1
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Coates S, Lazarus P. Hydrocodone, Oxycodone, and Morphine Metabolism and Drug-Drug Interactions. J Pharmacol Exp Ther 2023; 387:150-169. [PMID: 37679047 PMCID: PMC10586512 DOI: 10.1124/jpet.123.001651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023] Open
Abstract
Awareness of drug interactions involving opioids is critical for patient treatment as they are common therapeutics used in numerous care settings, including both chronic and disease-related pain. Not only do opioids have narrow therapeutic indexes and are extensively used, but they have the potential to cause severe toxicity. Opioids are the classical pain treatment for patients who suffer from moderate to severe pain. More importantly, opioids are often prescribed in combination with multiple other drugs, especially in patient populations who typically are prescribed a large drug regimen. This review focuses on the current knowledge of common opioid drug-drug interactions (DDIs), focusing specifically on hydrocodone, oxycodone, and morphine DDIs. The DDIs covered in this review include pharmacokinetic DDI arising from enzyme inhibition or induction, primarily due to inhibition of cytochrome p450 enzymes (CYPs). However, opioids such as morphine are metabolized by uridine-5'-diphosphoglucuronosyltransferases (UGTs), principally UGT2B7, and glucuronidation is another important pathway for opioid-drug interactions. This review also covers several pharmacodynamic DDI studies as well as the basics of CYP and UGT metabolism, including detailed opioid metabolism and the potential involvement of metabolizing enzyme gene variation in DDI. Based upon the current literature, further studies are needed to fully investigate and describe the DDI potential with opioids in pain and related disease settings to improve clinical outcomes for patients. SIGNIFICANCE STATEMENT: A review of the literature focusing on drug-drug interactions involving opioids is important because they can be toxic and potentially lethal, occurring through pharmacodynamic interactions as well as pharmacokinetic interactions occurring through inhibition or induction of drug metabolism.
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Affiliation(s)
- Shelby Coates
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
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2
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Zhu Z, Huang X, Tan Z, Huang J, Chen M, He B, Cai H, Zhang B. Development of a Sensitive and Rapid HPLC-MS Method for Dihydrocodeine and Dihydromorphine: Application to Bioequivalence Studies. J Chromatogr Sci 2022; 60:977-983. [PMID: 35862985 DOI: 10.1093/chromsci/bmac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 11/14/2022]
Abstract
A ultraperformance liquid chromatography-tandem mass spectrometry method has been developed to determine dihydrocodeine (DHC) and dihydromorphine (DHM) in human plasma using dihydrocodeine-d6 and desomorphine as internal standards (IS). Acetonitrile-water-ammonium format was used as the mobile phase, in gradient elution on a C18 column. The concentration of DHC and DHM was determined in the positive ionization mode of mass spectrometry. The total chromatogram run time was 3.2 min, and the linear ranges of DHC and DHM were 1.000-400.0 ng/mL and 0.050-20.00 ng/mL, respectively. The method was fully validated concerning precision, accuracy, selectivity, linearity, recovery, stability and matrix effect. The method had been successfully applied to the bioequivalence test. In addition, we found that a high-fat diet impacts the Tmax and t1/2 of DHC.
