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Feng S, Strickland E, Enders J, Roslawski M, McIntire T, McIntire G. Ritalinic acid in urine: Impact of age and dose. Pract Lab Med 2021; 27:e00258. [PMID: 34754895 PMCID: PMC8561308 DOI: 10.1016/j.plabm.2021.e00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives The objective of this work was to study the results of urine drug testing for ritalinic acid (RA), the major urinary metabolite of methylphenidate (MP) (e.g., Ritalin®). The impact of age from 4 to 65 years old and older on median levels of RA was investigated as well as potential variations in pH, specific gravity and creatinine content of the patient urine samples. Design and Methods Samples from patients who were 1) prescribed MP and found to be positive for RA, 2) prescribed MP but found to be negative for RA and 3) not prescribed MP but tested positive for RA were examined by liquid chromatography – mass spectrometry/mass spectrometry (LC-MS/MS) for RA concentration. The levels of RA were examined for median and average levels and further normalized and transformed to reveal a near gaussian distribution. Results Over 20,000 samples from patients who were prescribed MP were examined for this work. Analysis of these data for a subset of patients prescribed MP and testing positive for RA revealed statistically different median values of RA for school age patients of 6 years old through 17 years old from adult patients 18 through 64 years old. Another 6751 samples were positive for RA without a prescription but were not included in the overall assessment of these data. Conclusions While not clear as to the reason, these data indicate that school age children under the age of 18 have much higher levels of RA than adult patients. These results can be used to estimate “normal” levels of RA in these chronically dosed populations.
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Affiliation(s)
- Sheng Feng
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Erin Strickland
- Ameritox, LLC, 486 Gallimore Dairy Rd, Greensboro, NC, 27409, USA
| | - Jeffery Enders
- Molecular Education, Technology and Research Innovation Center (METRIC), Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27695, USA
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Feng S, Bridgewater B, Strickland EC, McIntire G. A Rapid LC-MS-MS Method for the Quantitation of Antiepileptic Drugs in Urine. J Anal Toxicol 2020; 44:688-696. [PMID: 32744607 DOI: 10.1093/jat/bkaa095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/15/2020] [Accepted: 07/13/2020] [Indexed: 01/22/2023] Open
Abstract
Epilepsy is a common neurologic disease that requires treatment with one or more medications. Due to the polypharmaceutical treatments, potential side effects, and drug-drug interactions associated with these medications, therapeutic drug monitoring is important. Therapeutic drug monitoring is typically performed in blood due to established clinical ranges. While blood provides the benefit of determining clinical ranges, urine requires a less invasive collection method, which is attractive for medication monitoring. As urine does not typically have established clinical ranges, it has not become a preferred specimen for monitoring medication adherence. Thus, large urine clinical data sets are rarely published, making method development that addresses reasonable concentration ranges difficult. An initial method developed and validated in-house utilized a universal analytical range of 50-5,000 ng/mL for all antiepileptic drugs and metabolites of interest in this work, namely carbamazepine, carbamazepine-10,11-epoxide, eslicarbazepine, lamotrigine, levetiracetam, oxcarbazepine, phenytoin, 4-hydroxyphenytoin, and topiramate. This upper limit of the analytical range was too low leading to a repeat rate of 11.59% due to concentrations >5,000 ng/mL. Therefore, a new, fast liquid chromatography-tandem mass spectrometry (LC-MS-MS) method with a run time under 4 minutes was developed and validated for the simultaneous quantification of the previously mentioned nine antiepileptic drugs and their metabolites. Urine samples were prepared by solid-phase extraction and analyzed using a Phenomenex Phenyl-Hexyl column with an Agilent 6460 LC-MS-MS instrument system. During method development and validation, the analytical range was optimized for each drug to reduce repeat analysis due to concentrations above the linear range and for carryover. This reduced the average daily repeat rate for antiepileptic testing from 11.59% to 4.82%. After validation, this method was used to test and analyze patient specimens over the course of approximately one year. The resulting concentration data were curated to eliminate specimens that could indicate an individual was noncompliant with their therapy (i.e., positive for illicit drugs) and yielded between 20 and 1,700 concentration points from the patient specimens, depending on the analyte. The resulting raw quantitative urine data set is presented as preliminary reference ranges to assist with interpreting urine drug concentrations for the nine aforementioned antiepileptic medications and metabolites.
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Affiliation(s)
- Sheng Feng
- Department of Toxicology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brandi Bridgewater
- Research and Development Department, Ameritox LLC, 486 Gallimore Dairy Rd, Greensboro, NC 27409, USA
| | - Erin C Strickland
- Research and Development Department, Ameritox LLC, 486 Gallimore Dairy Rd, Greensboro, NC 27409, USA
| | - Gregory McIntire
- Research and Development Department, Premier Biotech, 723 Kasota Ave SE, Minneapolis, MN 55414, USA
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Desrosiers NA, Huestis MA. Oral Fluid Drug Testing: Analytical Approaches, Issues and Interpretation of Results. J Anal Toxicol 2019; 43:415-443. [DOI: 10.1093/jat/bkz048] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/12/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022] Open
Abstract
AbstractWith advances in analytical technology and new research informing result interpretation, oral fluid (OF) testing has gained acceptance over the past decades as an alternative biological matrix for detecting drugs in forensic and clinical settings. OF testing offers simple, rapid, non-invasive, observed specimen collection. This article offers a review of the scientific literature covering analytical methods and interpretation published over the past two decades for amphetamines, cannabis, cocaine, opioids, and benzodiazepines. Several analytical methods have been published for individual drug classes and, increasingly, for multiple drug classes. The method of OF collection can have a significant impact on the resultant drug concentration. Drug concentrations for amphetamines, cannabis, cocaine, opioids, and benzodiazepines are reviewed in the context of the dosing condition and the collection method. Time of last detection is evaluated against several agencies' cutoffs, including the proposed Substance Abuse and Mental Health Services Administration, European Workplace Drug Testing Society and Driving Under the Influence of Drugs, Alcohol and Medicines cutoffs. A significant correlation was frequently observed between matrices (i.e., between OF and plasma or blood concentrations); however, high intra-subject and inter-subject variability precludes prediction of blood concentrations from OF concentrations. This article will assist individuals in understanding the relative merits and limitations of various methods of OF collection, analysis and interpretation.
