma) and 2-400 ng/mL (oral fluid), the intervals varying according to the compound; a mean R² value of 0.99 was obtained and the calibrator's accuracy (mean relative error) was within a ±15 % interval for all concentrations. The limits of detection ranged from 1 to 10 ng/mL. Within- and between-run precision and accuracy were acceptable for all studied compounds. The extraction efficiency of the process ranged from 79% to 95%. The method was applied to authentic specimens.

CONCLUSIONS

The described method was proven selective and sensitive for the determination of antipsychotics in low sample volumes using SPE and GC/MS/MS. This method was considered suitable not only for routine analysis of patients undergoing antipsychotic treatment (to evaluate compliance), but also in forensic scenarios where the studied compounds may be involved. To the best of our knowledge, this is the first work that reports the determination of antipsychotic drugs in oral fluid using MS/MS.

Mitochondrial DNA copy number is associated with psychosis severity and anti-psychotic treatment

Mitochondrial pathology has been implicated in the pathogenesis of psychotic disorders. A few studies have proposed reduced leukocyte mitochondrial DNA (mtDNA) copy number in schizophrenia and bipolar disorder type I, compared to healthy controls. However, it is unknown if mtDNA copy number alteration is driven by psychosis, comorbidity or treatment. Whole blood mtDNA copy number was determined in 594 psychosis patients and corrected for platelet to leukocyte count ratio (mtDNAcn_res). The dependence of mtDNAcn_res on clinical profile, metabolic comorbidity and antipsychotic drug exposure was assessed. mtDNAcn_res was reduced with age (β = −0.210, p < 0.001), use of clozapine (β = −0.110,p = 0.012) and risperidone (β = −0.109,p = 0.014), dependent on prescribed dosage (p = 0.006 and p = 0.026, respectively), and the proportion of life on treatment (p = 0.006). Clozapine (p = 0.0005) and risperidone (p = 0.0126) had a reducing effect on the mtDNA copy number also in stem cell-derived human neurons in vitro at therapeutic plasma levels. For patients not on these drugs, psychosis severity had an effect (β = −0.129, p = 0.017), similar to age (β = −0.159, p = 0.003) and LDL (β = −0.119, p = 0.029) on whole blood mtDNAcn_res. Further research is required to determine if mtDNAcn_res reflects any psychosis-intrinsic mitochondrial changes.

Inhibitory effect of α-terpinyl acetate on cytochrome P450 2B6 enzymatic activity

Human cytochrome P450 2B6 is an important hepatic enzyme for the metabolism of xenobiotics and clinical drugs. Recently, more attention has been paid to P450 2B6 because of the increasing number of drugs it metabolizes. It has been known to interact with terpenes, the major constituents of the essential oils used for various medicinal purposes. In this study, the effect of monoterpenes on P450 2B6 catalytic activity was investigated. Recombinant P450 2B6 was expressed in Escherichia coli and purified using Ni-affinity chromatography. The purified P450 2B6 enzyme displayed bupropion hydroxylation activity in gas-mass spectrometry (GC-MS) analysis with a k_cat of 0.5 min^-1 and a K_m of 47 μM. Many terpenes displayed the type I binding spectra to purified P450 2B6 enzyme and α-terpinyl acetate showed strong binding affinity with a K_d value of 5.4 μM. In GC-MS analysis, P450 2B6 converted α-terpinyl acetate to a putative oxidative product. The bupropion hydroxylation activity of P450 2B6 was inhibited by α-terpinyl acetate and its IC₅₀ value was 10.4 μM α-Terpinyl acetate was determined to be a competitive inhibitor of P450 2B6 with a K_i value of 7.6 μM. The molecular docking model of the binding site of the P450 2B6 complex with α-terpinyl acetate was constructed. It showed the tight binding of α-terpinyl acetate in the active site of P450 2B6, which suggests that it could be a competitive substrate for P450 2B6.

Mirtazapine

Mirtazapine is one of antidepression which is used mainly in the treatment of depression, moreover, it is sometimes used in the treatment of anxiety disorders, insomnia, nausea, and vomiting, and to produce weight gain when desirable. The action of mirtazapine is an antagonist of certain adrenergic and serotonin receptors, and, furthermore, the drug is used strong as antihistamine, and it is occasionally defined as a noradrenergic and specific serotonergic antidepressant (NaSSA). The comprehensive profile of mirtazapine gives more detailed information about nomenclature, formulae, elemental analysis, and appearance. In addition, the numerous methods of drug synthesis are summarized. Also the profile covers the physicochemical properties as: the value of pK_a, drug solubility, melting point, X-ray powder diffraction, and analysis methods for example: (compendial, electrochemical, spectroscopic, and method of chromatographic). Besides that, the profile covered pharmacological profile and clinical pharmacokinetics in subtitle's (absorption, distribution, metabolism, and elimination). About 100 references were given as a proof of the above-mentioned studies.

Antipsychotic drug poisoning monitoring of clozapine in urine by using coffee ring effect based surface-enhanced Raman spectroscopy

Antipsychotics are the drugs most often involved in drug poisoning cases, and therefore, therapeutic drug monitoring (TDM) is necessary for safe and effective medication administration of these drugs. In this study, a coffee ring effect-based surface-enhanced Raman spectroscopy (CRE-SERS) method was developed and successfully used to monitor antipsychotic poisoning by using urine samples for the first time. The established method exhibited excellent SERS performance since more hot spots were obtained in the "coffee ring". Using the optimized CRE-SERS method, the sensitivity was improved one order more than that of the conventional method with reasonable reproducibility. The antipsychotic drug clozapine (CLO) spiked into urine samples at 0.5-50 μg mL^-1 was quantitatively detected, at concentrations above the thresholds for toxicity. The CRE-SERS method allowed CLO and its metabolites to be ultimately distinguished from real poisoning urine samples. The coffee-ring effect would provide more opportunities for practical applications of the SERS-based method. The frequent occurrence of drug poisoning may have created a new area for the application of the CRE-SERS method. It is anticipated that the developed method will also have great potential for other drug poisoning monitoring.

Current state of bioanalytical chromatography in clinical analysis

Chromatographic methods have become popular in clinical analysis in both routine and research laboratories.