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Pfeifer P, Hildebrand K, Angelov A, Havemann-Reinecke U, Böttcher M, Hiemke C, Prentice T, Roll SC. Levomethadone Therapeutic Drug Monitoring to Aid Opioid Withdrawal Therapy: A Short Communication. Ther Drug Monit 2023; 45:772-776. [PMID: 37651587 DOI: 10.1097/ftd.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/16/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) is recommended for opioid maintenance therapy with levomethadone. However, TDM has not yet been applied to monitor opioid withdrawal therapy clinically, although tools to improve it are required. METHODS In this observational cohort study, repeated TDM with levomethadone was performed according to a prospective opioid withdrawal study protocol. Objective and subjective opioid withdrawal symptoms were measured using validated rating scales and correlated to levomethadone plasma concentrations. Plasma levels were measured using high-pressure liquid chromatography with column switching and spectroscopic detection of methadone and its major metabolite. RESULTS This study included 31 opioid-dependent patients who participated in standardized opioid withdrawal therapy. The serum levels of levomethadone were found to be highly variable and below the recommended therapeutic reference range of 250 ng/mL for maintenance therapy. These serum levels were positively correlated with dosage (r = 0.632; P < 0.001) and inversely correlated with subjective (r = -0.29; P = 0.011) and objective (r = -0.28; P = 0.014) withdrawal symptoms. CONCLUSIONS The evidence provided sheds light on how to improve levomethadone withdrawal therapy in patients with opioid dependence. It seems likely that higher initial doses at the beginning and lower dose reductions would have been advantageous. TDM can enhance the safety of opioid withdrawal therapies, minimize withdrawal symptoms, and reduce dropout rates.
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Affiliation(s)
- Philippe Pfeifer
- University Hospital of Psychiatry and Psychotherapy Bern, Bern, Switzerland
| | - Kathrin Hildebrand
- Department of Psychiatry and Psychotherapy University Medical Center Mainz, Untere, Mainz, Germany
| | | | | | | | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy University Medical Center Mainz, Untere, Mainz, Germany
| | | | - Sibylle C Roll
- Department of Mental Health, Varisano-Klinikum Frankfurt Höchst, Frankfurt Höchst, Germany
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2
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Krebs E, Hongdilokkul N, Dale LM, Min JE, Schnepel KT, Shigeoka H, Nosyk B. The effect of a methadone reformulation on opioid agonist treatment outcomes: A population-based study in British Columbia, Canada, 2013-14. J Subst Abuse Treat 2022; 138:108714. [PMID: 35101357 PMCID: PMC9833651 DOI: 10.1016/j.jsat.2021.108714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The province of British Columbia, Canada, changed the existing oral anhydrous methadone solution to a 10-times more concentrated pre-mixed solution, Methadose®, on February 1, 2014. We aimed to assess the immediate effects of the methadone reformulation on missed doses, days off methadone, changes in medication dosing and dispensations of opioids for pain, and hospitalizations and mortality among all people receiving treatment at or near the time of the change. METHODS We conducted a population-based retrospective cohort study including all individuals receiving at least one methadone dispensation in the 12 months prior to the study period. We executed a difference-in-differences analysis by estimating a multivariate regression model to compare outcomes in the three months before and after the reformulation (November 1, 2013 to April 30, 2014) versus a time-lagged control cohort with similar characteristics observed during an equivalent nonoverlapping interval. We used daily individual-level linked health administrative data capturing missed doses, days off methadone, changes in methadone dosing, concurrent dispensations of opioids for pain, hospitalizations, and mortality. We stratified the cohorts into three subgroups: (i) those receiving OAT for ≥12 months; (ii) those receiving OAT for <12 months; and (iii) those not receiving OAT at the start of the study period. We conducted sensitivity analyses and placebo tests to assess the robustness of our results. RESULTS Among the 16,339 individuals receiving methadone during the study period, the reformulation was associated with more instances of methadone dose increases (34.5% [95% Confidence Interval (CI): 27.4%, 41.5%]). For those retained in treatment ≥12 months prior to the study period (n = 7449), the reformulation was associated with more instances of methadone dose increases (50.2% [39.5%, 60.8%]) and dispensations of opioids for pain (62.2% [40.8%, 83.5%]), as well as an increase in missed doses (41.9% [29.1%, 54.7%]) and days off methadone (62.6% [39.7%, 85.4%]). We found no statistically significant change in risk of hospitalization or mortality. Sensitivity analyses supported our results. CONCLUSION Our results reinforce the need expressed by people receiving methadone for greater client involvement in the planning and implementation of regulatory changes that may impact client care, especially those patients with a relatively long treatment history.
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Affiliation(s)
- Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6,Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
| | - Natt Hongdilokkul
- BC Office of the Human Rights Commissioner, 999 Canada Place, Vancouver, British Columbia, Canada, V6C 3L5
| | - Laura M Dale
- Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
| | - Jeong E Min
- Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
| | - Kevin T Schnepel
- Department of Economics, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6
| | - Hitoshi Shigeoka
- Department of Economics, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6,Centre for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z IY6
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3
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Eap CB, Gründer G, Baumann P, Ansermot N, Conca A, Corruble E, Crettol S, Dahl ML, de Leon J, Greiner C, Howes O, Kim E, Lanzenberger R, Meyer JH, Moessner R, Mulder H, Müller DJ, Reis M, Riederer P, Ruhe HG, Spigset O, Spina E, Stegman B, Steimer W, Stingl J, Suzen S, Uchida H, Unterecker S, Vandenberghe F, Hiemke C. Tools for optimising pharmacotherapy in psychiatry (therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests): focus on antidepressants. World J Biol Psychiatry 2021; 22:561-628. [PMID: 33977870 DOI: 10.1080/15622975.2021.1878427] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives: More than 40 drugs are available to treat affective disorders. Individual selection of the optimal drug and dose is required to attain the highest possible efficacy and acceptable tolerability for every patient.Methods: This review, which includes more than 500 articles selected by 30 experts, combines relevant knowledge on studies investigating the pharmacokinetics, pharmacodynamics and pharmacogenetics of 33 antidepressant drugs and of 4 drugs approved for augmentation in cases of insufficient response to antidepressant monotherapy. Such studies typically measure drug concentrations in blood (i.e. therapeutic drug monitoring) and genotype relevant genetic polymorphisms of enzymes, transporters or receptors involved in drug metabolism or mechanism of action. Imaging studies, primarily positron emission tomography that relates drug concentrations in blood and radioligand binding, are considered to quantify target structure occupancy by the antidepressant drugs in vivo. Results: Evidence is given that in vivo imaging, therapeutic drug monitoring and genotyping and/or phenotyping of drug metabolising enzymes should be an integral part in the development of any new antidepressant drug.Conclusions: To guide antidepressant drug therapy in everyday practice, there are multiple indications such as uncertain adherence, polypharmacy, nonresponse and/or adverse reactions under therapeutically recommended doses, where therapeutic drug monitoring and cytochrome P450 genotyping and/or phenotyping should be applied as valid tools of precision medicine.
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Affiliation(s)
- C B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Switzerland, Geneva, Switzerland
| | - G Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Baumann
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - N Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A Conca
- Department of Psychiatry, Health Service District Bolzano, Bolzano, Italy.,Department of Child and Adolescent Psychiatry, South Tyrolean Regional Health Service, Bolzano, Italy
| | - E Corruble
- INSERM CESP, Team ≪MOODS≫, Service Hospitalo-Universitaire de Psychiatrie, Universite Paris Saclay, Le Kremlin Bicetre, France.,Service Hospitalo-Universitaire de Psychiatrie, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - S Crettol
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M L Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J de Leon
- Eastern State Hospital, University of Kentucky Mental Health Research Center, Lexington, KY, USA
| | - C Greiner
- Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - O Howes
- King's College London and MRC London Institute of Medical Sciences (LMS)-Imperial College, London, UK
| | - E Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - R Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - J H Meyer
- Campbell Family Mental Health Research Institute, CAMH and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - R Moessner
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - H Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,GGZ Drenthe Mental Health Services Drenthe, Assen, The Netherlands.,Department of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - D J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - M Reis
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Clinical Chemistry and Pharmacology, Skåne University Hospital, Lund, Sweden
| | - P Riederer
- Center of Mental Health, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, University of Southern Denmark Odense, Odense, Denmark
| | - H G Ruhe
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - O Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - E Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - B Stegman
- Institut für Pharmazie der Universität Regensburg, Regensburg, Germany
| | - W Steimer
- Institute for Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Munich, Germany
| | - J Stingl
- Institute for Clinical Pharmacology, University Hospital of RWTH Aachen, Germany
| | - S Suzen
- Department of Toxicology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - F Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Le Carpentier E, Deslandes G, Boidin L, Paget C, Clément R, Monteil-Ganière C. Intoxications mortelles par mésusage de fentanyl et traitement substitutif aux opiacés : description de 2 cas. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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METZGER IF, THOMAS AE, EVRARD CA, JONES DR, MASTERS AR, HAAS DM, HANELINE LS, QUINNEY SK. Stereoselective Analysis of Methadone and EDDP in Laboring Women and Neonates in Plasma and Dried Blood Spots and Association with Neonatal Abstinence Syndrome. Am J Perinatol 2021; 38:968-975. [PMID: 32052397 PMCID: PMC9393850 DOI: 10.1055/s-0040-1701505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This pilot study evaluated the relationship between maternal and neonatal R- and S-methadone and R- and S-2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) exposure and the severity of neonatal abstinence syndrome (NAS). The use of dried blood spots (DBS) as an alternative for plasma in assessing methadone and EDDP was also assessed. STUDY DESIGN Women receiving methadone for medication assisted treatment of opioid use disorder during pregnancy were eligible for recruitment. Plasma and DBS samples were collected from mothers during labor, from cord blood, and from newborns during genetic screen. R-/S-methadone and EDDP were measured by high-performance liquid chromatography tandem mass spectrometry (HPLC/MS/MS). Associations between methadone exposure, neonatal morphine requirements, and severity of NAS were examined. RESULTS Twenty women and infants completed the study. Maternal methadone dose at delivery was 112 mg/day (range = 60-180 mg/day). Sixteen neonates experienced NAS requiring morphine; three also required phenobarbital. Higher cord blood concentrations of R-methadone, R- and S-EDDP were associated with higher maximum doses of morphine (p < 0.05). CONCLUSION Maternal methadone and cord blood concentration at delivery are variable and may be potential markers of neonatal abstinence syndrome.