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Affiliation(s)
- Zhenyu Zhu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410000, Hunan Province, China
| | - Xiaomei Huang
- Xiangya Boai Rehabilitation Hospital, No. 61 Wanjiali North Road, Changsha, 410000, Hunan Province, China
| | - Zheng Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Changsha Psychiatric Hospital, No. 62 Xiangzhang Road, Yuhua District, Changsha, 410000, Hunan Province, China
| | - Jian Huang
- Xiangya Boai Rehabilitation Hospital, No. 61 Wanjiali North Road, Changsha, 410000, Hunan Province, China
| | - Mei Chen
- Hunan EverPro Medical Co., Ltd, No. 299 Jiayun Road, Yuelu District, Changsha, 410000, Hunan Province, China
| | - Binbin He
- Xiangya Boai Rehabilitation Hospital, No. 61 Wanjiali North Road, Changsha, 410000, Hunan Province, China
| | - Hualin Cai
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410000, Hunan Province, China
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410000, Hunan Province, China
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3
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Thomas SN, French D, Jannetto PJ, Rappold BA, Clarke WA. Liquid chromatography–tandem mass spectrometry for clinical diagnostics. NATURE REVIEWS. METHODS PRIMERS 2022; 2:96. [PMCID: PMC9735147 DOI: 10.1038/s43586-022-00175-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 12/13/2022]
Abstract
Mass spectrometry is a powerful analytical tool used for the analysis of a wide range of substances and matrices; it is increasingly utilized for clinical applications in laboratory medicine. This Primer includes an overview of basic mass spectrometry concepts, focusing primarily on tandem mass spectrometry. We discuss experimental considerations and quality management, and provide an overview of some key applications in the clinic. Lastly, the Primer discusses significant challenges for implementation of mass spectrometry in clinical laboratories and provides an outlook of where there are emerging clinical applications for this technology. Tandem mass spectrometry is increasingly utilized for clinical applications in laboratory medicine. In this Primer, Thomas et al. discuss experimental considerations and quality management for implementing clinical tandem mass spectrometry in the clinic with an overview of some key applications.
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Affiliation(s)
- Stefani N. Thomas
- grid.17635.360000000419368657Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN USA
| | - Deborah French
- grid.266102.10000 0001 2297 6811Laboratory Medicine, University of California San Francisco, San Francisco, CA USA
| | - Paul J. Jannetto
- grid.66875.3a0000 0004 0459 167XDepartment of Pathology & Laboratory Medicine, Mayo Clinic, Rochester, MN USA
| | - Brian A. Rappold
- grid.419316.80000 0004 0550 1859Research and Development, Labcorp, Burlington, NC USA
| | - William A. Clarke
- grid.21107.350000 0001 2171 9311Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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4
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Lee SY, Lee ST, Suh S, Ko BJ, Oh HB. Revealing Unknown Controlled Substances and New Psychoactive Substances Using High-Resolution LC-MS/MS Machine Learning Models and the Hybrid Similarity Search Algorithm. J Anal Toxicol 2021; 46:732-742. [PMID: 34498039 DOI: 10.1093/jat/bkab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
Abstract
High-resolution LC-MS/MS tandem mass spectra-based machine learning models are constructed to address the analytical challenge of identifying unknown controlled substances and new psychoactive substances (NPS's). Using a training set comprised of 770 LC-MS/MS barcode spectra (with binary entries 0 or 1) obtained generally by high-resolution mass spectrometers, three classification machine learning models were generated and evaluated. The three models are artificial neural network (ANN), support vector machine (SVM), and k-nearest neighbor (k-NN) models. In these models, controlled substances and NPS's were classified into 13 subgroups (benzylpiperazine, opiate, benzodiazepine, amphetamine, cocaine, methcathinone, classical cannabinoid, fentanyl, 2C series, indazole carbonyl compound, indole carbonyl compound, phencyclidine, and others). Using 193 LC-MS/MS barcode spectra as an external test set, accuracy of the ANN, SVM, and k-NN models were evaluated as 72.5%, 90.0%, and 94.3%, respectively. Also, the hybrid similarity search (HSS) algorithm was evaluated to examine whether this algorithm can successfully identify unknown controlled substances and NPS's whose data are unavailable in the database. When only 24 representative LC-MS/MS spectra of controlled substances and NPS's were selectively included in the database, it was found that HSS can successfully identify compounds with high reliability. The machine learning models and HSS algorithms are incorporated into our home-coded AI-SNPS (artificial intelligence screener for narcotic drugs and psychotropic substances) standalone software that is equipped with a graphic user interface. The use of this software allows unknown controlled substances and NPS's to be identified in a convenient manner.
