High-performance liquid chromatographic determination of fluvoxamine and fluvoxamino acid in human plasma

A facile on-off fluorescence approach for fluvoxamine determination in pharmaceutical tablets; application to content uniformity testing

A green-complied spectrofluorimetric approach for quantification of the antidepressant, fluvoxamine, has been established. The method that has been suggested relies on the development of an association complex between fluvoxamine and erythrosine B in an acetate buffer solution. After being excited at 530 nm, the quenching in erythrosine B's native fluorescence caused by complex formation with fluvoxamine was detected at a wavelength of 552 nm. The values of fluorescence quenching at the most optimal reaction conditions were rectilinear at the concentration range of 0.2-2.0 μg mL-1, with a good correlation coefficient (r = 0.9998). The detection limit for the method was 0.03 μg mL-1 while the quantitation limit was 0.09 μg mL-1. The suggested approach has been validated according to the ICH. The established approach was effectively used to determine the drug under study in its dosage form with an average percent recovery of 98.92 ± 0.87 (n = 5), with no effect caused by the existing excipients. The proposed approach was also successfully used for the content uniformity test.

A smartphone-based colorimetric assay using Au@Ag core-shell nanoparticles as the nanoprobes for visual tracing of fluvoxamine in biofluids as a common suicide drug

In the present study, bimetallic nanoparticles (NPs) consisting of gold (AuNPs) as the core and silver (AgNPs) as the shell have been synthesized and applied as the nanoprobe for detection of fluvoxamine (FXM) as the anti-depression drug. The physicochemical properties of the prepared citrate-capped Au@Ag core-shell NPs have been characterized by UV-Vis, Fourier-transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM) and scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) techniques. The design of the smartphone-based colorimetric FXM sensor relies on the fast hydrolysis of FXM under alkaline conditions by producing of 2-(Aminooxy)ethanamine without any significant peak at 400-700 nm. The interaction of the resulted molecule with the nanoprobe induced a red shift in the longitudinal localized surface plasmon resonance (LSPR) peak of the nanoprobe, which was accompanied by sharp and vivid color variations in the solution. A linear relationship between the absorption signal increasing by FXM concentration increasing from 1 µM to 10 µM presented a simple, low cost and minimally instrumented format for FXM quantification with a limit of detection (LOD) of 100 nM. The collected visual data with the elegant colorimetric response of the nanoprobe in the presence of FXM from Indian red to light red violet and bluish-purple color offered simple detection of FXM with the naked eye. The satisfactory results of the proposed cost-effective sensor in the rapid assay of FXM in human serum, urine, saliva and pharmaceutical samples guarantee the potential of the nanoprobe for on-site and visual determination of FXM in actual samples. The proposed sensor as the first non-invasive FXM sensor for saliva sample analysis may hold great promise to provide the technical support for the rapid and valid detection of FXM for forensic medicine and clinical organizations.

Distribution of Fluvoxamine and Identification of the Main Metabolite in a Fatal Intoxication

Fluvoxamine is a selective serotonin reuptake inhibitor, with a half-life of about 30 hours, that is commonly prescribed in the treatment of depression and obsessive and compulsive disorders. Though its more favorable adverse effect profile in comparison to tricyclic antidepressants, overdosages could lead to severe central nervous system depression. We hereby report the case of a 48-year-old woman with psychiatric disorders, who died in the Protected Community where she lived. An autopsy, during which multiorgan congestion and aspiration of gastric content were found, was performed 9 days after the death. Femoral and cardiac blood, urine and bile were collected for toxicological analysis. GC-MS, LC-MS-MS and LC-HRMS screenings were performed on blood samples. The analysis allowed to identify the following drugs: fluvoxamine, clotiapine, 7-aminoclonazepam, propranolol, gabapentin and haloperidol. Quantification of the detected drugs in blood was performed by means of a validated LC-MS-MS analytical procedure, and the following results were achieved: fluvoxamine (2.20 mg/L), gabapentin (41.00 mg/L), 7-aminoclonazepam (0.24 mg/L), clotiapine (0.07 mg/L), haloperidol (<0.01 mg/L) and propranolol (0.24 mg/L). Fluvoxamine concentration in blood exceeded ~10 times the upper limit of therapeutic blood levels (0.23 mg/L). Contributory causes of death, such as due to multiple drug use, however, cannot be excluded. The distribution of fluvoxamine in all biological fluids was evaluated and a postmortem redistribution effect was observed (C/P blood ratio: 1.86). Fluvoxamine acid metabolite was identified in urine, bile and in cardiac blood, through an LC-QTOF analytical procedure.

