Simultaneous determination of canrenone, digoxin and tolvaptan by UHPLC-MS/MS: application in heart failure patients

Overview of therapeutic drug monitoring and clinical practice

With the rapid development of clinical pharmacy in China, therapeutic drug monitoring (TDM) has become an essential tool for guiding rational clinical drug use and is widely concerned. TDM is a tool that combines pharmacokinetic and pharmacodynamic knowledge to optimize personalized drug therapy, which can improve treatment outcomes, reduce drug-drug toxicity, and avoid the risk of developing drug resistance. To effectively implement TDM, accurate and sophisticated analytical methods are required. By researching the literature published in recent years, we summarize the types of commonly monitored drugs, therapeutic windows, and clinical assays and track the trends and hot spots of therapeutic drug monitoring. The purpose is to provide guidelines for clinical blood drug concentration monitoring, to implement individualized drug delivery programs better, to ensure the rational use of drugs for patients, and to provide a reference for the group to carry out related topics in the future.

Development of highly selective and sensitive molecularly imprinted polymer-based electrochemical sensors for tolvaptan assay in tablets and serum

In this research, two different molecularly imprinted polymer (MIP)-based electrochemical sensors were proposed for the determination of tolvaptan (TOL). Photopolymerization (PP) and thermal polymerization (TP) techniques were developed for the determination of TOL. The advantages of MIP were used to design an electrochemical sensor for selective and sensitive determination of TOL. TOL was determined on a glassy carbon electrode (GCE) using differential pulse voltammetry (DPV) for both techniques. Some important parameters affecting the sensor efficiency, such as template/monomer ratio, PP and TP time, drop volume, removal solutions, removal and rebinding time, etc., were optimized. The surface characterization of the proposed MIP-based electrochemical sensors was carried out with electrochemical characterization by electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) methods. It was extended with the scanning electron microscopy (SEM) technique. Under optimal conditions, the developed sensors showed good linearity between 1.0 × 10-11 M and 1.0 × 10-10 M, and 2.5 × 10-11 M and 2.5 × 10-10 M for PP and TP, respectively. Low detection limits (2.89 × 10-12 M (PP) and 1.88 × 10-13 M (TP)) were also obtained for TOL determination. The applicability of the proposed sensor was evaluated using tablet and commercial human serum samples. Interference and imprinting factor studies verified the selectivity and specificity of the proposed sensors, and the efficiency of the sensors was verified using an unprinted polymer for comparison at each step.

An automated streamlined method for the therapeutic drug monitoring of digoxin based on the online-solid-phase extraction liquid chromatography tandem high-resolution mass spectrometry

RATIONALE

Digoxin is widely used in the clinical treatment of cardiovascular diseases. However, due to its extremely narrow therapeutic window, therapeutic drug monitoring (TDM) is vitally important. In consideration of the time-consuming and labor-intensive nature of the traditional techniques, an automated and efficient method was required for the clinical individualized TDM of digoxin.

METHODS

An online solid-phase extraction liquid chromatography tandem high-resolution mass spectrometry (online-SPE-LC-HRMS) method was developed and applied for the determination of digoxin in plasma. The online SPE-LC steps included pretreatment and separation of plasma samples that were carried out using a Waters Oasis HLB cartridge and XBridge Shield RP18 column, respectively. A high-resolution Q Orbitrap mass spectrometer with targeted-selected ion monitoring in negative scan mode was applied to monitor formate-adduct ions [M + HCOO]^- m/z 825.42781 for digoxin.

RESULTS

Linearity was shown over the range 0.1-10 ng mL^-1 for digoxin with correlation coefficients of R²  > 0.999. The lower limit of quantitation (LLOQ) for digoxin was 0.1 ng mL^-1 . Extraction recoveries ranged from 82.61% to 94.28% for digoxin. The intra- and inter-day precision values were < 5.53% with accuracy ranging from 84.97% to 96.75%. The total running time was 10 min for each sample.

CONCLUSION

The established method displayed satisfactory recoveries, accuracy, precision, and stability, and successfully applied on the TDM of digoxin. This automated streamlined method provides a powerful tool to guide the individualized administration of digoxin, which is significant for the practice of precision medicine.