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Affiliation(s)
- Ingrid F. METZGER
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA,Present address University of Barilia, Brasilia, Brazil
| | - Anna E. THOMAS
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Cindy A. EVRARD
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David R. JONES
- Division of Clinical Pharmacology - Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea R. MASTERS
- Clinical Pharmacology Analytical Core - Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David M. HAAS
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA,Division of Clinical Pharmacology - Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Laura S. HANELINE
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sara K. QUINNEY
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA,Division of Clinical Pharmacology - Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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6
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The Use of the Methadone/Metabolite Ratio (MMR) to Identify an Individual Metabolic Phenotype and Assess Risks of Poor Response and Adverse Effects: Towards Scientific Methadone Dosing. J Addict Med 2021; 14:431-436. [PMID: 32032212 DOI: 10.1097/adm.0000000000000620] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Significant genetic variability of metabolism confounds reliable clinical use of methadone because physicians have no way of identifying individual patient metabolism. The methadone/metabolite ratio (MMR), the numerical ratio of serum methadone to its inactive metabolite ethylidine-dimethyl-diphenypyrrolidine (EDDP), represents the net expression of the genes controlling metabolism. The MMR has been adapted to four established pharmacogenetic metabolic categories: ultra-rapid (URM), extensive (EM, normal), intermediate (IM), and ultra-slow (USM). METHODS This study reports on the analysis of 1700 paired peak and trough serum samples for methadone and EDDP. The MMR data were stratified by metabolic category. The reliability of these categories and the relationship of the MMR to 2 other laboratory assessments, a peak/trough ratio (PTR) and a methadone half-life, was tested. Additionally, peak and trough serum levels were analyzed by MMR category. RESULTS Each category of MMR identified significantly different mean serum levels (peak and trough), peak/trough ratios, and half-lives. When serum levels were analyzed, evidence of subtherapeutic serum levels were found, predominantly in the URM and EM categories. Seventeen percent of peak serum levels were greater than 1000 ng (a level indicating potential toxicity) with a range up to 2384 ng, predominantly in the IM and USM categories. CONCLUSIONS The MMR measures an individual's phenotype for methadone metabolism. The data suggested underdosing in the URM category, as well as evidence of excessive dosing in IM and USM categories. The MMR provides a guide to safe and effective dosing, an alternative to the pharmacokinetically 'blind' dosing algorithms currently in use.
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7
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The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med 2021; 14:1-91. [PMID: 32511106 DOI: 10.1097/adm.0000000000000633] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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8
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Chalabianloo F, Fadnes LT, Høiseth G, Ohldieck C, Vold JH, Aas C, Løberg EM, Johansson KA, Bramness JG. Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:39. [PMID: 33941217 PMCID: PMC8091668 DOI: 10.1186/s13011-021-00367-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND There is little evidence-based guidance on how to optimize methadone dosages among patients with opioid addiction undergoing methadone maintenance treatment (MMT). This study aims to investigate whether self-perceived opioid withdrawal symptoms, adverse effects, and self-reported substance use in patients on MMT are related to serum methadone concentrations and the role that these variables could play in clinical decisions on dose adjustments. METHODS This naturalistic prospective cohort study included clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway, from May 2017 to January 2020. Information on age, gender, methadone daily doses and serum concentrations, subjective opioid withdrawal symptoms using 16 items Subjective Opioid Withdrawal Scale (SOWS) questionnaire, self-reported adverse effects, and substance use was obtained. Linear mixed modelling was used for analyzing the data. RESULTS The mean age of the participants was 45 years, and 33% were women. Almost half reported mild to moderate subjective opioid withdrawal symptoms, and all had experienced at least one subjective adverse effect. The use of at least one substance was reported by 88% of the participants. Serum concentration-to-dose ratios were lower among those who had reported subjective opioid withdrawal symptoms (p) = 0.039). The total SOWS score (p < 0.001); the specific subjective withdrawal symptoms of anxiety (p = 0.004), bone and muscle aches (p = 0.003), restlessness (p = 0.017), and (slightly) shaking (p = 0.046), also use of heroin (p = 0.015) and alcohol (p = 0.011) were associated with lower methadone concentrations. Cannabis use was slightly related to higher methadone concentrations (p = 0.049). CONCLUSIONS The findings suggest that the patient's self-perceived symptoms and current clinical condition are related to the serum concentrations of methadone. This interpretation supports dose adjustments based on patient-reported symptoms. In some aberrant cases, measurement of serum concentrations together with other individual assessments may be considered to support the clinical decision.
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Affiliation(s)
- Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gudrun Høiseth
- Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Christian Ohldieck
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christer Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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Teymourian H, Parrilla M, Sempionatto JR, Montiel NF, Barfidokht A, Van Echelpoel R, De Wael K, Wang J. Wearable Electrochemical Sensors for the Monitoring and Screening of Drugs. ACS Sens 2020; 5:2679-2700. [PMID: 32822166 DOI: 10.1021/acssensors.0c01318] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Wearable electrochemical sensors capable of noninvasive monitoring of chemical markers represent a rapidly emerging digital-health technology. Recent advances toward wearable continuous glucose monitoring (CGM) systems have ignited tremendous interest in expanding such sensor technology to other important fields. This article reviews for the first time wearable electrochemical sensors for monitoring therapeutic drugs and drugs of abuse. This rapidly emerging class of drug-sensing wearable devices addresses the growing demand for personalized medicine, toward improved therapeutic outcomes while minimizing the side effects of drugs and the related medical expenses. Continuous, noninvasive monitoring of therapeutic drugs within bodily fluids empowers clinicians and patients to correlate the pharmacokinetic properties with optimal outcomes by realizing patient-specific dose regulation and tracking dynamic changes in pharmacokinetics behavior while assuring the medication adherence of patients. Furthermore, wearable electrochemical drug monitoring devices can also serve as powerful screening tools in the hands of law enforcement agents to combat drug trafficking and support on-site forensic investigations. The review covers various wearable form factors developed for noninvasive monitoring of therapeutic drugs in different body fluids and toward on-site screening of drugs of abuse. The future prospects of such wearable drug monitoring devices are presented with the ultimate goals of introducing accurate real-time drug monitoring protocols and autonomous closed-loop platforms toward precise dose regulation and optimal therapeutic outcomes. Finally, current unmet challenges and existing gaps are discussed for motivating future technological innovations regarding personalized therapy. The current pace of developments and the tremendous market opportunities for such wearable drug monitoring platforms are expected to drive intense future research and commercialization efforts.
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Affiliation(s)
- Hazhir Teymourian
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | - Marc Parrilla
- AXES Research Group, Bioscience Engineering Department, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Juliane R. Sempionatto
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | - Noelia Felipe Montiel
- AXES Research Group, Bioscience Engineering Department, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Abbas Barfidokht
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | - Robin Van Echelpoel
- AXES Research Group, Bioscience Engineering Department, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Karolien De Wael
- AXES Research Group, Bioscience Engineering Department, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
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10
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Badhan RKS, Gittins R, Al Zabit D. The optimization of methadone dosing whilst treating with rifampicin: A pharmacokinetic modeling study. Drug Alcohol Depend 2019; 200:168-180. [PMID: 31122724 DOI: 10.1016/j.drugalcdep.2019.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/28/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The use of oral methadone in opioid substitution treatment (OST) for the management of opioid use disorder is established clinical practice. Confounding treatment is the increased risks of contracting Mycobacterium tuberculosis, the mainstay treatment of which incorporates the potent CYP 2B6 inducer rifampicin. METHODS This study applied pharmacokinetic modelling using virtual clinical trials, to pharmacokinetically quantify the extent and impact of rifampicin-mediated drug-drug interactions (DDI) on methadone plasma concentrations. An R-methadone model was developed and validated against 11 retrospective clinical studies prior to use in all subsequent studies. The aims were to investigate: (i) the impact of the DDI on daily methadone doses of 60 mg, 90 mg and 120 mg; (ii) dose escalation during rifampicin and (iii) dose reduction following rifampicin cessation. RESULTS A dose increase to 160 mg daily during rifampicin treatment phases was required to maintain peak methadone plasma concentrations within a derived therapeutic window of 80-700 ng/mL. Dose escalation prior to rifampicin initiation was not required and resulted in an increase in subjects with supra-therapeutic concentrations. However, during rifampicin cessation, a dose reduction of 10 mg every 2 days commencing prior to rifampicin cessation, ensured that most patients possessed a peak methadone plasma concentration within an optimal therapeutic window. IMPLICATIONS Rifampicin significantly alters methadone plasma concentrations and necessitates dose adjustments. Daily doses of almost double those used perhaps more commonly in clinical practice are required for optimal plasma concentration and careful consideration of dose reduction strategies would be required during the deinduction phase.
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Affiliation(s)
- Raj K S Badhan
- Medicines Optimisation Research Group, Aston Pharmacy School, Aston University, Birmingham, B4 7ET, United Kingdom.
| | | | - Dina Al Zabit
- Medicines Optimisation Research Group, Aston Pharmacy School, Aston University, Birmingham, B4 7ET, United Kingdom
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11
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Victorri-Vigneau C, Verstuyft C, Bouquié R, Laforgue EJ, Hardouin JB, Leboucher J, Le Geay B, Dano C, Challet-Bouju G, Grall-Bronnec M. Relevance of CYP2B6 and CYP2D6 genotypes to methadone pharmacokinetics and response in the OPAL study. Br J Clin Pharmacol 2019; 85:1538-1543. [PMID: 30907440 DOI: 10.1111/bcp.13936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 02/07/2023] Open
Abstract
AIMS Our study aimed to evaluate the impacts of the cytochrome P450 (CYP) 2B6-G516T and CYP2D6 genetic polymorphisms on pharmacokinetic and clinical parameters in patients receiving methadone maintenance treatment. METHODS Opioid PhArmacoLogy (OPAL) was a clinical survey of the sociodemographic characteristics, history and consequences of pathology associated with methadone maintenance treatment response and current addictive comorbidities. A subgroup of 72 methadone patients was genotyped. RESULTS When comparing the three CYP2B6 genotype groups, the methadone (R)- and (S)-methadone enantiomer concentrations/doses (concentrations relative to doses) were different (P = .029, P = .0019). The CYP2D6 phenotypes did not seem to be relevant with regard to methadone levels. On multivariate analysis, neither the CYP2B6 genotype nor the CYP2D6 phenotype explained the (R)-methadone concentration/dose values (P = .92; P = .86); the (S)-methadone concentration/dose values (P = .052; P = .95 [although there was a difference between the TT group and GT and GG groups {P = .019}]); or opiate cessation (P = .12; P = .90). CONCLUSION The genotyping of CYP2B6 G516T could be an interesting tool to explore methadone intervariability.
