Quantitation of paracetamol by liquid chromatography-mass spectrometry in human plasma in support of clinical trial

Emergency diagnosis made easy: matrix removal and analyte enrichment from raw saliva using paper-arrow mass spectrometry

Paracetamol overdose is a leading cause of acute liver failure that can prove fatal. Establishing paracetamol concentration accurately and quickly is critical. Current detection methods are invasive, time-consuming and/or expensive. Non-invasive, rapid and cost-effective techniques are urgently required. To address this challenge, a novel approach, called Paper-Arrow Mass Spectrometry (PA-MS) has been developed. This technique combines sample collection, extraction, enrichment, separation and ionisation onto a single paper strip, and the entire analysis process, from sample to result, can be carried out in less than 10 min requiring only 2 μL of raw human saliva. PA-MS achieved a LOQ of 185 ng mL-1, mean recovery of 107 ± 7%, mean accuracy of 11 ± 8% and precision ≤5% using four concentrations, and had excellent linearity (r2 = 0.9988) in the range of 0.2-200 μg mL-1 covering the treatment concentration range, surpassing the best-in-class methods currently available for paracetamol analysis. Furthermore, from a panel of human saliva samples, inter-individual variability was found to be <10% using this approach. This technique represents a promising tool for rapid and accurate emergency diagnosis.

Simultaneous determination of tramadol and paracetamol in human plasma using LC-MS/MS and application in bioequivalence study of -fixed-dose combination

The study aimed to develop a sensitive and high-throughput liquid chromatography coupled with tandem mass spectrometry method to quantify concentrations of tramadol and paracetamol simultaneously in human plasma. Sample preparation involved single-step protein precipitation using methanol and two deuterated internal standards, tramadol D6 and paracetamol D4. Agilent Poroshell 120 EC-C18 (100 × 2.1 mm, 2.1 µm) analytical column was employed to achieve chromatographic separation. Detection was in positive ion multiple reaction monitoring mode. A tailing factor (Tf) of <1.2, separation factor (K prime) of >1.5 from the column dead time and signal-to-noise (S/N) ratio >10, were obtained for analytes and internal standards. The standard curve was linear over the concentration range of 2.5-500.00 ng/mL for tramadol and 0.025-20.00 μg/mL for paracetamol. A small injection volume of 1 µL, low flow rate of 440 µL/min and short analysis time of 3.5 min reduced the solvent consumption, analysis cost and system contamination. The results of method validation parameters fulfilled the acceptance criteria of bioanalytical guidelines. The method was successfully applied to a bioequivalence study of fixed-dose combination products of tramadol and paracetamol in Malaysian healthy subjects.

The effect of regularly dosed acetaminophen versus no acetaminophen on renal function in Plasmodium knowlesi malaria (PACKNOW): a randomised controlled trial

Background

Acetaminophen inhibits cell-free hemoglobin-induced lipid peroxidation and improves renal function in severe falciparum malaria but has not been evaluated in other infections with prominent hemolysis, including Plasmodium knowlesi malaria.

Methods

PACKNOW was an open-label, randomized, controlled trial of acetaminophen (500 mg or 1000 mg every 6 hours for 72 hours) vs no acetaminophen in Malaysian patients aged ≥5 years with knowlesi malaria of any severity. The primary end point was change in creatinine at 72 hours. Secondary end points included longitudinal changes in creatinine in patients with severe malaria or acute kidney injury (AKI), stratified by hemolysis.

Results

During 2016–2018, 396 patients (aged 12–96 years) were randomized to acetaminophen (n = 199) or no acetaminophen (n = 197). Overall, creatinine fell by a mean (standard deviation) 14.9% (18.1) in the acetaminophen arm vs 14.6% (16.0) in the control arm (P = .81). In severe disease, creatinine fell by 31.0% (26.5) in the acetaminophen arm vs 20.4% (21.5) in the control arm (P = .12), and in those with hemolysis by 35.8% (26.7) and 19% (16.6), respectively (P = .07). No difference was seen overall in patients with AKI; however, in those with AKI and hemolysis, creatinine fell by 34.5% (20.7) in the acetaminophen arm vs 25.9% (15.8) in the control arm (P = .041). Mixed-effects modeling demonstrated a benefit of acetaminophen at 72 hours (P = .041) and 1 week (P = .002) in patients with severe malaria and with AKI and hemolysis (P = .027 and P = .002, respectively).