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Affiliation(s)
| | - Marilyn A Huestis
- Lambert Center for the Study of Medicinal Cannabis and Hemp, Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
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Feng S, Cummings O, McIntire G. Nicotine and cotinine in oral fluid: Passive exposure vs active smoking. Pract Lab Med 2018; 12:e00104. [PMID: 30009247 PMCID: PMC6041420 DOI: 10.1016/j.plabm.2018.e00104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/30/2018] [Accepted: 05/25/2018] [Indexed: 11/25/2022] Open
Abstract
Scheidweiler and colleagues have clinically tested and identified a reporting cutoff (10 ng/mL) of nicotine and cotinine in oral fluid that could reliably determine active smoking in patients. The results from that study were reevaluated using a large data set of oral fluid nicotine and cotinine results available from pain medication monitoring. Additionally, test results from patients using a nicotine transdermal patch delivery device are compared with those from smokers. Finally, oral fluid test results collected over a 2-year period were normalized and transformed to yield a near Gaussian distribution for nicotine. The normalized and transformed data reveal the presence of two independent populations: a larger population consistent with active smokers and a smaller population consistent with those passively exposed to smoke. Furthermore, application of this model to patients prescribed transdermal nicotine reveals oral fluid levels consistent with those of active smokers. The clinical delineation of smokers from non-smokers reported earlier is supported by the oral fluid nicotine data modelling presented herein. These data indicate that oral fluid is an acceptable sample matrix for determining the smoking status of patients. Further, these data indicate that oral fluid test results are indistinguishable between patients prescribed transdermal patches and active smokers; however, oral fluid testing can determine absence of patches or smoking.
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Affiliation(s)
- Sheng Feng
- Ameritox LLC, 486 Gallimore Dairy Rd, Greensboro, NC 27409, United States
| | - Oneka Cummings
- Insource Diagnostics, 231 W. Chestnut Ave, Monrovia, CA 91016, United States
| | - Gregory McIntire
- Ameritox LLC, 486 Gallimore Dairy Rd, Greensboro, NC 27409, United States
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Feng S, Cummings OT, McIntire G. Zolpidem and Zolpidem Carboxylic Acid Results from Medication Monitoring. J Anal Toxicol 2018; 42:491-495. [PMID: 29750249 DOI: 10.1093/jat/bky033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/20/2018] [Indexed: 11/12/2022] Open
Abstract
Zolpidem (Ambien®) is one of the "Z" drugs often used to improve sleep in older patients and those suffering from insomnia. Schwope, D.M., DePriest, A., Black, D.L., Caplan, Y.H., Cone, E.J., Heltsley, R. (2014) Determing zolpidem compliance: urinary metabolite detection and prevalence in chronic pain patients . Journal of Analytical Toxicology, 38, 513-518 reported that zolpidem in urine is not very prevalent being present <23% of the time in patient urine while the major metabolite, zolpidem 4-phenyl carboxylic acid (ZCA), is much more prevalent in urine with positive rates as high as 50% of the patient samples reviewed. Results from patient testing over a year's time are in agreement with the reported zolpidem results. However, the data observed herein for ZCA are not consistent with the earlier report. These data suggest that monitoring ZCA may result in even higher levels of positivity. Further, while the Food and Drug Administration has pointed out that female dosing should be half that given to males, results of this population testing indicate that the majority of patients (83% male and 73% female) receive 10 mg/day or 12.5 mg/day for Ambien CR® with females demonstrating statistically significantly higher levels of ZCA albeit zolpidem levels are not statistically significantly different between men and women. Estimates of patient positivity are dependent upon the value of the limit of quantification (LOQ) as demonstrated by the zolpidem results herein (LOQ = 50 ng/mL vs. 4 ng/mL). However, even with a much higher LOQ of 50 ng/mL for ZCA in this work, the positivity from ZCA results is significantly higher (e.g., 64.8%) than reported earlier (50.3%). Nevertheless, these data support the addition of ZCA for monitoring zolpidem in urine.
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Affiliation(s)
- Sheng Feng
- Ameritox, LLC, 486 Gallimore Dairy Rd, Greensboro, NC, USA
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Cummings OT, Enders J, McIntire GL. Response to: Fentanyl-Norfentanyl Concentrations During Transdermal Patch Application: LC-MS-MS Urine Analysis. J Anal Toxicol 2017; 41:165-166. [PMID: 27744370 DOI: 10.1093/jat/bkw117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Oneka T Cummings
- Ameritox, LLC, 486 Gallimore Dairy Road, Greensboro, NC 27409, USA
| | - J Enders
- Ameritox, LLC, 486 Gallimore Dairy Road, Greensboro, NC 27409, USA
| | - G L McIntire
- Ameritox, LLC, 486 Gallimore Dairy Road, Greensboro, NC 27409, USA
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