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Affiliation(s)
- Caroline Victorri-Vigneau
- INSERM UMR_S1178, Team "Depression and Antidepressants", Medicine Faculty, CESP, Paris-Sud University, Le Kremlin Bicêtre, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes and Tours, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
| | - Céline Verstuyft
- INSERM UMR_S1178, Team "Depression and Antidepressants", Medicine Faculty, CESP, Paris-Sud University, Le Kremlin Bicêtre, France.,Molecular Genetics, Pharmacogenetics and Hormonology Departments, Bicêtre Hospital, Group Paris-Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Régis Bouquié
- Clinical Pharmacology Department, CHU Nantes, Nantes, France
| | - Edouard-Jules Laforgue
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes and Tours, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France.,Addictology and Psychiatry Department, CHU Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes and Tours, France
| | | | | | - Corine Dano
- Addictology department, CHU Angers, Angers, France
| | - Gaëlle Challet-Bouju
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes and Tours, France.,Addictology and Psychiatry Department, CHU Nantes, Nantes, France
| | - Marie Grall-Bronnec
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes and Tours, France.,Addictology and Psychiatry Department, CHU Nantes, Nantes, France
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12
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Younis IR, Lakota EA, Volpe DA, Patel V, Xu Y, Sahajwalla CG. Drug-Drug Interaction Studies of Methadone and Antiviral Drugs: Lessons Learned. J Clin Pharmacol 2019; 59:1035-1043. [PMID: 30973652 DOI: 10.1002/jcph.1405] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 02/22/2019] [Indexed: 12/29/2022]
Abstract
Different views appear in the literature on the extent of specific cytochrome P450 (CYP) involvement in methadone metabolism. The aim of this work is to leverage knowledge from drug-drug interaction (DDI) studies in new drug applications between methadone and antiviral medications to better understand methadone disposition and to inform design of future DDI studies with methadone. A database of DDI studies between all FDA-approved human immunodeficiency virus and hepatitis C virus medications and methadone was constructed. The database contains data from 29 DDI studies. Sixteen of the 29 studies had statistically significant changes in methadone area under the concentration-time curve. Methadone exposure was either decreased or unchanged when it was coadministered with weak to strong CYP3A inhibitors or a moderate CYP3A4 inducer. Methadone exposure was reduced when it was coadministered with CYP2B6 inducers. The role of other enzymes (CYP2C9, CYP2C19, and CYP2D6) cannot be fully elucidated from these studies. In conclusion, CYP2B6 plays a prominent role in methadone metabolism, although methadone exposure is not sensitive to CYP3A perturbation. In designing methadone DDI studies, (1) measuring R- and S-methadone is more informative than measuring total methadone, and (2) CYP2B6 genotyping of subjects enrolled in methadone DDI studies should be considered. Finally, there is a need for the development of predictive models to determine the influence of medications on methadone disposition.
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Affiliation(s)
- Islam R Younis
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.,Current affiliation: Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Elizabeth A Lakota
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.,Intitute for Clinical Pharmacodynamics, Schenectady, NY, USA
| | - Donna A Volpe
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Vikram Patel
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yun Xu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Chandra G Sahajwalla
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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13
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de Bernardis E. Comment on "Methadone Dose Adjustments, Plasma R-Methadone Levels and Therapeutic Outcome of Heroin Users: A Randomized Clinical Trial". Eur Addict Res 2018; 24:88. [PMID: 29902789 DOI: 10.1159/000488719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022]
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14
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Mannaioni G, Lanzi C, Lotti M, Galli V, Totti A, Pacileo I, Sili M, Pracucci C, Dilaghi A, Bertieri L, Quaranta M, Orsini F, Occupati B, Michahelles A, Ciuti R, Bianchini E, Fabbro G, Biggeri A, Masini E, Moroni F. Methadone Dose Adjustments, Plasma R-Methadone Levels and Therapeutic Outcome of Heroin Users: A Randomized Clinical Trial. Eur Addict Res 2018; 24:9-18. [PMID: 29393208 DOI: 10.1159/000485029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
Abstract
AIMS We aimed to improve the retention in treatment and therapeutic outcome of methadone maintenance treatment (MMT) patients by adjusting the oral methadone dose in order to reach a "target" plasma R-methadone level (80-250 ng/mL). METHODS A multicenter randomized controlled trial was organized. RESULTS The intention-to-treat statistical analysis showed that repeated dose adjustments performed in order to obtain therapeutic plasma R-methadone levels did not improve retention in treatment of heroin-dependent patients. However, patients having plasma methadone levels in the "target range" at the beginning of the study had a better retention in treatment than controls. Furthermore, patients succeeding in keeping plasma R-methadone target levels (per protocol analysis) remained in treatment and improved their social scores better than controls. -Conclusion: Although the primary endpoint of this study was not demonstrated, a post hoc and a per protocol analysis suggested that patients in MMT with plasma R-methadone concentrations in the target range have a better therapeutic outcome than controls.
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Affiliation(s)
- Guido Mannaioni
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Cecilia Lanzi
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Michela Lotti
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Valentina Galli
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Arianna Totti
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Ilaria Pacileo
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Maria Sili
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Chiara Pracucci
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Arianna Dilaghi
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Lara Bertieri
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Mariarita Quaranta
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Francesco Orsini
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | | | | | | | | | | | | | - Emanuela Masini
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
| | - Flavio Moroni
- Department of NEUROFARBA, Pharmacology Section, University of Florence, Florence, Italy.,AOUC Hospital, Medical Toxicology Unit, Florence, Italy
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15
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Moroni F, Mannaioni G. Response to Letter to the Editor by Ernesto de Bernadis. Eur Addict Res 2018; 24:89-90. [PMID: 29902790 DOI: 10.1159/000488720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
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16
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17
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Chen YH, Wu KL, Tsai MT, Chien WH, Chen ML, Wang Y. Methadone enhances human influenza A virus replication. Addict Biol 2017; 22:257-271. [PMID: 26350582 DOI: 10.1111/adb.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 12/24/2022]
Abstract
Growing evidence has indicated that opioids enhance replication of human immunodeficiency virus and hepatitis C virus in target cells. However, it is unknown whether opioids can enhance replication of other clinically important viral pathogens. In this study, the interaction of opioid agonists and human influenza A/WSN/33 (H1N1) virus was examined in human lung epithelial A549 cells. Cells were exposed to morphine, methadone or buprenorphine followed by human H1N1 viral infection. Exposure to methadone differentially enhanced viral propagation, consistent with an increase in virus adsorption, susceptibility to virus infection and viral protein synthesis. In contrast, morphine or buprenorphine did not alter H1N1 replication. Because A549 cells do not express opioid receptors, methadone-enhanced H1N1 replication in human lung cells may not be mediated through these receptors. The interaction of methadone and H1N1 virus was also examined in adult mice. Treatment with methadone significantly increased H1N1 viral replication in lungs. Our data suggest that use of methadone facilitates influenza A viral infection in lungs and might raise concerns regarding the possible consequence of an increased risk of serious influenza A virus infection in people who receive treatment in methadone maintenance programs.
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Affiliation(s)
- Yun-Hsiang Chen
- Center for Neuropsychiatric Research; National Health Research Institutes; Taiwan
- Department of Life Science; Fu Jen Catholic University; Taiwan
| | - Kuang-Lun Wu
- Center for Neuropsychiatric Research; National Health Research Institutes; Taiwan
| | - Ming-Ta Tsai
- Center for Neuropsychiatric Research; National Health Research Institutes; Taiwan
| | - Wei-Hsien Chien
- Department of Occupational Therapy; Fu Jen Catholic University; Taiwan
| | - Mao-Liang Chen
- Department of Research; Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taiwan
| | - Yun Wang
- Center for Neuropsychiatric Research; National Health Research Institutes; Taiwan
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18
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Rollman CM, Moini M. Ultrafast capillary electrophoresis/mass spectrometry of controlled substances with optical isomer separation in about a minute. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2016; 30:2070-2076. [PMID: 27470537 DOI: 10.1002/rcm.7691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Abstract
RATIONALE Analysis of forensic evidence by information-rich technologies such as mass spectrometry (MS) is one of the fastest growing areas in forensic analysis. To provide more accurate identification of forensic evidence, in the past few years there has been a growing interest in moving this technology to the field for on-site, real-time analysis. To this end, several portable mass spectrometers have been introduced; however, the analysis of controlled substances could be complicated by the existence of various isomers including optical isomers in which sentencing may depend on the identification of the isomer. To date very few portable separation devices are capable of separating and identifying the optical isomers. METHODS In this study, the application of the portable ultrafast capillary electrophoresis (UFCE) to the separation of controlled substances is presented and the results are compared with the results obtained from a bench-top CE system. Both a nominal mass ion trap mass spectrometer and an accurate mass orbitrap mass spectrometer were interfaced with CE using a porous tip capillary. RESULTS A mixture of several controlled substances can be separated and detected using UFCE/MS in about a minute using field strengths of ≥1000 V/cm. Furthermore, separation and detection of underivatized optical isomers of amphetamine, cathinone, nor-mephedrone, and pregabalin using UFCE/MS can be achieved with an analysis time of less than two minutes. Resolutions of 1.3, 3.7 and 3.8 were achieved for pregabalin, cathinone and nor-mephedrone, respectively, under UFCE/MS conditions. CONCLUSIONS Amphetamine, cathinone, nor-mephedrone and pregabalin were separated and detected in about a minute, demonstrating the utility of the portable CE instrument for the analysis of controlled substances and their optical isomers. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christopher M Rollman
- Department of Forensics Sciences, George Washington University, Washington, DC, 20007, USA
| | - Mehdi Moini
- Department of Forensics Sciences, George Washington University, Washington, DC, 20007, USA
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19
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Wedam EF, Haigney MC. The Impact of Opioids on Cardiac Electrophysiology. Curr Cardiol Rev 2016; 12:27-36. [PMID: 26818485 PMCID: PMC4807715 DOI: 10.2174/1573403x1201160126122405] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/22/2022] Open
Abstract
Synthetic opioid agents have been used in modern medicine for over a century and for opioid addiction treatment for over a half-century. Liberal use of opioids in the United States has been attended by an extraordinary increase in opioid-related mortality, with over 16,000 deaths in 2012. As there have been advances in opioid agents for pain and addiction, so have there been advances in our understanding of the cardiac effects of these agents. In the last 10 years, significant data regarding electrophysiologic effects of these agents have been collected. We aim in this review to discuss the effects on cardiac electrophysiology of the various opioid agents currently in use and the evidence that these effects are contributing to the rise in opioid-related mortality.
