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Wang LL, Ren XX, He Y, Cui GF, Liu JJ, Jia J, Cao J, Liu Y, Cong B, Wei ZW, Yun KM. Pharmacokinetics of Diazepam and Its Metabolites in Urine of Chinese Participants. Drugs R D 2022; 22:43-50. [PMID: 35099786 PMCID: PMC8885946 DOI: 10.1007/s40268-021-00375-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Urine is conventionally used as a specimen to document diazepam-related crimes; however, few reports have described the pharmacokinetics of diazepam and its metabolites in urine. OBJECTIVE This study aimed to investigate the pharmacokinetics of diazepam and its metabolites, including glucuronide compounds, in the urine of Chinese participants. METHODS A total of 28 volunteers were recruited and each participant ingested 5 mg of diazepam orally. Ten milliliters of urine were collected from each participant at post-consumption timepoints of prior (zero), 1, 2, 4, 8, 12, and 24 h and 2, 3, 6, 12, and 15 days. All samples were extracted by solid-phase extraction and analyzed using high-performance liquid chromatography-tandem mass spectrometry. Diazepam and its main metabolites, except for temazepam, were detected in the urine of volunteers. Pharmacokinetic parameters were analyzed using the pharmacokinetic software DAS according to the non-compartment model. RESULTS Urinary diazepam peaked at 2.38 ng/mL (Cmax) and 1.93 h (Tmax). The urinary metabolite nordiazepam peaked at 1.17 ng/mL and 100.21 h; temazepam glucuronide (TG) peaked at 145.61 ng/mL and 41.14 h; and oxazepam glucuronide (OG) peaked at 101.57 ng/mL and 165.86 h. The elimination half-life (t½z) and clearance (CLz/F) for diazepam were 119.58 h and 65.77 L/h, respectively. The t½z of the metabolites nordiazepam, TG, and OG was 310.58 h, 200.17 h, and 536.44 h, respectively. Finally, this study found that both diazepam and its main metabolites in urine were detectable for at least 15 days, although there were individual differences. CONCLUSION The results regarding diazepam pharmacokinetics in urine would be of great help in forensic science and drug screening.
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Affiliation(s)
- Le-le Wang
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China
- Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, 030600, Shanxi, China
| | - Xin-Xin Ren
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, China
| | - Yi He
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, China
| | - Guan-Feng Cui
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, China
| | - Jia-Jia Liu
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China
- Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, 030600, Shanxi, China
| | - Juan Jia
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China
- Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, 030600, Shanxi, China
| | - Jie Cao
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China
- Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, 030600, Shanxi, China
| | - Yao Liu
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, China
| | - Bin Cong
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China
- Department of Forensic Medicine, Hebei Medical University, Shijiazhuang, 050017, China
| | - Zhi-Wen Wei
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China.
- Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, 030600, Shanxi, China.
| | - Ke-Ming Yun
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, 030600, Shanxi, China.
- Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, 030600, Shanxi, China.
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Wang LL, Ren XX, He Y, Cui GF, Wei ZW, Yun KM. An Experimental Pharmacokinetics Study of Diazepam and Its Metabolites in Oral Fluid of Chinese Population. J Anal Toxicol 2020; 44:348-353. [PMID: 31965188 DOI: 10.1093/jat/bkz101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
Diazepam abuse is widespread all over the word, leading to an increasing number of forensic cases such as suicide, drug-driving and robbery, but relevant studies are limited regarding the extraction of diazepam and its metabolites in oral fluid. This study aimed to investigate the pharmacokinetics of diazepam and its metabolites in oral fluid after a single oral dose in healthy volunteers. There was a total of 28 volunteers, and each ingested 5 mg diazepam orally, then ~2 mL oral fluid were collected from each participant at post-consumption time-points of prior (zero), 1, 2, 4, 8, 12, 24 h and 2, 3, 6, 12 and 15 days, respectively. All samples were extracted with solid-phase extraction and analyzed with high-performance liquid chromatography-tandem mass spectrometry method, and diazepam and nordazepam were detected in the oral fluid of volunteers. Pharmacokinetics of diazepam in oral fluid conformed to a two-compartment model, and k01_HL, k12_HL, k10_HL were 0.7 ± 1.1, 31.4 ± 68.5, 12.1 ± 11.6 h, respectively, nordazepam conformed to an one-compartment model, and k01_HL, k10_HL were 41.5 ± 44.8, 282.3 ± 365.5 h, respectively. Both diazepam and nordazepam could be detected continuously for 15 days, although there were individual differences, and the results regarding diazepam detecting in oral fluid will be of much help in forensic science and drug screening filed.
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Affiliation(s)
- Le-le Wang
- School of Forensic Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Xin-Xin Ren
- Institute of Forensic Science, Ministry of Public Security, Beijing 100038, China
| | - Yi He
- Institute of Forensic Science, Ministry of Public Security, Beijing 100038, China
| | - Guan-Feng Cui
- Institute of Forensic Science, Ministry of Public Security, Beijing 100038, China
| | - Zhi-Wen Wei
- School of Forensic Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Ke-Ming Yun
- School of Forensic Medicine, Shanxi Medical University, Taiyuan 030001, China
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Diagnosis and treatment of patients with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder: a review of recent publications. Curr Opin Psychiatry 2019; 32:300-306. [PMID: 31008730 DOI: 10.1097/yco.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Attention-deficit and hyperactivity disorder (ADHD) often presents with comorbid substance use disorders (SUD). Due to similarities in key symptoms of both disorders and suboptimal efficacy of the available treatments, clinicians are faced with difficulties in the diagnosis and treatment of these patients with both disorders. This review addresses recent publications between 2017 and 2019 on the etiology, prevalence, diagnosis and treatment of co-occurring ADHD and SUD. RECENT FINDINGS ADHD is diagnosed in 15-20% of SUD patients, mostly as ADHD with combined (hyperactive/inattentive) presentation. Even during active substance use, screening with the Adult ADHD Self-Report Scale (ASRS) is useful to address whether further diagnostic evaluation is needed. After SUD treatment, the diagnosis of ADHD generally remains stable, but ADHD subtype presentations are not. Some evidence supports pharmacological treatment with long-acting stimulants in higher than usual dosages. Studies on psychological treatment remain scarce, but there are some promising findings on integrated cognitive behaviour therapy. SUMMARY Diagnosis and treatment of patients with comorbid ADHD and SUD remain challenging. As ADHD presentations can change during active treatment, an active follow-up is warranted to provide treatment to the individuals' personal strengths and weaknesses.
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