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Affiliation(s)
- So Yeon Lee
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
| | - Sang Tak Lee
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
| | - Sungill Suh
- Forensic genetics & chemistry division, Supreme prosecutors' office, Seoul 06590, Republic of Korea
| | - Bum Jun Ko
- Forensic genetics & chemistry division, Supreme prosecutors' office, Seoul 06590, Republic of Korea
| | - Han Bin Oh
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
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5
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Langman LJ, Gaskins J, Korte E, Maluf C, Wooderchak-Donahue WL, McMillin GA, Jannetto PJ, Hartley B, Malkani A, Yakkanti M, Jortani SA. Endogenous and iatrogenic sources of variability in response to opioid therapy in Post-Surgical and injured orthopedic patients. Clin Chim Acta 2021; 522:105-113. [PMID: 34384754 DOI: 10.1016/j.cca.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hydrocodone is the most prescribed opioid in the US. The objective was to evaluate associations between genetic, intrinsic, and extrinsic patient factors, plasma hydrocodone and metabolites, common side effects, and pain scores in a cohort of orthopedic surgery patients. METHODS Data for each patient was collected by review of the electronic hospital record (EHR), and patient interview. Patients were recruited from those with trauma or undergoing scheduled elective surgery for total knee replacement or total hip at the University of Louisville Hospital, Baptist East Hospital, and Jewish Hospital, Louisville, KY. Plasma opiate concentrations and a targeted genotyping panel was performed. RESULTS There were statistically significant correlations with daily (p < 0.001) and total dose (p = 0.002) of hydrocodone in hospital and duration of opioid therapy. The length of opioid administration was significantly shorter in CYP2D6 EM/UM versus CYP2D6 PM/IM patients (p = 0.018). Subjects with the OPRM1 c.118G variant were also on opioids longer (p = 0.022). The effect of co-administration of a CYP2D6 inhibitor had a significant effect on the length of opioid therapy (P < 0.001). And not surprisingly the effect of the inhibitor adjusted CYP2D6 phenotype was greater in both the hospital stay period and days of opioid use post hospital discharge (p < 0.001). CONCLUSIONS Based on this study, patients should be evaluated for the use of inhibitors of CYP2D6, during hydrocodone therapy can alter the phenotype of the patient (phenocopy) and increase the probability that the patient will be on opioids for longer periods of time.
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Affiliation(s)
- Loralie J Langman
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, United States of America.
| | - Jeremy Gaskins
- Departments of Bioinformatics and Biostatistics, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Erik Korte
- Departments of Pathology, and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Cynthia Maluf
- Departments of Pathology, and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
| | | | - Gwendolyn A McMillin
- Department of Pathology, University of Utah, ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States of America
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Brandi Hartley
- Departments of Orthopedic Surgery, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Arthur Malkani
- Departments of Orthopedic Surgery, University of Louisville School of Medicine, Louisville, KY, United States of America
| | | | - Saeed A Jortani
- Departments of Pathology, and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
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6
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Orfanidis A, Gika HG, Theodoridis G, Mastrogianni O, Raikos N. A UHPLC-MS-MS Method for the Determination of 84 Drugs of Abuse and Pharmaceuticals in Blood. J Anal Toxicol 2021; 45:28-43. [PMID: 32369171 DOI: 10.1093/jat/bkaa032] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The analysis of blood samples for forensic or clinical intoxication cases is a daily routine in an analytical laboratory. The list of 'suspect' drugs of abuse and pharmaceuticals that should be ideally screened is large, so multi-targeted methods for comprehensive detection and quantification are a useful tool in the hands of a toxicologist. In this study, the development of an ultra-high performance liquid chromatography (LC)-tandem mass spectrometry (MS-MS) method is described for the detection and quantification of 84 drugs and pharmaceuticals in postmortem blood. The target compounds comprise pharmaceutical drugs (antipsychotics, antidepressants, etc.), some of the most important groups of drugs of abuse: opiates, cocaine, cannabinoids, amphetamines, benzodiazepines and new psychoactive substances. Sample pretreatment was studied applying a modified Mini-QuEChERS single step, and the best results were obtained after adding a mixture of 20 mg MgSO4, 5 mg K2CO3 and 5 mg NaCl together with 600 μL of cold acetonitrile in 200 μL of sample. After centrifugation, the supernatant was collected for direct injection. LC-MS analysis took place on a C18 column with a gradient elution over 17 min. The method was found to be selective and sensitive, offering limits of detection ranging from 0.01 to 9.07 ng/mL. Validation included evaluation of limit of quantification, recovery, carryover, matrix effect, accuracy and precision of the method. The method performed satisfactorily in relation to established bioanalytical criteria and was therefore applied to the analysis of blood obtained postmortem from chronic drug abusers, offering unambiguous identification and quantitative determination of drugs in postmortem blood.