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Affiliation(s)
| | - Mark C Haigney
- Division of Cardiology, Department of Medicine, Uniformed Services University of the Health Sciences, A3060, USUHS, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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20
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Ogbuagu O, Friedland G, Bruce RD. Drug interactions between buprenorphine, methadone and hepatitis C therapeutics. Expert Opin Drug Metab Toxicol 2016; 12:721-31. [DOI: 10.1080/17425255.2016.1183644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - R. Douglas Bruce
- Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine, Cornell Scott-Hill Health Center, New Haven, CT, USA
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21
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Mouly S, Bloch V, Peoc'h K, Houze P, Labat L, Ksouda K, Simoneau G, Declèves X, Bergmann JF, Scherrmann JM, Laplanche JL, Lepine JP, Vorspan F. Methadone dose in heroin-dependent patients: role of clinical factors, comedications, genetic polymorphisms and enzyme activity. Br J Clin Pharmacol 2016; 79:967-77. [PMID: 25556837 DOI: 10.1111/bcp.12576] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/05/2014] [Accepted: 12/21/2014] [Indexed: 01/11/2023] Open
Abstract
AIMS Methadone is characterized by wide intersubject variability regarding the dose needed to obtain full therapeutic response. We assessed the influence of sociodemographic, ethnic, clinical, metabolic and genotypic variables on methadone maintenance dose requirement in opioid-dependent responder patients. METHODS Eighty-one stable patients (60 men and 21 women, 43.7 ± 8.1 years old, 63.1 ± 50.9 mg day(-1) methadone), divided into quartiles with respect to the median daily dose, were enrolled and underwent clinical examination, treatment history and determination of liver/intestinal cytochrome P450 (CYP) 3A4 activity measured by the midazolam test, R,S-methadone trough concentration and clinically significant polymorphisms of the OPRM1, DRD2, COMT, ABCB1, CYP2B6, CYP3A5, CYP2C19 and CYP2D6 genes. RESULTS Methadone maintenance dose was correlated to the highest dose ever used (r(2) = 0.57, P < 0.0001). Fractioned methadone intake (odds ratio 4.87, 95% confidence interval 1.27-18.6, P = 0.02), bodyweight (odds ratio 1.57, 95% confidence interval 1.01-2.44, P = 0.04), history of cocaine dependence (80 vs. 44 mg day(-1) in never-addict patients, P = 0.005) and ethnicity (Asian > Caucasian > African, P = 0.04) were independently associated with high-dose methadone in multiple regression analysis. A modest correlation was observed between liver/intestinal CYP3A4 activity and methadone dose at steady state (Spearman rank correlation coefficient [rs ] = 0.21, P = 0.06) but not with highest dose ever used (rs = 0.15, P = 0.18) or dose-normalized R,S-methadone trough concentrations (rs = -0.05, P = 0.64). Concomitant CYP3A4 inhibitors only affected the relationship between methadone dose and R,S-methadone trough concentration. None of the genetic polymorphisms explored was predictive of the methadone maintenance dose. CONCLUSIONS Methadone maintenance dose was predicted by sociodemographic and clinical variables rather than genetic polymorphisms or liver/intestinal CYP3A4 activity in stable patients.
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Affiliation(s)
- Stéphane Mouly
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France.,Unit of Therapeutic Research & Internal Medicine Department, Lariboisière-Saint Louis Hospital, Paris, France
| | - Vanessa Bloch
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France
| | - Katell Peoc'h
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France.,Laboratory of Biochemistry and Molecular Biology, Lariboisière-Saint Louis Hospital, Paris, France
| | - Pascal Houze
- Laboratory of Pharmacology, Lariboisière-Saint Louis Hospital, Paris, France
| | - Laurence Labat
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France
| | - Kamilia Ksouda
- Psychiatric Unit, Assistance Publique-Hôpitaux de Paris (APHP), Lariboisière-Saint Louis Hospital, Paris, France
| | - Guy Simoneau
- Unit of Therapeutic Research & Internal Medicine Department, Lariboisière-Saint Louis Hospital, Paris, France
| | - Xavier Declèves
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France
| | - Jean Francois Bergmann
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France.,Unit of Therapeutic Research & Internal Medicine Department, Lariboisière-Saint Louis Hospital, Paris, France
| | - Jean-Michel Scherrmann
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France
| | - Jean-Louis Laplanche
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France.,Laboratory of Biochemistry and Molecular Biology, Lariboisière-Saint Louis Hospital, Paris, France
| | - Jean-Pierre Lepine
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France.,Psychiatric Unit, Assistance Publique-Hôpitaux de Paris (APHP), Lariboisière-Saint Louis Hospital, Paris, France
| | - Florence Vorspan
- Inserm, U1144, Paris, F-75006, France.,Université Paris Descartes, UMR-S1144, Paris, F-75006, France.,Université Paris Diderot, UMR-S1144, Paris, F-75010, France.,Psychiatric Unit, Assistance Publique-Hôpitaux de Paris (APHP), Lariboisière-Saint Louis Hospital, Paris, France
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22
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Rass O, Schacht RL, Buckheit K, Johnson MW, Strain EC, Mintzer MZ. A randomized controlled trial of the effects of working memory training in methadone maintenance patients. Drug Alcohol Depend 2015; 156:38-46. [PMID: 26404954 PMCID: PMC4633307 DOI: 10.1016/j.drugalcdep.2015.08.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/02/2015] [Accepted: 08/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Working memory impairment in individuals with chronic opioid dependence can play a major role in cognitive and treatment outcomes. Cognitive training targeting working memory shows promise for improved function in substance use disorders. To date, cognitive training has not been incorporated as an adjunctive treatment for opioid dependence. METHODS Methadone maintenance patients were randomly assigned to experimental (n=28) or active control (n=28) 25-session computerized training and run in parallel. Cognitive and drug use outcomes were assessed before and after training. RESULTS Participants in the experimental condition showed performance improvements on two of four working memory measures, and both groups improved on a third measure of working memory performance. Less frequent drug use was found in the experimental group than in the control group post-training. In contrast to previous findings with stimulant users, no significant effect of working memory training on delay discounting was found using either hypothetical or real rewards. There were no group differences on working memory outcome measures that were dissimilar from the training tasks, suggesting that another mechanism (e.g., increased distress tolerance) may have driven drug use results. CONCLUSIONS Working memory training improves performance on some measures of working memory in methadone maintenance patients, and may impact drug use outcomes. Working memory training shows promise in patients with substance use disorders; however, further research is needed to understand the mechanisms through which performance is improved and drug use outcomes are impacted.
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Affiliation(s)
- Olga Rass
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Rebecca L Schacht
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
| | - Katherine Buckheit
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Matthew W Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Miriam Z Mintzer
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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23
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Lewis T, Dinh J, Leeder JS. Genetic determinants of fetal opiate exposure and risk of neonatal abstinence syndrome: Knowledge deficits and prospects for future research. Clin Pharmacol Ther 2015; 98:309-20. [PMID: 26058918 DOI: 10.1002/cpt.159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/03/2015] [Indexed: 01/11/2023]
Abstract
Opiate-dependent pregnant women receive opiate maintenance medications to prevent illicit use and withdrawal. Fetal opiate exposure causes central nervous system (CNS) alterations which manifest as postnatal physical withdrawal. The extensive variability in the Neonatal Abstinence Syndrome phenotype remains unexplained and may be related to variability in fetal exposure and response. Improved understanding of functionally significant genetic variants in pathways influencing placental opiate transfer and fetal response can lead to personalized maternal therapy and optimized neonatal outcomes.
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Affiliation(s)
- T Lewis
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.,Division of Neonatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - J Dinh
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - J S Leeder
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
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Meini M, Moncini M, Daini L, Giarratana T, Scaramelli D, Chericoni S, Stefanelli F, Rucci P. Relationship between plasma concentrations of the l-enantiomer of methadone and response to methadone maintenance treatment. Eur J Pharmacol 2015; 760:1-6. [PMID: 25891369 DOI: 10.1016/j.ejphar.2015.03.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 03/20/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
This study evaluated the relationship between the plasma concentration of l-methadone and response to methadone in real-world patients, in order to identify a minimum plasma concentration above which methadone treatment is effective. Ninety-four patients with opioid dependence under maintenance methadone treatment were consecutively recruited. Response was defined as negative urine analyses in the three weeks prior to the blood sampling. The percentage of participants with a plasma l-methadone concentration between 100 and 250 ng/ml was 54.2% among those with a methadone dosage ≥60 mg/day. Plasma l-methadone concentrations were significantly higher in patients with negative urine analyses compared with those with positive urine analyses (median 93 vs. 77 ng/ml, Mann-Whitney test, P<0.05). Above plasma l-methadone concentrations of 200 ng/ml no heroin use was reported and urine analyses were negative. Moreover, above concentrations of 250 ng/ml craving was absent. Examination of demographic correlates of treatment outcome indicated that older age, a stable job and being married were protective against the use of heroin. Mean plasma l-methadone concentration was significantly lower in patients who used cannabis compared with those who did not use cannabis, after adjusting for methadone dosage. In conclusion our results identify specific cut-offs for plasma l-methadone concentrations about which therapeutic response is observed and provide new evidence that therapeutic response is associated with patient׳s demographic characteristics. This underscores the need to monitor plasma methadone concentrations as part of Drug Addiction Services routine practice, in order to provide an objective framework for changing the methadone dosage.