Edge plane pyrolytic graphite as a sensing surface for the determination of fluvoxamine in urine samples of obsessive-compulsive disorder patients

There is an increasing demand for fast and sensitive determination of antidepressants in human body fluids because of the present scenario of rising depression cases at the global level. A simple and sensitive voltammetric method using edge plane pyrolytic graphite electrode (EPPGE) as a novel sensor is presented for the determination of antidepressant fluvoxamine in urine and blood plasma samples of obsessive-compulsive disorder (OCD) patients. EPPGE is delineated the first time for this determination. EPPGE exhibited strong electrocatalytic activity and enhanced reduction signal towards the sensing of fluvoxamine. Fluvoxamine gave a well-defined reduction peak at ~ - 670 mV using EPPGE. The fluvoxamine reduction peak current was linear to its concentration in the range 5.00 × 10^-9 - 0.1 × 10^-6 mol L^-1 and the limit of detection was found to be 3.5 × 10^-9 mol L^-1. The pre-eminence of EPPGE over mercury electrodes has been proved in terms of sensitivity and imperative analytical parameters. The pH study reveals the involvement of an equal number of electrons and protons in the reduction reaction mechanism. The frequency study indicated the adsorption controlled irreversible reaction mechanism. The stability and reproducibility of the offered sensor were also found most favorable. The interference study confirmed the optimum selectivity of the proposed sensor. The edge plane pyrolytic graphite sensing platform is recommended as a potential contender for the accurate and fast determination of fluvoxamine in depression medications as well as biological specimens of OCD patients.

Molecularly Imprinted Polymer Nanoparticles for Selective Solid Phase Extraction of Fluvoxamine in Human Urine and Plasma

In this work, the molecularly imprinted polymer nanoparticles (MIP-NPs) for the selective determination of fluvoxamine have been described. The polymer nanoparticles were synthesized by the polymerization of methacrylic acid as a functional monomer, ethylene glycol dimethacrylate as a cross-linker, 2,2-azobisisobutyronitrile as an initiator and fluvoxamine as a template molecule. The MIP-NPs were characterized using techniques that included Fourier transform infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM). Imprinted fluvoxamine molecules were removed from the polymeric structure using acetonitrile in methanol (2:8; v/v) as the eluting solvent. The linear dynamic range for fluvoxamine was 10-1200 μg L-1. The developed method was successfully applied to the extraction of fluvoxamine in complex biological samples.

Cost-Effective Potentiometric Platforms Modified with Multi-Walled Carbon Nanotubes (MWCNTs) and Based on Imprinted Receptors for Fluvoxamine Assessment

A simple, efficient and reliable analytical method was developed and used for the determination of the fluvoxamine drug (FLV) in pharmaceutical preparations and biological fluids. The method is based on the cost-effective screen-printed platform for the potential transduction of the drug. Host-tailored molecular imprinting polymer (MIP) was integrated with the potentiometric platform as a recognition receptor, in which FLV, acrylamide (AAm), ethylene glycol dimethacrylate (EGDMA) and acetonitrile were used as a template, functional monomer, cross-linker, and solvent, respectively. MIP particles were dispersed in plasticized poly (vinyl chloride) (PVC) and the membrane was drop-casted on carbon screen-printed electrode. The MIP, in addition to non-imprinted polymers (NIP), was characterized and the binding experiment revealed high affinity and adsorption capacity of MIP towards FLV. The proposed sensor displayed near-Nernstian cationic slope of 55.0 ± 0.8 mV/decade (r² = 0.999) with a low detection limit of 4.8 × 10⁻⁶ mol/L over a wide pH range (3.0–8.5). The electrochemical features of the proposed sensors including electrochemical impedance spectroscopy (EIS) and chronopotentiometry measurements (CP) in the presence of multi-walled carbon nanotubes (MWCNTs) as a solid contact transducer were also investigated. The applications of the proposed sensor for the determination of FLV in different dosage forms with recovery values (98.8%–101.9%) and (97.4%–101.1%), respectively compared with the reference HPLC method with acceptedFandt-student tests values at the 95% confidence level.