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Affiliation(s)
- Amvrosios Orfanidis
- Department of Medicine, Laboratory of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.,Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thessaloniki-Thermi road, Greece
| | - Helen G Gika
- Department of Medicine, Laboratory of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.,Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thessaloniki-Thermi road, Greece
| | - Georgios Theodoridis
- Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thessaloniki-Thermi road, Greece.,Department of Chemistry, Laboratory of Analytical Chemistry, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece, and
| | - Orthodoxia Mastrogianni
- Laboratory of Toxicology, Forensic Service of Thessaloniki, Palaia Symmahiki Odos, Thessaloniki 56334, Greece
| | - Nikolaos Raikos
- Department of Medicine, Laboratory of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.,Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thessaloniki-Thermi road, Greece
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7
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Hosseinnejad K, Yin T, Gaskins JT, Stauble ME, Wu Y, Jannetto P, Langman LL, Jortani SA. Lack of Influence by CYP3A4 and CYP3A5 Genotypes on Pain Relief by Hydrocodone in Postoperative Cesarean Section Pain Management. J Appl Lab Med 2019; 3:954-964. [DOI: 10.1373/jalm.2018.026070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/13/2018] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Genetic polymorphisms of cytochrome P450 are contributors to variability in individual response to drugs. Within the P450 family, CYP2D6 is responsible for metabolizing hydrocodone, a widely prescribed opioid for pain management. Alternatively, CYP3A4 and CYP3A5 can form norhydrocodone and dihydrocodeine. We have previously found that in a postcesarean section cohort, the rate of hydromorphone formation was dependent on the genotype of CYP2D6 and that plasma hydromorphone, not hydrocodone, was predictive of pain relief.
Method
Blood was obtained from a postcesarean cohort that were surveyed for pain response and common side effects. Plasma samples were genotyped for CYP3A4/5, and their hydrocodone concentrations were measured by LC-MS. R statistical software was used to check for differences in the outcomes due to CYP3A4/5 and CYP2D6, and a multivariate regression model was fit to determine factors associated with pain score.
Results
Two-way ANOVA between CYP3A4/A5 and CYP2D6 phenotypes revealed that the former variants did not have a statistical significance on the outcomes, and only CYP2D6 phenotypes had a significant effect on total dosage (P = 0.041). Furthermore, a 3-way ANOVA analysis showed that CYP2D6 (P = 0.036) had a predictive effect on plasma hydromorphone concentrations, and CYP3A4/A5 did not have any effect on the measured outcomes.
Conclusions
With respect to total dosages in a cesarean section population, these results confirm that CYP2D6 phenotypes are predictors for plasma hydromorphone concentration and pain relief, but CYP3A4/A5 phenotypes have no influence on pain relief or on side effects.