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Affiliation(s)
- Milo Meini
- Department of Drug Addiction Medicine, Local Health Authority of Pisa, Italy
| | - Marco Moncini
- Department of Drug Addiction Medicine, Local Health Authority of Pisa, Italy
| | - Laura Daini
- Department of Drug Addiction Medicine, Local Health Authority of Pisa, Italy
| | - Tania Giarratana
- Department of Drug Addiction Medicine, Local Health Authority of Pisa, Italy
| | - Daniela Scaramelli
- Department of Drug Addiction Medicine, Local Health Authority of Pisa, Italy
| | - Silvio Chericoni
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Section of Forensic Medicine, University of Pisa and University Hospital Trust, Pisa, Italy
| | - Fabio Stefanelli
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Section of Forensic Medicine, University of Pisa and University Hospital Trust, Pisa, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy.
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Bouquié R, Hélène Hernando, Guillaume Deslandes, Mostefa Daho AB, Renaud C, Grall-Bronnec M, Dailly E, Jolliet P. Chiral on-line solid phase extraction coupled to liquid chromatography–tandem mass spectrometry assay for quantification of (R) and (S) enantiomers of methadone and its main metabolite in plasma. Talanta 2015; 134:373-378. [DOI: 10.1016/j.talanta.2014.11.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/17/2014] [Accepted: 11/22/2014] [Indexed: 11/28/2022]
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Rass O, Kleykamp BA, Vandrey RG, Bigelow GE, Leoutsakos JM, Stitzer ML, Strain E, Copersino ML, Mintzer MZ. Cognitive performance in methadone maintenance patients: effects of time relative to dosing and maintenance dose level. Exp Clin Psychopharmacol 2014; 22:248-256. [PMID: 24548244 PMCID: PMC4041803 DOI: 10.1037/a0035712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the long-term nature of methadone maintenance treatment, it is important to assess the extent of cognitive side effects. This study investigated cognitive and psychomotor performance in 51 methadone maintenance patients (MMP) as a function of time since last methadone dose and maintenance dose level. MMP maintained on doses ranging from 40 to 200 mg (mean = 97 mg) completed a battery of psychomotor and cognitive measures across 2 sessions, during peak and trough states, in a double-blind crossover design. Peak sessions were associated with worse performance on measures of sensory processing, psychomotor speed, divided attention, and working memory, compared with trough sessions. The effects of maintenance dose were mixed, with higher dose resulting in worse performance on aspects of attention and working memory, improved performance on executive function, and no effects on several measures. Longer treatment duration was associated with better performance on some measures, but was also associated with increased sensitivity to time since last dose (i.e., worse performance at peak vs. trough) on some measures. The results suggest that cognitive functioning can fluctuate as a function of time since last dose even in MMP who have been maintained on stable doses for an extended time (mean duration in treatment = 4 years), but worsened performance at peak is limited to a subset of functions and may not be clinically significant at these modest levels of behavioral effect. For patients on stable methadone maintenance doses, maintenance at higher doses may not significantly increase the risk of performance impairment.
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Affiliation(s)
- Olga Rass
- Address correspondence to: Olga Rass, Department
of Psychiatry and Behavioral Sciences, Behavioral Biology Research Center, Johns
Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD
21224.
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Isaza C, Henao J, Velez J, Rodríguez MA, Sierra J, Beltrán L, Sepúlveda A. [Evaluation of the Methadone Maintenance Program of the Risaralda Mental Hospital]. ACTA ACUST UNITED AC 2014; 43:96-105. [PMID: 26574964 DOI: 10.1016/j.rcp.2014.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/01/2014] [Accepted: 02/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychosocial care and methadone maintenance treatment (MMT) are the preferred strategies for the management of heroin addicts, but the results are still unsatisfactory, justifying the search and intervention of the factors influencing the response to treatment. METHODOLOGY In order to determine the contribution of demographic, clinical and genetic variables on serum concentrations and response to methadone, we investigated patients on MMT, who were receiving methadone in supervised and unchanged doses at least during the previous two weeks. The age, gender, body mass index (BMI), duration of heroin abuse, addiction to other drugs, criminal background, current daily methadone doses, time spent in the TMM, comorbidity and concomitant medication were recorded. Blood samples were taken for the determination of serum levels of racemic methadone and its R and S-enantiomers, and for typing of candidate alleles of POR, CYP2B6, ABCB1, GRIN1, OPRM1, SLC6A3, DßH and ARRB2 genes, all associated with the metabolism, tissue distribution and mechanism of action of methadone. Methadone quantification was by HPLC-DAD, and the detection of genetic markers by Real Time PCR and VNTR methods. RESULTS A total of 80 subject volunteers were enrolled, with a mean age of 23.5 (5) years (86% male), all of them were addicts of multiple drugs, 60% with a criminal background, 5.1 (2.9) years taking heroin, and 5.3 (4) months on MMT, and taking a supervised dose of 41 (12) mg/day methadone. The (R), (S) and (R, S) methadone enantiomer trough plasma levels were, 84 (40), 84 (42), and 168 (77) ng/mL, respectively. All genotypes were in Hardy-Weinberg equilibrium. The two urine tests were negative for heroin in 61.3% (49/80) of the volunteers, the decline in cocaine/crack use was 83%, 30% of marijuana, and other psychoactives (inhalants, benzodiazepines, amphetamines) decreased to zero, while the consumption of snuff remained at 93.5% (75/80). Blood concentrations of racemic methadone and its enantiomers were significantly associated with the dose/day of the medication, but none of the other demographic, clinical or genetic variables impacted on serum levels of methadone. As for the results of the MMT, non-users and occasional users of heroin, as well as those who stopped taking other psychoactive drugs, and the ones who did not, were similar as regards the demographic, genetic and clinical variables. This included the blood metahdone concentrations, except for individuals who did not reduce their consumption of other psychoactives other than heroin, who had significantly (P=.03) higher blood levels of S-methadone, compared with those who did stop taking them. CONCLUSIONS There was a significant reduction in the consumption of heroin and other psychoactives, and social rehabilitation of patients. However, the extensive overlap between effective and ineffective doses of methadone suggests the presence of personal and social variables that transcend the simple pharmacological management. These probably need to be addressed more successfully from the psychosocial features, particularly as regards to identifying and overcoming relapse-trigger experiences, as well as certain features of the patient, such as their psychological distress level or their psychiatric disorders.
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Affiliation(s)
- Carlos Isaza
- Farmacología, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia.
| | - Julieta Henao
- Genética, Facultad de Ciencias de la Salud, Laboratorio de Genética Médica, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan Velez
- Epidemiología, Dirección Científica, ESE Hospital Mental de Risaralda, Pereira, Colombia
| | | | - Juan Sierra
- Farmacodependencia, ESE Hospital Mental de Risaralda, Pereira, Colombia
| | - Leonardo Beltrán
- Laboratorio de Genética Médica, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Ana Sepúlveda
- Laboratorio de Genética Médica, Universidad Tecnológica de Pereira, Pereira, Colombia
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Somogyi AA, Barratt DT, Ali RL, Coller JK. Pharmacogenomics of methadone maintenance treatment. Pharmacogenomics 2014; 15:1007-27. [DOI: 10.2217/pgs.14.56] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Methadone is the major opioid substitution therapy for opioid dependence. Dosage is highly variable and is often controlled by the patient and prescriber according to local and national policy and guidelines. Nevertheless many genetic factors have been investigated including those affecting its metabolism (CYP2B6-consistent results), efflux transport (P-gp-inconsistent results), target μ-opioid receptor (μ-opioid receptor-inconsistent results) and a host of other receptors (DRD2) and signaling elements (GIRK2 and ARRB2; not replicated). None by themselves have been able to substantially explain dosage variation (the major but not sole end point). When multiple genes have been combined such as ABCB1, CYP2B6, OPRM1 and DRD2 a greater contribution to dosage variation was found but not as yet replicated. As stabilization of dosage needs to be made rapidly, it is imperative that larger internationally based studies be instigated so that genetic contribution to dosage can be properly assessed, which may or may not tailor to different ethnic groups and each country’s policy towards an outcome that benefits all.
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Affiliation(s)
- Andrew A Somogyi
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, 5005, Australia
| | - Daniel T Barratt
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Robert L Ali
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
- DASSA World Health Organization Collaborating Centre for Research in the Treatment of Drug & Alcohol Problems, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Janet K Coller
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
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Abstract
OBJECTIVES Methadone is a well-studied, safe, and effective medication when dispensed and consumed properly. However, a number of studies have identified elevated rates of overdose and death in patients being treated with methadone for either addiction or chronic pain. Among patients being treated with methadone in federally certified opioid treatment programs, deaths most often occur during the induction and stabilization phases of treatment. To address this issue, the federal Substance Abuse and Mental Health Services Administration invited the American Society of Addiction Medicine to convene an expert panel to develop a consensus statement on methadone induction and stabilization, with recommendations to reduce the risk of patient overdose or death related to methadone maintenance treatment of addiction. METHODS A comprehensive literature search of English-language publications (1979-2011) was conducted via MEDLINE and EMBASE. Methadone Action Group members evaluated the resulting information and collaborated in formulating the consensus statement presented here, which subsequently was reviewed by more than 100 experts in the field. RESULTS Published data indicate that deaths during methadone induction occur because the initial dose is too high, the dose is increased too rapidly, or the prescribed methadone interacts with another drug. Therefore, the Methadone Action Group has developed recommendations to help methadone providers avoid or minimize these risks. CONCLUSIONS Careful management of methadone induction and stabilization, coupled with patient education and increased clinical vigilance, can save lives in this vulnerable patient population.