Association between serotonin transporter polymorphisms (5-HTTLPR) and the MADRS Dysphoria, Retardation, and Vegetative Subscale scores in the treatment of depression

OBJECTIVE

We investigated the association between serotonin- or 5-hydroxytryptamine (5-HT)-related gene polymorphisms and response to antidepressant treatment in a specific symptom cluster of major depression by using the three-factor model of the Montgomery-Åsberg Depression Rating Scale (MADRS), ie, dysphoria (items of sadness, pessimistic thoughts, and suicidal thoughts), retardation (items of lassitude, inability to feel, apparent sadness, and concentration difficulties), and vegetative symptoms (items of reduced sleep, reduced appetite, and inner tension).

METHODS

This study was an open-label and nonrandomized trial. A total of 160 patients with baseline MADRS scores of ≥21, who were treated with fluvoxamine or milnacipran for 6 weeks, were included in the statistical analysis. Polymorphisms within a 5-HT transporter (5-HTT) gene-linked polymorphic region (5-HTTLPR), a variable number of tandem repeats in the second intron of the 5-HTT gene (5-HTTVNTR), and 5HT2A receptor (1438G/A) were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

RESULTS

The 5-HTTLPR polymorphisms affected the MADRS score change in dysphoria, but not in retardation, vegetative, or total symptoms. Dysphoria scores significantly decreased in patients with the S/S genotype compared to those in patients with the short (S)/long (L) + L/L genotype. However, 5-HTTVNTR and 1438G/A polymorphisms were not significantly associated with the treatment response to any cluster of depressive symptoms. When a Bonferroni correction was made, however, our results did not reach the criteria for statistical significance.

CONCLUSION

The use of a single total depression rating scale may not be sufficient to accurately estimate the clinical response to antidepressants. Analyzing a subset of symptoms in psychological scales could be important when performing pharmacogenetic studies.

Bcl1 polymorphism of the glucocorticoid receptor gene and treatment response to milnacipran and fluvoxamine in Japanese patients with depression

BACKGROUND

Polymorphisms in the glucocorticoid receptors (GRs) have been widely studied with rather less emphasis on relating their differences with possible pharmacological treatment outcomes. The purpose of this study was to investigate whether Bcl1 polymorphisms of GRs are associated with the antidepressant effect of milnacipran, a serotonin noradrenaline reuptake inhibitor (SNRI), and fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), in Japanese patients with depression.

METHODS

Patients were prescribed either milnacipran (n = 98) or fluvoxamine (n = 95). The severity of depression was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) at 0, 1, 2, 4 and 6 weeks of treatment.

RESULTS

Both agents were similarly effective in reducing MADRS scores in 6 weeks. In all subjects receiving milnacipran or fluvoxamine, our data showed no significant interaction between Bcl1 polymorphisms and therapeutic effects. However, when milnacipran- and fluvoxamine-treated subjects were analyzed independently, patients with G allele in Bcl1 polymorphism had a significantly better response to fluvoxamine than those with C/C genotype. On the other hand, no significant relationship was found between treatment response to milnacipran and Bcl1 polymorphism.

CONCLUSION

Bcl1 polymorphism may be one of the genetic factors in predicting treatment response to SSRI but not SNRI in Japanese patients with depression.

Spectrofluorimetric determination of fluvoxamine in dosage forms and plasma via derivatization with 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole

A highly sensitive and simple spectrofluorimetric method has been developed and validated for the determination of the antidepressant fluvoxamine (FXM) in its dosage forms and plasma. The method was based on nucleophilic substitution reaction of FXM with 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole in an alkaline medium (pH 8) to form a highly fluorescent derivative that was measured at 535 nm after excitation at 470 nm. The factors affecting the reaction was carefully studied and optimized. The kinetics of the reaction was investigated, and the reaction mechanism was presented. Under the optimized conditions, linear relationship with good correlation coefficient (0.9995) was found between the fluorescence intensity and FXM concentration in the range of 65-800 ng ml(-1). The limits of detection and quantitation for the method were 21 and 64 ng ml(-1), respectively. The precision of the method was satisfactory; the values of relative standard deviations did not exceed 2.17%. The proposed method was successfully applied to the determination of FXM in its pharmaceutical tablets with good accuracy; the recovery values were 97.8-101.4 +/- 1.08-2.75%. The results obtained by the proposed method were comparable with those obtained by the official method. The high sensitivity of the method allowed its successful application to the analysis of FXM in spiked human plasma. The proposed method is superior to the previously reported spectrofluorimetric method for determination of FXM in terms of its simplicity. The proposed method is practical and valuable for its routine application in quality control and clinical laboratories for analysis of FXM.