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Affiliation(s)
| | - Tyler Yin
- Department of Pathology, University of Louisville, Louisville, KY
| | - Jeremy T Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - M Elaine Stauble
- Department of General Obstetrics, Gynecology, and Women's Health, University of Louisville, Louisville, KY
| | - Yanhong Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Paul Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Loralie L Langman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Saeed A Jortani
- Department of Pathology, University of Louisville, Louisville, KY
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8
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Ramírez Fernández MDM, Wille SMR, Di Fazio V, Samyn N. Time course detection of dihydrocodeine in body hair after a single dose. Forensic Sci Int 2019; 302:109864. [PMID: 31261035 DOI: 10.1016/j.forsciint.2019.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/13/2019] [Accepted: 06/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND When head hair is not suitable or not available, body hair, such as leg or beard hair might be the most suitable sample for drug hair analysis. Information about the time course of drugs in hair, from the different anatomical body sites, should still be well documented. AIM The aim of this study was to determine and compare (a) the detection window of dihydrocodeine in frequently shaved legs and beard, (b) in unshaved hair from head hair, chest hair, leg hair, and/or arm hair, and (c) the distribution concentrations over the scalp, after a single dihydrocodeine intake. METHOD Before a single intake of 12 mg dihydrocodeine by subject 1 (woman), both legs hair were shaved in the morning. The subject 2 (man) shaved his beard in the morning and 30 min later he had a dose of 10 mg of dihydrocodeine. The samples were washed with water and shampoo, dried and collected as follows: Subject 1: every 3-days shaved leg hair (n = 9) and 1-month-later head hair (n = 1). Subject 2: daily shaved beard hair (n = 15), 2 months later head hair (n = 145), and every 20 days unshaved arm, leg and chest hair (from different areas) (n = 4/area). The samples were analysed for dihydrocodeine using a validated liquid chromatography-tandem mass spectrometry method with a limit of quantification (LOQ) of 15.6 pg/mg for dihydrocodeine. About 20 mg of hair samples were weighted, washed with dichloromethane, centrifuged, dried, and pulverized in the same disposable tubes. Then the samples were incubated with methanol (under sonication at 45 °C) during 4 h. After centrifugation, the supernatant was evaporated and a cation exchange solid phase extraction followed by separation and quantification using ultra performance liquid chromatography-tandem mass spectrometry (ULC-MS/MS) was carried out. Chromatographic separation was achieved using a BEH phenyl column eluted with 0.1% formic acid: methanol (0.1% formic acid). The UPLC-MS/MS method was validated and used in routine for drug hair analysis for already several years. RESULTS AND DISCUSSION In the present study leg hair was collected every 3 days, as an average of frequent shaved hair in western woman population. Shaved leg hair was very limited and only one hair sample was available per analysis. Beard was collected daily and in a higher amount. Dihydrocodeine was detected in leg hair from the first sample (3 days after the intake). Maximum concentration at 68 pg/mg for the single intake was obtained after 15 days (±2 days), decreasing later to the LOQ from the 21th day. Beard hair was positive from the first day sample, and the maximum concentration was observed at 66 pg/mg, 6 days after the intake, decreasing later to the LOQ from day 13. This may be explained by growth rate and the amount of growing hairs, in anagen phase. In other body hair samples, dihydrocodeine was negative or detected from 1 month after the intake. No significant differences in dihydrocodeine concentrations over the scalp in the different regions were observed (p > 0.05). CONCLUSION Body hair presents different time course window detection due to the different growth rates. Frequently shaved leg and beard hair may be suitable samples for recent single dihydrocodeine dose detection from the first days up to 2-3 weeks after the intake, respectively, when a LOQ of 15.6 pg/mg is applied.
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Affiliation(s)
- María Del Mar Ramírez Fernández
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120 Brussels, Belgium.
| | - Sarah M R Wille
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120 Brussels, Belgium
| | - Vincent Di Fazio
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120 Brussels, Belgium
| | - Nele Samyn
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120 Brussels, Belgium
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9
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Emara S, Zarad W, Kamal M, Ali A, Aboulella Y. Sensitivity Enhancement for Direct Injection Capillary Electrophoresis to Determine Morphine in Human Serum via In-capillary Derivatization. J Chromatogr Sci 2019; 57:177-185. [PMID: 30272145 DOI: 10.1093/chromsci/bmy092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/23/2018] [Indexed: 12/27/2022]
Abstract
Rapid and simple micellar electrokinetic chromatography (MEKC) with in-capillary derivatization and fluorescence detection has been developed to determine morphine in human serum. The sample was introduced into a background electrolyte (BGE) containing potassium ferricyanide, whereas morphine was oxidized into highly fluorescent product, pseudomorphine. Different parameters for derivatization and subsequent separation were systematically investigated for the analysis of morphine in serum. Efficient performance of the developed MEKC system was carried out in a single run using BGE made up of 70 mM sodium tetraborate decahydrate (pH 10.5), 0.30 mM potassium ferrricyanide, 80 mM sodium dodecyl sulfate, and applied voltage of 9 kV. The combination of MEKC with in-capillary derivatization of morphine was successfully achieved with a high degree of sensitivity. The validation of the method showed good linearity between areas of morphine and the corresponding concentrations over the range of 5-5000 ng/mL. Excellent accuracy and precision were obtained at all concentration levels. The mean recoveries of morphine were ranging from 83.86 to 94.45%. The validated MEKC method successfully permitted determination of morphine in clinical samples after a single oral dose of controlled release morphine sulfate tablets.