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Crauwels HM, van Heeswijk RP, Vandevoorde A, Buelens A, Stevens M, Hoetelmans RM. The effect of rilpivirine on the pharmacokinetics of methadone in HIV-negative volunteers. J Clin Pharmacol 2013; 54:133-40. [DOI: 10.1002/jcph.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/31/2013] [Indexed: 11/10/2022]
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Wang SC, Ho IK, Tsou HH, Liu SW, Hsiao CF, Chen CH, Tan HKL, Lin L, Wu CS, Su LW, Huang CL, Yang YH, Liu ML, Lin KM, Liu SC, Wu HY, Kuo HW, Chen ACH, Chang YS, Liu YL. Functional genetic polymorphisms in CYP2C19 gene in relation to cardiac side effects and treatment dose in a methadone maintenance cohort. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2013; 17:519-26. [PMID: 24016178 DOI: 10.1089/omi.2012.0068] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract Methadone maintenance therapy is an established treatment for heroin dependence. This study tested the influence of functional genetic polymorphisms in CYP2C19 gene encoding a CYP450 enzyme that contributes to methadone metabolism on treatment dose, plasma concentration, and side effects of methadone. Two single nucleotide polymorphisms (SNPs), rs4986893 (exon 4) and rs4244285 (exon 5), were selected and genotyped in 366 patients receiving methadone maintenance therapy in Taiwan. The steady-state plasma concentrations of both methadone and its EDDP metabolite enantiomers were measured. SNP rs4244285 allele was significantly associated with the corrected QT interval (QTc) change in the electrocardiogram (p=0.021), and the Treatment Emergent Symptom Scale (TESS) total score (p=0.021) in patients who continued using heroin, as demonstrated with a positive urine opiate test. Using the gene dose (GD) models where the CYP2C19 SNPs were clustered into poor (0 GD) versus intermediate (1 GD) and extensive (2 GD) metabolizers, we found that the extensive metabolizers required a higher dose of methadone (p=0.035), and showed a lower plasma R-methadone/methadone dose ratio (p=0.007) in urine opiate test negative patients, as well as a greater QTc change (p=0.008) and higher total scores of TESS (p=0.018) in urine opiate test positive patients, than poor metabolizers. These results in a large study sample from Taiwan suggest that the gene dose of CYP2C19 may potentially serve as an indicator for the plasma R-methadone/methadone dose ratio and cardiac side effect in patients receiving methadone maintenance therapy. Further studies of pharmacogenetic variation in methadone pharmacokinetics and pharmacodynamics are warranted in different world populations.
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Affiliation(s)
- Sheng-Chang Wang
- 1 Center for Neuropsychiatric Research, National Health Research Institutes , Miaoli, Taiwan
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Abstract
Hepatitis C virus (HCV) antibody is present in most patients enrolled in methadone maintenance programs. Therefore, interactions between the HCV protease inhibitor telaprevir and methadone were investigated. The pharmacokinetics of R- and S-methadone were measured after administration of methadone alone and after 7 days of telaprevir (750 mg every 8 h [q8h]) coadministration in HCV-negative subjects on stable, individualized methadone therapy. Unbound R-methadone was measured in predose plasma samples before and during telaprevir coadministration. Safety and symptoms of opioid withdrawal were evaluated throughout the study. In total, 18 subjects were enrolled; 2 discontinued prior to receiving telaprevir. The minimum plasma concentration in the dosing interval (C(min)), the maximum plasma concentration (Cmax), and the area under the plasma concentration-time curve from h 0 (time of administration) to 24 h postdose (AUC(0-24)) for R-methadone were reduced by 31%, 29%, and 29%, respectively, in the presence of telaprevir. The AUC0-24 ratio of S-methadone/R-methadone was not altered. The median unbound percentage of R-methadone increased by 26% in the presence of telaprevir. The R-methadone median (absolute) unbound C(min) values in the absence (10.63 ng/ml) and presence (10.45 ng/ml) of telaprevir were similar. There were no symptoms of opioid withdrawal and no discontinuations due to adverse events. In summary, exposure to total R-methadone was reduced by approximately 30% in the presence of telaprevir, while the exposure to unbound R-methadone was unchanged. No symptoms of opioid withdrawal were observed. These results suggest that dose adjustment of methadone is not required when initiating telaprevir treatment. (This study has been registered at ClinicalTrials.gov under registration no. NCT00933283.).
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Holm KMD, Linnet K. Chiral Analysis of Methadone and its Main Metabolite, EDDP, in Postmortem Brain and Blood by Automated SPE and Liquid Chromatography-Mass Spectrometry. J Anal Toxicol 2012; 36:487-96. [DOI: 10.1093/jat/bks057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kiss B, Bogdan C, Pop A, Loghin F. A rapid UPLC-MS/MS method for simultaneous determination of flunitrazepam, 7-aminoflunitrazepam, methadone and EDDP in human, rat and rabbit plasma. Talanta 2012; 99:649-59. [PMID: 22967607 DOI: 10.1016/j.talanta.2012.06.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/18/2012] [Accepted: 06/25/2012] [Indexed: 11/17/2022]
Abstract
A simple, high-throughput, sensitive LC-ESI-MS/MS method is presented for the simultaneous determination of methadone (MET), flunitrazepam (FNZ) and their major metabolites, EDDP (2-ethilidene-1,5-dimethyl-3,3-diphenylpyrrolidone) and 7-aminoflunitrazepam (7-AFNZ), respectively, in human, rat and rabbit plasma. The isolation of the selected compounds involved a liquid-liquid extraction with ethyl acetate at a basic pH. Good chromatographic separation was achieved on a HSS T3 column (1.8 μm particle size), with a 3 min gradient elution using a mixture of acetonitrile with 0.1% formic acid (solvent A) and 5mM ammonium acetate (solvent B) as the mobile phase. The tandem mass spectrometric detection was performed in multiple reaction monitoring (MRM) mode with ionization of the analytes in positive mode. The assay was fully validated according to current acceptance criteria for bioanalytical methods validation. It was proved to be linear in the range of 0.5-250 ng/mL, with adequate accuracy and precision over this range. Based on accuracy and CV% values the LOQ and ULOQ values were set at 0.509 ng/mL and 2036 ng/mL for MET, 0.520 ng/mL and 2080 ng/mL for EDDP, 0.524 ng/mL and 2096 ng/mL for FNZ and 0.528 ng/mL and 2114 ng/mL for 7-AFNZ, respectively. The method was tested for potential matrix effects, without observing significant ion suppression. The investigated compounds stability was examined in plasma at room temperature and after three freeze-thaw cycles and in the final extract when maintained at 4 °C in the autosampler. Potential stability issues were observed only for FNZ at room temperature. The method was successfully applied to quantify the selected compounds in human, rat and rabbit plasma samples, after exposure to FNZ or simultaneous exposure to FNZ and MET.
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Affiliation(s)
- Béla Kiss
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy Iuliu Hatieganu, no. 6 Pasteur, RO-400349 Cluj-Napoca, Romania.
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Therapeutic drug monitoring for drugs used in the treatment of substance-related disorders: literature review using a therapeutic drug monitoring appropriateness rating scale. Ther Drug Monit 2012; 33:561-72. [PMID: 21912330 DOI: 10.1097/ftd.0b013e31822fbf7c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The efficacy of drugs for the treatment of substance-related disorders is moderate at best. Therapeutic drug monitoring (TDM) could be an instrument to improve outcomes. Because TDM for most of those drugs is not established, the authors reviewed the literature and built a rating scale to detect the potential added value of TDM for these pharmacologic agents. METHODS A literature search was performed for acamprosate, bupropion, buprenorphine, clomethiazole, disulfiram, methadone, naltrexone, and varenicline. The rating scale included 22 items and was divided in five categories: efficacy, toxicity, pharmacokinetics, patient characteristics, and cost-effectiveness. Three reference substances with established TDM were similarly assessed for comparison: clozapine, lithium, and nortriptyline. The three reference substances achieved scores of 15, 12, and 14 points, respectively. RESULTS Drugs for treatment of substance-related disorders achieved 3 to 17 points, 17 for methadone, 11 for buprenorphine, 10 for disulfiram, also 10 for naltrexone for the indication opioid-dependence and 9 for the indication alcohol dependence as well as bupropion, 7 points for acamprosate, 6 points for clomethiazole, and 3 for varenicline. CONCLUSIONS It is concluded that systematic evaluation of drug- and patient-related variables with the new rating scale can estimate the appropriateness of TDM. Because their rating revealed similar scores as the three reference drugs, it is proposed that TDM should be established for bupropion, buprenorphine, disulfiram or a metabolite, methadone, and naltrexone. An objective rating of drug- and patient-related characteristics could help laboratories focus their method development on the most likely drugs to require TDM along with a thorough drug use evaluation.
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Tetrault JM, Fiellin DA. Current and potential pharmacological treatment options for maintenance therapy in opioid-dependent individuals. Drugs 2012; 72:217-28. [PMID: 22235870 PMCID: PMC3701303 DOI: 10.2165/11597520-000000000-00000] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Opioid dependence, manifesting as addiction to heroin and pharmaceutical opioids is increasing. Internationally, there are an estimated 15.6 million illicit opioid users. The global economic burden of opioid dependence is profound both in terms of HIV and hepatitis C virus transmission, direct healthcare costs, and indirectly through criminal activity, absenteeism and lost productivity. Opioid agonist medications, such as methadone and buprenorphine, that stabilize neuronal systems and provide narcotic blockade are the most effective treatments. Prolonged provision of these medications, defined as maintenance treatment, typically produces improved outcomes when compared with short-duration tapers and withdrawal. The benefits of opioid agonist maintenance include decreased illicit drug use, improved retention in treatment, decreased HIV risk behaviours and decreased criminal behaviour. While regulations vary by country, these medications are becoming increasingly available internationally, especially in regions experiencing rapid transmission of HIV due to injection drug use. In this review, we describe the rationale for maintenance treatment of opioid dependence, discuss emerging uses of opioid antagonists such as naltrexone and sustained-release formulations of naltrexone and buprenorphine, and provide a description of the experimental therapies.