Conclusions

Acetaminophen did not improve creatinine among the entire cohort but may improve renal function in patients with severe knowlesi malaria and in those with AKI and hemolysis.

Clinical Trials Registration

NCT03056391.

Intravenous Acetaminophen Does Not Provide Adequate Postoperative Analgesia in Dogs Following Ovariohysterectomy

Simple Summary

Acetaminophen is the most commonly used pain relief (analgesic) agent in humans worldwide and its use is becoming more frequent in dogs. However, limited evidence supports this use. This study aimed to investigate the analgesic effect of acetaminophen when administered as an intravenous injection post-operatively in female dogs. A total of 34 dogs were randomly divided into two groups and either administered acetaminophen or saline intravenously immediately after desexing. The dogs had their pain levels evaluated at 10, 20, 40, 60, 120, and 180 min after awakening from general anesthesia and the pain levels between groups were compared. Concurrently, the dogs had blood collected at 2, 5, 10, 40, and 80 min following injection of the acetaminophen. The blood was analyzed to quantify the levels of acetaminophen in the body. This study found that acetaminophen was no better than saline in providing analgesia in dogs following surgery. This study suggests that acetaminophen used alone may not be an appropriate post-operative analgesic agent for desexing procedures.

Abstract

(1) Objective: To investigate the analgesic effects of intravenous acetaminophen after intravenous administration in dogs presenting for ovariohysterectomy. (2) Methods: 14 ASA I client-owned female entire dogs. In this randomized, blinded, clinical study, dogs were given meperidine and acepromazine intramuscularly before induction of anesthesia with intravenous propofol. Anesthesia was maintained with isoflurane in oxygen. Intravenous acetaminophen 20 mg/kg or 0.9% NaCl was administered postoperatively. Pain assessments were conducted using the Glasgow Pain Scale short form before premedication and at 10, 20, 60, 120, and 180 min post-extubation or until rescue analgesia was given. The pain scores, times, and incidences of rescue analgesia between the groups was compared. Blood was collected before and 2, 5, 10, 20, 40, and 80 min after acetaminophen administration. Acetaminophen plasma concentration was quantified by liquid chromatography-mass spectrometry. The acetaminophen plasma concentration at the time of each pain score evaluation was subsequently calculated. (3) Results: There was no significant difference in pain scores at 10 min, highest pain scores, or time of rescue analgesia between groups. In each group, 3 dogs (43%) received rescue analgesia within 20 min. (4) Conclusions: Following ovariohysterectomy in dogs, there was no detectable analgesic effect of a 20 mg/kg dosage of intravenous acetaminophen administered at the end of surgery.

Selective Electrochemical Sensing Platform Based on the Synergy between Carbon Black and Single-Crystalline Bismuth Sulfide for Rapid Analysis of Antipyretic Drugs

Nanomaterials are of significant interest in acetaminophen (APAP) detection in pharmaceutical samples. Herein, a carbon black/single-crystalline rodlike bismuth sulfide (CB/Bi₂S₃) composite prepared by an ultrasonic method is reported and utilized for the rapid analysis of APAP. The highly oriented edge reactive sites of the CB/Bi₂S₃ composite promoted synergy and good electrochemical sensing performance with a fast electron transfer rate and low overpotential (0.35 V). Therefore, a CB/Bi₂S₃ composite-modified glassy carbon electrode (GCE) was applied to the selective determination of APAP by the voltammetric technique. The CB/Bi₂S₃ composite-modified electrode showed the lowest limit of detection of APAP (1.9 nM) with excellent sensitivity. The proposed CB/Bi₂S₃/GCE platform exhibited high selectivity, excellent stability (87.15%), and reproducibility. Also, the CB/Bi₂S₃/GCE sensor was then successfully used to analyze an APAP pharmaceutical sample and exhibited satisfactory outcomes. Therefore, the CB/Bi₂S₃-modified GCE sensor platform would be a low-cost and robust GCE electrode material for APAP detection.