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Affiliation(s)
- Samy Emara
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Misr International University, Km 28 Ismailia Road, Cairo, Egypt
| | - Walaa Zarad
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Misr International University, Km 28 Ismailia Road, Cairo, Egypt
| | - Maha Kamal
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Modern Sciences and Arts University, 26 July Mehwar Road intersection with Wahat Road, 6 October City, Egypt
| | - Ahmed Ali
- Laboratory for Single Cell Mass Spectrometry, RIKEN Quantitative Biology Center, 6-2-3, Furuedai, Suita, Osaka, Japan
| | - Yasmine Aboulella
- Laboratory for Single Cell Mass Spectrometry, RIKEN Quantitative Biology Center, 6-2-3, Furuedai, Suita, Osaka, Japan
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10
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Kristoffersen L, Langødegård M, Gaare KI, Amundsen I, Terland MN, Strand DH. Determination of 12 commonly found compounds in DUID cases in whole blood using fully automated supported liquid extraction and UHPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1093-1094:8-23. [PMID: 29980102 DOI: 10.1016/j.jchromb.2018.06.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 01/23/2023]
Abstract
A high-throughput UHPLC-MS/MS method for the most frequently found compounds; tetrahydrocannabinol (THC), amphetamine, methamphetamine, MDMA, clonazepam, diazepam, nordiazepam, oxazepam, alprazolam, nitrazepam, morphine, and codeine, in driving under the influence of drugs (DUID) cases in whole blood, is presented. Automated sample preparation by 96-well supported liquid extraction (SLE) plates with ethyl acetate + heptane (80 + 20, v/v) as organic solvent was carried out on a Freedom Evo 200 platform from Tecan. An aliquot of 100 μL whole blood was used. Sample preparation time for 96 samples was 1.5 h. Compounds were separated with gradient elution on a C18 column (50 × 2.1 mm, 1.7 μm) with a mobile phase consisting of 5 mM pH 10.2 ammonium formate and methanol. The run time was 4.5 min and 1 μL was injected on an Acquity UPLC I-Class system with a Xevo TQS tandem-quadrupole mass spectrometer in multiple-reaction monitoring mode (MRM) from Waters. Isotope labelled, 13C, internal standards (ISs) were used for all compounds except for alprazolam and morphine, which had deuterated analogs. Quantification was carried out with calibrators without whole blood matrix. Full validation was carried out according to international guidelines, and a new approach for evaluation of process efficiency (PE) has been presented. Linear or quadratic weighted (1/x) calibration curves were used with R2 ≥ 0.999. The method showed satisfactory deviations ±16% when compared to the existing methods, and satisfactory agreement with proficiency testing control samples (z-score -1.6 to 1.8, n = 16 samples). The precision, estimated as the relative standard deviation (RSD) of the concentration difference between results from two independent analyses of authentic whole blood samples, was ≤7.2% in antemortem and ≤9.3% in postmortem samples. Recovery was ≥85% for all the compounds, except morphine ≥62% and THC ≥ 50%. PE was satisfactory for all the compounds with low variation in IS response, RSD ≤ 16% (THC 27%) in antemortem samples and ≤34% (THC 66%) in postmortem samples. To the best of our knowledge, this is the first automated 96-well SLE UHPLC-MS/MS method developed for the simultaneous determination of these 12 compounds in whole blood covering the concentration ranges found in forensic samples. The method has been used in routine work during the last ten months, analysing about 9900 antemortem and 1000 postmortem whole blood samples, and has proven to be robust and reliable.