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Methadone, cocaine, opiates, and metabolite disposition in umbilical cord and correlations to maternal methadone dose and neonatal outcomes. Ther Drug Monit 2012; 33:443-52. [PMID: 21743375 DOI: 10.1097/ftd.0b013e31822724f0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose was to explore methadone and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) umbilical cord disposition, correlate with maternal methadone dose and neonatal outcomes, and evaluate the window of drug detection in umbilical cord of in utero illicit drug exposure. METHODS Subjects comprised 19 opioid-dependent pregnant women from 2 clinical studies, one comparing methadone and buprenorphine pharmacotherapy for opioid-dependence treatment and the second examining monetary reinforcement schedules to maintain drug abstinence. Correlations were calculated for methadone and EDDP umbilical cord concentrations and maternal methadone dose, and neonatal outcomes. Cocaine- and opiate-positive umbilical cord concentrations were compared with those in placenta and meconium, and urine specimens collected throughout gestation. RESULTS Significant positive correlations were found for umbilical cord methadone concentrations and methadone mean daily dose, mean dose during the third trimester, and methadone cumulative daily dose. Umbilical cord EDDP concentrations and EDDP/methadone concentration ratios were positively correlated to newborn length, peak neonatal abstinence syndrome (NAS) score, and time-to-peak NAS score. Methadone concentrations and EDDP/methadone ratios in umbilical cord and placenta were positively correlated. Meconium identified many more cocaine- and opiate-positive specimens than did umbilical cord. CONCLUSIONS Umbilical cord methadone concentrations were correlated to methadone doses. Also, our results indicate that methadone and EDDP concentrations might help to predict the NAS severity. Meconium proved to be more suitable than umbilical cord to detect in utero exposure to cocaine and opiates; however, umbilical cord could be useful when meconium is unavailable due to in utero or delayed expulsion.
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Garg V, Kauffman RS, Beaumont M, van Heeswijk RPG. Telaprevir: pharmacokinetics and drug interactions. Antivir Ther 2012; 17:1211-21. [DOI: 10.3851/imp2356] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 10/27/2022]
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Bogen DL, Perel JM, Helsel JC, Hanusa BH, Thompson M, Wisner KL. Estimated infant exposure to enantiomer-specific methadone levels in breastmilk. Breastfeed Med 2011; 6:377-84. [PMID: 21348770 PMCID: PMC3228593 DOI: 10.1089/bfm.2010.0060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Breastfeeding, a public health priority, improves outcomes for infants. Methadone is dispensed as a racemic mixture; R-methadone is the active enantiomer. Pharmacologic data for R-methadone in breastmilk could improve risk-benefit decision-making for treatment of lactating women. This study estimated infant exposure to R- and S-methadone via breastmilk by theoretic infant dose (TID) and relative infant dose (RID) and reported the milk-to-maternal plasma (M/P) ratio. METHODS Women treated with methadone doses of 40-200 mg/day (mean, 102 mg/day) provided concomitantly collected plasma and breastmilk samples 1-6 days after delivery. Most (16 of 20) samples were taken at the time of peak maternal plasma levels; thus infant exposure estimates are for maximum possible exposure. Concentrations of R- and S-methadone were measured in maternal plasma and breastmilk; M/P ratio, TID, and RID were calculated for each enantiomer and total methadone. RESULTS The 20 participants were 18-38 years old and publicly insured; a quarter did not complete high school, and only one was not white. R-Methadone concentration was 1.3-3.0 times that of S-methadone in all breastmilk samples. The mean (SD) R-, S-, and total methadone M/P ratios were 0.52 (0.28), 0.28 (0.15), and 0.40 (0.21), respectively. Mean (range) R-, S-, and total methadone TID were 0.02 mg/kg/day (0.004-0.099), 0.013 mg/kg/day (0.002-0.071), and 0.033 mg/kg/day (0.006-0.170), respectively. Mean (range) RID of R-, S-, and total methadone were 2.7% (0.7-10.1%), 1.6% (0.3-7.2%), and 2.1% (0.52-8.8%), respectively. CONCLUSIONS R-Methadone is found in higher concentrations than S-methadone in breastmilk. Even at high methadone doses, breastmilk methadone concentrations were relatively low and support American Academy of Pediatrics recommendations that dose should not be a factor in determining whether women on methadone breastfeed.
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Affiliation(s)
- Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Pelet A, Favrat B, Cavassini M, Eap CB, Besson J, Monnat M. Usefulness of Methadone Plasma Concentration Measurement in Patients Receiving Nevirapine or Efavirenz. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:264-8. [DOI: 10.3109/00952990.2011.591465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anne Pelet
- Department of Ambulatory Care and Community Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
Lausanne, Switzerland
| | - Bernard Favrat
- Department of Ambulatory Care and Community Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
Lausanne, Switzerland
| | - Matthias Cavassini
- Service of Infectious diseases, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
Lausanne, Switzerland
| | - Chin B. Eap
- Unit of Biochemistry and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Department of Psychiatry–Centre Hospitalier Universitaire Vaudois, University of Lausanne,
Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne,
Geneva, Switzerland
| | - Jacques Besson
- Addiction Unit, Community Psychiatry Service, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
Lausanne, Switzerland
| | - Martine Monnat
- Department of Ambulatory Care and Community Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
Lausanne, Switzerland
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Fonseca F, de la Torre R, Díaz L, Pastor A, Cuyàs E, Pizarro N, Khymenets O, Farré M, Torrens M. Contribution of cytochrome P450 and ABCB1 genetic variability on methadone pharmacokinetics, dose requirements, and response. PLoS One 2011; 6:e19527. [PMID: 21589866 PMCID: PMC3093392 DOI: 10.1371/journal.pone.0019527] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 04/06/2011] [Indexed: 12/22/2022] Open
Abstract
Although the efficacy of methadone maintenance treatment (MMT) in opioid dependence disorder has been well established, the influence of methadone pharmacokinetics in dose requirement and clinical outcome remains controversial. The aim of this study is to analyze methadone dosage in responder and nonresponder patients considering pharmacogenetic and pharmacokinetic factors that may contribute to dosage adequacy. Opioid dependence patients (meeting Diagnostic and Statistical Manual of Mental Disorders, [4(th) Edition] criteria) from a MMT community program were recruited. Patients were clinically assessed and blood samples were obtained to determine plasma concentrations of (R,S)-, (R) and (S)-methadone and to study allelic variants of genes encoding CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19, and P-glycoprotein. Responders and nonresponders were defined by illicit opioid consumption detected in random urinalysis. The final sample consisted in 105 opioid dependent patients of Caucasian origin. Responder patients received higher doses of methadone and have been included into treatment for a longer period. No differences were found in terms of genotype frequencies between groups. Only CYP2D6 metabolizing phenotype differences were found in outcome status, methadone dose requirements, and plasma concentrations, being higher in the ultrarapid metabolizers. No other differences were found between phenotype and responder status, methadone dose requirements, neither in methadone plasma concentrations. Pharmacokinetic factors could explain some but not all differences in MMT outcome and methadone dose requirements.
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Affiliation(s)
- Francina Fonseca
- Institut de Neuropsiquiatria i Addiccions - Parc de Salut Mar, Barcelona, Spain
- Universitat Pompeu Fabra (CEXS-UPF), Barcelona, Spain
- Disorders by Use of Substances Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
| | - Rafael de la Torre
- Universitat Pompeu Fabra (CEXS-UPF), Barcelona, Spain
- Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CB06/03), Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Díaz
- Institut de Neuropsiquiatria i Addiccions - Parc de Salut Mar, Barcelona, Spain
- Disorders by Use of Substances Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
| | - Antonio Pastor
- Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- Pharmacology Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Elisabet Cuyàs
- Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- Pharmacology Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Nieves Pizarro
- Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- Pharmacology Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Olha Khymenets
- Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CB06/03), Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Magí Farré
- Human Pharmacology and Clinical Neurosciences Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- Pharmacology Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Torrens
- Institut de Neuropsiquiatria i Addiccions - Parc de Salut Mar, Barcelona, Spain
- Disorders by Use of Substances Research Group, Neuropsychopharmacology Research Program, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar Research Institute), Barcelona, Spain
- Psychiatric Department, Autonomous University of Barcelona, Barcelona, Spain
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de Castro A, Jones HE, Johnson RE, Gray TR, Shakleya DM, Huestis MA. Maternal methadone dose, placental methadone concentrations, and neonatal outcomes. Clin Chem 2011; 57:449-58. [PMID: 21245372 DOI: 10.1373/clinchem.2010.154864] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few investigations have used placenta as an alternative matrix to detect in utero drug exposure, despite its availability at the time of birth and the large amount of sample. Methadone-maintained opioid-dependent pregnant women provide a unique opportunity to examine the placental disposition of methadone and metabolite [2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)], to explore their correlations with maternal methadone dose and neonatal outcomes, and to test the ability to detect in utero exposure to illicit drugs. METHODS We calculated the correlations of placental methadone and EDDP concentrations and their correlations with maternal methadone doses and neonatal outcomes. Cocaine- and opiate-positive placenta results were compared with the results for meconium samples and for urine samples collected throughout gestation. RESULTS Positive correlations were found between placental methadone and EDDP concentrations (r=0.685), and between methadone concentration and methadone dose at delivery (r=0.542), mean daily dose (r=0.554), mean third-trimester dose (r=0.591), and cumulative daily dose (r=0.639). The EDDP/methadone concentration ratio was negatively correlated with cumulative daily dose (r=-0.541) and positively correlated with peak neonatal abstinence syndrome (NAS) score (r=0.513). Placental EDDP concentration was negatively correlated with newborn head circumference (r=-0.579). Cocaine and opiate use was detected in far fewer placenta samples than in thrice-weekly urine and meconium samples, a result suggesting a short detection window for placenta. CONCLUSIONS Quantitative methadone and EDDP measurement may predict NAS severity. The placenta reflects in utero drug exposure for a shorter time than meconium but may be useful when meconium is unavailable or if documentation of recent exposure is needed.