Efflux transporters in rat placenta and developing brain: transcriptomic and functional response to paracetamol

Adenosine triphosphate binding cassette (ABC) transporters transfer lipid-soluble molecules across cellular interfaces either directly or after enzymatic metabolism. RNAseq analysis identified transcripts for ABC transporters and enzymes in rat E19, P5 and adult brain and choroid plexus and E19 placenta. Their functional capacity to efflux small molecules was studied by quantitative analysis of paracetamol (acetaminophen) and its metabolites using liquid scintillation counting, autoradiography and ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS). Animals were treated acutely (30 min) and chronically (5 days, twice daily) with paracetamol (15 mg/kg) to investigate ability of brain and placenta barriers to regulate ABC transport functionality during extended treatment. Results indicated that transcripts of many efflux-associated ABC transporters were higher in adult brain and choroid plexus than at earlier ages. Chronic treatment upregulated certain transcripts only in adult brain and altered concentrations of paracetamol metabolites in circulation of pregnant dams. Combination of changes to metabolites and transport system transcripts may explain observed changes in paracetamol entry into adult and fetal brains. Analysis of lower paracetamol dosing (3.75 mg/kg) indicated dose-dependent changes in paracetamol metabolism. Transcripts of ABC transporters and enzymes at key barriers responsible for molecular transport into the developing brain showed alterations in paracetamol pharmacokinetics in pregnancy following different treatment regimens.

Simultaneous determination of dantrolene and paracetamol in human plasma by liquid chromatography tandem mass spectrometry

A simple, sensitive, rapid and specific method based on ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for the simultaneous quantification of dantrolene (DAN) and paracetamol (PAR) in real human plasma was developed and validated. The preparation of sample was achieved by liquid-liquid extraction with tertiary butyl methyl ether. The analysis was performed on a reversed-phase C₁₈column (1.7 µm, 2.1 × 30 mm) using acetonitrile: 0.1% formic acid (80:20, v/v) as the mobile phase and pumped in an isocratic mode at a flow rate of 0.3 mL/min using citalopram (CIT) as an internal standard. Tandem mass spectrometric detection was carried out by both positive and negative electrospray ionization (ESI) in the multiple-reaction monitoring mode (MRM). The analysis was carried out within 1 min for each sample which made it possible to analyze more than 350 human samples per day. Validation of the method was performed according to FDA guidelines for bio-analytical method. The method was found to be linear in the range of 25-2500 ng/mL and 100-10,000 ng/mL for DAN and PAR, respectively. The method was applied successfully for the determination of the two analytes in the plasma after oral administration of Dantrelax® compound capsules to healthy volunteers. The study was accomplished after approval of the ethics committee.

Electrochemically Activated Screen-Printed Carbon Sensor Modified with Anionic Surfactant (aSPCE/SDS) for Simultaneous Determination of Paracetamol, Diclofenac and Tramadol

In this work, an electrochemically activated screen-printed carbon electrode modified with sodium dodecyl sulfate (aSPCE/SDS) was proposed for the simultaneous determination of paracetamol (PA), diclofenac (DF), and tramadol (TR). Changes of surface morphology and electrochemical behaviour of the electrode after the electrochemical activation with H₂O₂ and SDS surface modification were studied by scanning electron microscopy (SEM), cyclic voltammetry (CV), and electrochemical impedance spectroscopy (EIS). The influence of various parameters on the responses of the aSPCE/SDS such as pH and concentration of the buffer, SDS concentration, and techniques parameters were investigated. Using optimised conditions (E_acc. of −0.4 V, t_acc. of 120 s, ΔE_A of 150 mV, ν of 250 mV s⁻¹, and t_m of 10 ms), the aSPCE/SDS showed a good linear response in the concentration ranges of 5.0 × 10⁻⁸–2.0 × 10⁻⁵ for PA, 1.0 × 10⁻⁹–2.0 × 10⁻⁷ for DF, and 1.0 × 10⁻⁸–2.0 × 10⁻⁷ and 2.0 × 10⁻⁷–2.0 × 10⁻⁶ mol L⁻¹ for TR. The limits of detection obtained during the simultaneous determination of PA, DF, and TR are 1.49 × 10⁻⁸ mol L⁻¹, 2.10 × 10⁻¹⁰ mol L⁻¹, and 1.71 × 10⁻⁹ mol L⁻¹, respectively. The selectivity of the aSPCE/SDS was evaluated by examination of the impact of some inorganic and organic substances that are commonly present in environmental and biological samples on the responses of PA, DF, and TR. Finally, the differential pulse adsorptive stripping voltammetric (DPAdSV) procedure using the aSPCE/SDS was successfully applied for the determination of PA, DF, and TR in river water and serum samples as well as pharmaceuticals.