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Affiliation(s)
- L Kristoffersen
- Oslo University Hospital, Division of Laboratory Medicine, Department of Forensic Sciences, Norway.
| | - M Langødegård
- Oslo University Hospital, Division of Laboratory Medicine, Department of Forensic Sciences, Norway
| | - K I Gaare
- Oslo University Hospital, Division of Laboratory Medicine, Department of Forensic Sciences, Norway
| | - I Amundsen
- Oslo University Hospital, Division of Laboratory Medicine, Department of Forensic Sciences, Norway
| | - M N Terland
- Oslo University Hospital, Division of Laboratory Medicine, Department of Forensic Sciences, Norway
| | - D H Strand
- Oslo University Hospital, Division of Laboratory Medicine, Department of Forensic Sciences, Norway
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Adams KJ, Ramirez CE, Smith NF, Muñoz-Muñoz AC, Andrade L, Fernandez-Lima F. Analysis of isomeric opioids in urine using LC-TIMS-TOF MS. Talanta 2018; 183:177-183. [DOI: 10.1016/j.talanta.2018.02.077] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/17/2018] [Accepted: 02/17/2018] [Indexed: 01/25/2023]
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12
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Kwong TC, Magnani B, Moore C. Urine and oral fluid drug testing in support of pain management. Crit Rev Clin Lab Sci 2017; 54:433-445. [PMID: 28990451 DOI: 10.1080/10408363.2017.1385053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In recent years, the abuse of opioid drugs has resulted in greater prevalence of addiction, overdose, and deaths attributable to opioid abuse. The epidemic of opioid abuse has prompted professional and government agencies to issue practice guidelines for prescribing opioids to manage chronic pain. An important tool available to providers is the drug test for use in the initial assessment of patients for possible opioid therapy, subsequent monitoring of compliance, and documentation of suspected aberrant drug behaviors. This review discusses the issues that most affect the clinical utility of drug testing in chronic pain management with opioid therapy. It focuses on the two most commonly used specimen matrices in drug testing: urine and oral fluid. The advantages and disadvantages of urine and oral fluid in the entire testing process, from specimen collection and analytical methodologies to result interpretation are reviewed. The analytical sensitivity and specificity limitations of immunoassays used for testing are examined in detail to draw attention to how these shortcomings can affect result interpretation and influence clinical decision-making in pain management. The need for specific identification and quantitative measurement of the drugs and metabolites present to investigate suspected aberrant drug behavior or unexpected positive results is analyzed. Also presented are recent developments in optimization of test menus and testing strategies, such as the modification of the standard screen and reflexed-confirmation testing model by eliminating some of the initial immunoassay-based tests and proceeding directly to definitive testing by mass spectrometry assays.