Identification of human cytochrome P450 enzymes involved in the major metabolic pathway of fluvoxamine

The metabolism of fluvoxamine to fluvoxamino acid is known to involve a two-step oxidation process via an alcohol intermediate, fluvoxamino alcohol. The present study was carried out to identify the cytochrome P450 (CYP) enzyme(s) involved in the metabolism offluvoxamine to fluvoxamino alcohol using human liver microsomes and cDNA-expressed human CYP enzymes. The mean Km and Vmax values for the formation of fluvoxamino alcohol from fluvoxamine in human liver microsomes were 76.3 microM and 37.5 pmol min(-1) mg(-1) protein, respectively. The formation of fluvoxamino alcohol from fluvoxamine in pooled human liver microsomes was significantly inhibited by quinidine, a relatively specific CYP2D6 inhibitor, with a Ki value of 2.2 microM, whereas other several relatively specific CYP inhibitors did not inhibit the formation of fluvoxamino alcohol. In addition, only CYP2D6 of several cDNA-expressed human CYP enzymes examined showed substantial activity for the formation of fluvoxamino alcohol. Furthermore, the formation of fluvoxamino acid from fluvoxamino alcohol is potently inhibited by 4-methylpyrazole in human liver cytosol. These data suggest that CYP2D6 is the only enzyme predominantly responsible for the first-step oxidation of fluvoxamine to fluvoxamino alcohol, and alcohol dehydrogenase is involved in the second-step oxidation of fluvoxamino alcohol to the corresponding carbolic acid.

Rapid and sensitive bioanalytical method for measurement of fluvoxamine in human serum using 4-chloro-7-nitrobenzofurazan as pre-column derivatization agent: Application to a human pharmacokinetic study

A sensitive and rapid high-performance liquid chromatographic method for the analysis of fluvoxamine, a selective serotonin reuptake inhibitor in human serum, is described using 4-chloro-7-nitrobenzofurazan as pre-column derivatization agent. The drug and an internal standard (fluoxetine) were extracted from 0.25 mL of serum using ethyl acetate as extracting solvent and subjected to pre-column derivatization by the reagent. A mobile phase consisting of methanol and sodium phosphate buffer (0.05 M; pH 2.8) containing 1 mL/L triethylamine (72:28 v/v) was used and chromatographic separation was performed on a Shimpack CLC-C18 (150 mm x 4.6mm) column. The fluorescence derivatives of the drugs were monitored at excitation and emission wavelengths of 470 and 537 nm, respectively. The calibration curve was linear over the concentration range of 0.5-240 ng/mL with a limit of quantification (LOQ) of 0.5 ng/mL using 0.25 mL serum sample. The method validation was performed for its selectivity, specificity, sensitivity, precision and accuracy. In this method, which was applied in a randomized cross-over bioequivalence study of two different fluvoxamine preparations in 24 healthy volunteers, the sensitivity and run time of analysis were significantly improved.

Gender differences in the clinical effects of fluvoxamine and milnacipran in Japanese major depressive patients

Gender differences in the treatment response to fluvoxamine (selective serotonin re-uptake inhibitor) and milnacipran (serotonin/norepinephrine re-uptake inhibitor) were investigated in Japanese major depressive patients. A total of 125 Japanese patients was included in the present study. Sixty-six patients received fluvoxamine treatment. The daily dose was 50 mg/day for the first week and increased to 100 mg after 1 week, up to 200 mg after another week. Fifty-nine patients were given milnacipran. The daily dose was 50 mg/day for the first week, and up to 100 mg/day thereafter. Patients were divided into three groups: younger women (<44 years of age), older women (> or =44 years of age) and men. Depressive symptoms were evaluated using the Montgomery and Asberg Depression Rating Scale (MADRS) before treatment and at 1, 2, 4 and 6 weeks after the beginning of the study. In comparison with other groups, younger women treated with fluvoxamine demonstrated a significant difference in the time course of MADRS score change. However, these gender/age-related differences of antidepressant response were not observed in the patients treated with milnacipran. The results suggest that fluvoxamine is more effective in younger female patients than older female patients and male patients, while milnacipran is generally effective irrespective of gender or age.