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Affiliation(s)
- Ana de Castro
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, NIH, Baltimore, MD 21224, USA
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Huang MH, Shen AY, Wang TS, Wu HM, Kang YF, Chen CT, Hsu TI, Chen BS, Wu SN. Inhibitory action of methadone and its metabolites on erg-mediated K+ current in GH₃ pituitary tumor cells. Toxicology 2010; 280:1-9. [PMID: 21094671 DOI: 10.1016/j.tox.2010.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 10/20/2010] [Accepted: 10/21/2010] [Indexed: 01/05/2023]
Abstract
Methadone (Mtd) is a widely used opioid drug associated with the side effect of hyperprolactinemia. The mechanism of how Mtd induces prolactin secretion remains unclear. The effects of Mtd and its two main metabolites (EDDP: (±)-2-ethyl-1,5-dimethyl-3,3-diphenylpyrrolinium percholarate and EMDP: 2-ethyl-5-methyl-3,3-dipnehyl-1-pyrroline) on ion currents were investigated in GH₃ pituitary tumor cells. Hyperpolarization-elicited K+ currents in GH₃ cells bathed in a high-K(+), Ca(2+)-free solution were studied to evaluate the effects of Mtd and other related compounds on the ether-à-go-go-related-gene (erg) K(+) current (I(K(erg))). Mtd suppressed the amplitude of I(K(erg)) in a concentration-dependent manner with an IC(50) value of 10.4 μM. With the aid of a minimal binding scheme, the inhibitory action of Mtd on I(K(erg)) was estimated with a dissociation constant of 8.2 μM. Mtd tended to increase the rate of I(K(erg)) deactivation in a voltage-dependent fashion. EDDP (10 μM) had no effect on I(K(erg)), while EMDP (10μM) slightly suppressed it. In GH₃ cells incubated with naloxone (30 μM), the Mtd-induced inhibition of I(K(erg)) remained unaltered. Under cell-attached voltage-clamp recordings, Mtd increased the frequency of spontaneous action currents with no change in current amplitude. Similarly, Mtd can suppress I(K(erg)) in differentiated NG108-15 cells; dynorphin A(1-13) did not reverse Mtd-induced inhibition of I(K(erg)). This study shows that Mtd has a depressant effect on I(K(erg)), and suggests its ability to affect membrane excitability and prolactin secretion. The cyclization of Mtd, in which EDDP and EMDP are formed, tends to be critical in removal of the Mtd binding to erg K+ channel.
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Affiliation(s)
- Mei-Han Huang
- College of Medical and Health Sciences, Fooyin University, Ta-Liao, Kaohsiung County, Taiwan
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Sekar V, Tomaka F, Lefebvre E, De Pauw M, Vangeneugden T, van den Brink W, Hoetelmans R. Pharmacokinetic interactions between darunavir/ritonavir and opioid maintenance therapy using methadone or buprenorphine/naloxone. J Clin Pharmacol 2010; 51:271-8. [PMID: 20421512 DOI: 10.1177/0091270010365558] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vanitha Sekar
- Johnson & Johnson, 1125 Trenton Harbourton R, Titusville, NJ 08560-1504, USA.
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Lu WJ, Bies R, Kamden LK, Desta Z, Flockhart DA. Methadone: a substrate and mechanism-based inhibitor of CYP19 (aromatase). Drug Metab Dispos 2010; 38:1308-13. [PMID: 20410453 DOI: 10.1124/dmd.110.032474] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The peripheral conversion of testosterone to estradiol by aromatase is the primary source of endogenous estrogen in postmenopausal women. Studies indicating that placental aromatase is able to metabolize methadone to its primary metabolite, 2-ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidin (EDDP), led us to test the hypothesis that methadone is able to act as an inhibitor of aromatase. Using recombinant human CYP19, we examined the ability of methadone to bring about either reversible or mechanism-based inhibition of the conversion of testosterone to estradiol. To test for reversible inhibition, racemic methadone or its metabolite EDDP or 2-ethyl-5-methyl-3, 3-diphenylpyrroline (EMDP) was incubated for 30 min with testosterone at the K(m) (4 microM). To test for mechanism-based inhibition, microsomal preincubations were performed for up to 30 min using racemic methadone (1-1000 microM), R- or S-methadone (0.5-500 microM), or EDDP or EMDP (10 and 100 microM) followed by incubation with testosterone at a V(max) concentration (50 microM). Racemic methadone, EDDP, and EMDP did not act as competitive inhibitors of CYP19. Preincubation of methadone, EDDP, or EMDP with CYP19 resulted in time- and concentration-dependent inhibition, indicating a mechanism-based reaction that destroys CYP19 activity. The K(I) and k(inact) values for racemic methadone were calculated to be 40.6 +/- 2.8 microM and 0.061 +/- 0.001 min(-1), respectively. No stereoselectivity was observed. Methadone is metabolized by CYP19 and may act as a potent inhibitor of CYP19 in vivo. These findings may contribute to variability in methadone clearance, to drug-drug interactions, and to side effects observed in individual patients.
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Affiliation(s)
- Wenjie Jessie Lu
- Division of Clinical Pharmacology, Departments of Medicine and Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Wedekind D, Jacobs S, Karg I, Luedecke C, Schneider U, Cimander K, Baumann P, Ruether E, Poser W, Havemann-Reinecke U. Psychiatric comorbidity and additional abuse of drugs in maintenance treatment with L- and D,L-methadone. World J Biol Psychiatry 2010; 11:390-9. [PMID: 20218800 DOI: 10.3109/15622970802176487] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sixty D,L- or L-methadone treated patients in maintenance therapy were interviewed for additional drug abuse and psychiatric comorbidity; 51.7% of the entire population had a comorbid Axis-I disorder, with a higher prevalence in females (P=0.05). Comorbid patients tended to have higher abuse of benzodiazepines, alcohol, cannabis, and cocaine, but not of heroin. They had received a significantly lower D,L- (P<0.05) and L-methadone dose than non-comorbid subjects. The duration of maintenance treatment showed an inverse relationship to frequency of additional heroin intake (P<0.01). Patients with additional heroin intake over the past 30 days had been treated with a significantly lower L-methadone dosage (P<0.05) than patients without. Axis-I comorbidity appears to be decreased when relatively higher dosages of D,L- (and L-methadone) are administered; comorbid individuals, however, were on significantly lower dosages. Finally, L-, but not D,L-methadone seems to be more effective in reducing additional heroin abuse.
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Affiliation(s)
- Dirk Wedekind
- Department of Psychiatry, University of Goettingen, Goettingen, Germany.
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Heikman PK, Ojanperä IA. Inadequate Dose of Opioid-agonist Medication is Related to Misuse of Benzodiazepines. ADDICTIVE DISORDERS & THEIR TREATMENT 2009. [DOI: 10.1097/adt.0b013e31817ea8b8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vann RE, Wise LE, Varvel SA, Philibin SD, Walentiny DM, Porter JH. Route of administration influences substitution patterns in rats trained to discriminate methadone vs. vehicle. Drug Alcohol Depend 2009; 103:124-30. [PMID: 19443130 PMCID: PMC3386854 DOI: 10.1016/j.drugalcdep.2009.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 02/19/2009] [Accepted: 02/21/2009] [Indexed: 10/20/2022]
Abstract
Replacement therapy with the synthetic mu-opioid agonist methadone is an efficacious treatment for opioid abuse. While much is known about methadone's pharmacology, its discriminative stimulus properties remain largely unexplored. The present study sought to establish methadone discrimination in rats. Moreover, some research suggests that route of administration alters the discriminative stimulus of methadone. Thus, the present study also compared intraperitoneal (i.p.) and subcutaneous (s.c.) routes of administration. Male Sprague-Dawley rats were trained to discriminate 3.0mg/kg methadone (i.p.) from vehicle in a two-lever discrimination procedure. Generalization tests were conducted with a variety of compounds administered i.p. and s.c. Methadone fully substituted for itself, yielding ED(50)s of 1.5mg/kg (i.p.) and 0.2mg/kg (s.c.). Naltrexone (i.p.), an opioid antagonist produced a dose-dependent reduction in methadone-appropriate responding. The methadone stereoisomers fully substituted for methadone when given s.c.; however, when administered i.p., (+) and (-) methadone produced partial and no substitution, respectively. Heroin fully generalized to methadone regardless of administration route, while morphine fully substituted when given s.c., but not i.p. The kappa-agonist U50-488 failed to generalize to methadone with either route of administration. These results demonstrated that methadone's discriminative stimulus is mediated through mu-opioid receptor activity and is similar to that of commonly abused opioids (heroin, morphine). Additionally, route of administration produced differential results for many of the drugs tested, suggesting decreased drug bioavailability following i.p. administration due to hepatic first pass metabolism. Taken together, these results suggest that methadone's shared subjective effects with abused opioids, as well as its unique metabolic properties contribute to its efficacy in opioid maintenance therapy.
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Affiliation(s)
- Robert E. Vann
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, PO Box 980613, Richmond, VA 23298-0613, United States,Corresponding author. Tel.: +1 804 828 8060; fax: +1 804 828 2117. (R.E. Vann)
| | - Laura E. Wise
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, PO Box 980613, Richmond, VA 23298-0613, United States
| | - Stephen A. Varvel
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, PO Box 980613, Richmond, VA 23298-0613, United States
| | - Scott D. Philibin
- Department of Behavioral Neuroscience, Oregon Health & Science University, VA Medical Center (R&D 12), 3710 SW US Veterans Hospital Road, Portland, OR 97239, United States
| | - D. Matthew Walentiny
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, PO Box 980613, Richmond, VA 23298-0613, United States,Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA 23284-2018, United States
| | - Joseph H. Porter
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA 23284-2018, United States
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Cannabis and benzodiazepines as determinants of methadone trough plasma concentration variability in maintenance treatment: a transnational study. Eur J Clin Pharmacol 2009; 65:1113-20. [DOI: 10.1007/s00228-009-0706-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 06/20/2009] [Indexed: 11/25/2022]
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