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Affiliation(s)
- Tai C Kwong
- a Department of Pathology and Laboratory Medicine , University of Rochester Medical Center , Rochester , NY , USA
| | - Barbarajean Magnani
- b Department of Pathology and Laboratory Medicine , Tufts Medical Center , Boston , MA , USA
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13
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Remane D, Wissenbach DK, Peters FT. Recent advances of liquid chromatography–(tandem) mass spectrometry in clinical and forensic toxicology — An update. Clin Biochem 2016; 49:1051-71. [DOI: 10.1016/j.clinbiochem.2016.07.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/04/2016] [Accepted: 07/17/2016] [Indexed: 12/21/2022]
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14
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Yang HS, Wu AHB, Lynch KL. Development and Validation of a Novel LC-MS/MS Opioid Confirmation Assay: Evaluation of β-glucuronidase Enzymes and Sample Cleanup Methods. J Anal Toxicol 2016; 40:323-9. [DOI: 10.1093/jat/bkw026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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15
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Abstract
This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants). This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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16
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Zhang WM, Duan YP, Li W, Qiu JF, Zhang ZY. UPLC-MS-MS Determination of Dihydrocodeine in Human Plasma and Its Application to a Pharmacokinetic Study. J Chromatogr Sci 2015; 54:569-73. [PMID: 26689716 DOI: 10.1093/chromsci/bmv188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Indexed: 11/12/2022]
Abstract
A sensitive and rapid ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS-MS) method was developed to determine dihydrocodeine (DHC) in human plasma using diazepam as the internal standard (IS). Sample preparation was accomplished through a liquid-liquid extraction procedure with ethyl acetate. The analyte and IS were separated on an Acquity UPLC BEH C18 column (2.1 × 50 mm, 1.7 μm) with the mobile phase of acetonitrile and 1% formic acid in water with gradient elution at a flow rate of 0.4 mL/min. The detection was performed on a triple quadrupole tandem mass spectrometer equipped with positive-ion electrospray ionization by multiple reaction monitoring (MRM) of the transitions at m/z 302.3 → 199.2 for DHC and m/z 285.1 → 193.1 for IS. The linearity of this method was found to be within the concentration range of 0.5-100 ng/mL with a lower limit of quantification of 0.5 ng/mL. The overall run time was 4.0 min. The method herein described was superior to previous methods and was successfully applied to the pharmacokinetic study of DHC in healthy Chinese volunteers after oral administration.
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Affiliation(s)
- Wei-min Zhang
- The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
| | - Yan-pei Duan
- Department of Pharmacy, Xinxiang Central Hospital, Xinxiang, Henan 453000, PR China
| | - Wei Li
- The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
| | - Jian-fei Qiu
- Medical College of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
| | - Zhi-yin Zhang
- Medical College of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
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Eckart K, Röhrich J, Breitmeier D, Ferner M, Laufenberg-Feldmann R, Urban R. Development of a new multi-analyte assay for the simultaneous detection of opioids in serum and other body fluids using liquid chromatography–tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 1001:1-8. [DOI: 10.1016/j.jchromb.2015.06.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/24/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
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18
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Sartori D, Lewis T, Breaud A, Clarke W. The development of a high-performance liquid chromatography-tandem mass spectrometric method for simultaneous quantification of morphine, morphine-3-β-glucuronide, morphine-6-β-glucuronide, hydromorphone, and normorphine in serum. Clin Biochem 2015; 48:1283-90. [PMID: 26118474 DOI: 10.1016/j.clinbiochem.2015.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/08/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Development and validation of a selective, robust high-performance liquid chromatography-tandem mass spectrometric (HPLC/MS-MS) method for the quantification of morphine, morphine-3-β-glucuronide, morphine-6-β-glucuronide, hydromorphone, and normorphine in human serum. DESIGN AND METHODS Drug-free human serum samples spiked with morphine, morphine-3-β-glucuronide, morphine-6-β-glucuronide, hydromorphone, and normorphine were prepared by protein precipitation using methanol containing the internal standards. Samples were injected onto a Thermo Scientific AccuCore PFP column for chromatographic separation. Detection was achieved using a Thermo Scientific TSQ Vantage mass spectrometer. Assay validation followed the new Clinical and Laboratory Standards Institute (CLSI) C62-A guidelines. RESULTS The analytical measuring range for all analytes was determined to be 5 to 1000 ng/mL. Intra- and inter-assay precision for three quality control levels were ≤ 7.0% and ≤ 13.5%, respectively. Carryover, stability, linearity, matrix effects, extraction and processing efficiency and method comparison characteristics were acceptable relative to the CLSI C62 guidelines. CONCLUSION The validation of this HPLC-MS/MS method demonstrated a robust and rapid assay for the quantification of morphine, morphine-3-β-glucuronide, morphine-6-β-glucuronide, hydromorphone, and normorphine.
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Affiliation(s)
- David Sartori
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamorah Lewis
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Stauble ME, Moore AW, Langman LJ, Boswell MV, Baumgartner R, McGee S, Metry J, Jortani SA. Hydrocodone in postoperative personalized pain management: Pro-drug or drug? Clin Chim Acta 2014; 429:26-9. [DOI: 10.1016/j.cca.2013.11.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/13/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
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