HPLC method for the determination of fluvoxamine in human plasma and urine for application to pharmacokinetic studies

A simple, specific and sensitive high-performance liquid chromatographic (HPLC) method has been developed for the assay of fluvoxamine in human plasma and urine. The method was based on reaction of fluvoxamine with 1,2-naphthoquinone-4-sulphonic acid sodium salt (NQS) forming orange colored product. The fluvoxamine-NQ derivative was separated by isocratic reversed-phase HPLC and detected at 450 nm. The chromatographic conditions were as follows: Phenomenex C(18) (250 mm x 4.6 mm i.d., 5 microm) column, mobile phase consisting of acetonitrile/water (80:20 v/v) at a flow rate of 1 ml/min. Tryptamine was selected as an internal standard. The assay was linear over the concentration range of 5-145 and 2-100 ng/ml for plasma and urine, respectively. The limits of detection (LOD) were 1.4 and 1 ng/ml for plasma and urine estimation at a signal-to-noise (S/N) ratio of 3. The limits of quantification (LOQ) were 5 and 2 ng/ml for plasma and urine, respectively. The extraction recoveries were found to be 96.66+/-0.69 and 96.73+/-2.17% for plasma and urine, respectively. The intra-day and inter-day standard deviations (S.D.) were less than 1. The method indicated good performance in terms of specificity, linearity, detection and quantification limits, precision and accuracy. This assay was demonstrated to be applicable for clinical pharmacokinetic studies.

Electroanalytical study of fluvoxamine

Fluvoxamine (FVX) can be reduced at a mercury-drop electrode, with a maximum peak current intensity being obtained at a potential of -0.7 V vs. Ag/AgCl, in an aqueous electrolyte solution of pH 2. The compound was determined in a pharmaceutical product and in spiked human serum by square-wave adsorptive-stripping voltammetry (SWAdSV) after accumulation at the electrode surface, under batch conditions. Because the presence of dissolved oxygen did not interfere significantly with the analysis, it was also possible to determine FVX in the pharmaceutical product by use of a flow-injection analysis (FIA) system with SWAdSV detection. The methods developed were validated and successfully applied to the quantification of FVX in a pharmaceutical product. Recoveries between 76 and 89% were obtained in serum analysis. The FIA-SWAdSV method enabled analysis of up to 120 samples per hour at reduced cost, implying the possibility of competing with the chromatographic methods usually used for this analysis.

Determination of fluvoxamine and its metabolite fluvoxamino acid by liquid–liquid extraction and column-switching high-performance liquid chromatography

This study describes a new simultaneous determination of fluvoxamine and fluvoxamino acid by automated column-switching high-performance liquid chromatography. The test compounds were extracted from 1.5 ml of plasma using chloroform-toluene (15:85, v/v), and the extract was injected into a hydrophilic metaacrylate polymer column for clean-up and a C18 analytical column for separation. The mobile phase for separation consisted of phosphate buffer (0.02 M, pH 4.6), acetonitrile and perchloric acid (60%) (62.4:37.5:0.1, v/v/v) and was delivered at a flow rate of 0.6 ml/min. The peak was detected using a UV detector set at 254 nm. The method was validated for the concentration range 0.8-153.6 ng/ml for fluvoxamine and 0.6-115.2 ng/ml for fluvoxamino acid, and their good linearity (r > 0.998) were confirmed. Intra-day coefficient variations (CVs) for fluvoxamine and fluvoxamino acid were less than 6.6 and 6.0%, respectively. Inter-day CVs for corresponding compounds were 6.3 and 6.5%, respectively. Relative errors ranged from -18 to 9% and mean recoveries were 96-100%. The limit of quantification was 1.2 and 0.9 ng/ml for fluvoxamine and fluvoxamino acid, respectively. This method shows successful application for pharmacokinetic studies and therapeutic drug monitoring.

A variable number of tandem repeats in the serotonin transporter gene does not affect the antidepressant response to fluvoxamine

A variable number of tandem repeats (VNTR) in the second intron of the serotonin transporter gene (STin2) has been studied in association with the susceptibility to affective disorders. Recently, it was reported that selective serotonin reuptake inhibitors were more effective in patients with major depressive disorder having the homozygous allele pair (12-copy/12-copy) of VNTR in the STin2 than in ones having other allele combinations. As the study had methodological problems, further studies are needed to confirm the above finding. Therefore, the authors investigated whether the allelic variation of VNTR in the STin2 was associated with the antidepressant response to fluvoxamine in 66 patients with major depressive disorder. Fluvoxamine was prescribed up to 200 mg/day in the dosing protocol for 6 weeks. The present study showed no significant association between the polymorphism of VNTR in the STin2 and the treatment response to fluvoxamine.