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Vet NJ, de Winter BCM, Koninckx M, Boeschoten SA, Boehmer ALM, Verhallen JT, Plötz FB, Vaessen-Verberne AA, van der Nagel BCH, Knibbe CAJ, Buysse CMP, de Wildt SN, Koch BCP, de Hoog M. Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus. Clin Pharmacokinet 2021; 59:257-264. [PMID: 31432470 PMCID: PMC7007440 DOI: 10.1007/s40262-019-00811-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Intravenous salbutamol is used to treat children with refractory status asthmaticus, however insufficient pharmacokinetic data are available to guide initial and subsequent dosing recommendations for its intravenous use. The pharmacologic activity of salbutamol resides predominantly in the (R)-enantiomer, with little or no activity and even concerns of adverse reactions attributed to the (S)-enantiomer. OBJECTIVE Our aim was to develop a population pharmacokinetic model to characterize the pharmacokinetic profile for intravenous salbutamol in children with status asthmaticus admitted to the pediatric intensive care unit (PICU), and to use this model to study the effect of different dosing schemes with and without a loading dose. METHODS From 19 children (median age 4.9 years [range 9 months-15.3 years], median weight 18 kg [range 7.8-70 kg]) treated with continuous intravenous salbutamol at the PICU, plasma samples for R- and S-salbutamol concentrations (111 samples), as well as asthma scores, were collected prospectively at the same time points. Possible adverse reactions and patients' clinical data (age, sex, weight, drug doses, liver and kidney function) were recorded. With these data, a population pharmacokinetic model was developed using NONMEM 7.2. After validation, the model was used for simulations to evaluate the effect of different dosing regimens with or without a loading dose. RESULTS A two-compartment model with separate clearance for R- and S-salbutamol (16.3 L/h and 8.8 L/h, respectively) best described the data. Weight was found to be a significant covariate for clearance and volume of distribution. No other covariates were identified. Simulations showed that a loading dose can result in higher R-salbutamol concentrations in the early phase after the start of infusion therapy, preventing accumulation of S-salbutamol. CONCLUSIONS The pharmacokinetic model of intravenous R- and S-salbutamol described the data well and showed that a loading dose should be considered in children. This model can be used to evaluate the pharmacokinetic-pharmacodynamic relationship of intravenous salbutamol in children, and, as a next step, the effectiveness and tolerability of intravenous salbutamol in children with severe asthma.
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Affiliation(s)
- Nienke J Vet
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | | | - Muriel Koninckx
- Pediatric Intensive Care, Middelheim Ziekenhuis, Antwerp, Belgium
| | - Shelley A Boeschoten
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Jacintha T Verhallen
- Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | | | | | - Catherijne A J Knibbe
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Corinne M P Buysse
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Saskia N de Wildt
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Bahmany S, de Wit LEA, Hesselink DA, van Gelder T, Shuker NM, Baan C, van der Nagel BCH, Koch BCP, de Winter BCM. Highly sensitive and rapid determination of tacrolimus in peripheral blood mononuclear cells by liquid chromatography-tandem mass spectrometry. Biomed Chromatogr 2018; 33:e4416. [PMID: 30362145 PMCID: PMC6587946 DOI: 10.1002/bmc.4416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 11/12/2022]
Abstract
After solid organ transplantation, tacrolimus is given to prevent rejection. Therapeutic drug monitoring is used to reach target concentrations of tacrolimus in whole blood. Because the site of action of tacrolimus is the lymphocyte, and tacrolimus binds ~80% to erythrocytes, the intracellular tacrolimus concentration in lymphocytes is possibly more relevant. For this purpose, we aimed to develop, improve and validate a UPLC–MS/MS method to measure tacrolimus concentrations in isolated peripheral blood mononuclear cells (PBMCs). PBMCs were isolated using a Ficoll separation technique, followed by a washing step using red blood cell lysis. A cell suspension of 50 μL containing 1 million PBMCs was used in combination with MagSiMUS‐TDMPREP. To each sample we added 30 μL lysis buffer, 20 μL reconstitution buffer containing 13C2H4‐tacrolimus as internal standard, 40 μL MagSiMUS‐TDMPREP Type I Particle Mix and 175 μL Organic Precipitation Reagent VI for methanol‐based protein precipitation. A 10 μL aliquot of the supernatant was injected into the UPLC–MS/MS system. The method was validated, resulting in high sensitivity and specificity. The method was linear (r2 = 0.997) over the range 5.0–1250 pg/1 × 106 PBMCs. The inaccuracy was <5% and the imprecision was <15%. The washing steps following Ficoll isolation could be performed at either room temperature or on ice, with no effect of the temperature on the results. A method for the analysis of tacrolimus concentrations in PBMCs was developed and successfully validated. Further research will be performed to investigate the correlation between concentrations in PBMCs and clinical outcome.
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Affiliation(s)
- Soma Bahmany
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Lucia E A de Wit
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Teun van Gelder
- Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Nauras M Shuker
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Carla Baan
- Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Bart C H van der Nagel
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Flint RB, Bahmany S, van der Nagel BCH, Koch BCP. Simultaneous quantification of fentanyl, sufentanil, cefazolin, doxapram and keto-doxapram in plasma using liquid chromatography-tandem mass spectrometry. Biomed Chromatogr 2018; 32:e4290. [PMID: 29768657 PMCID: PMC6175396 DOI: 10.1002/bmc.4290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 12/16/2022]
Abstract
A simple and specific UPLC–MS/MS method was developed and validated for simultaneous quantification of fentanyl, sufentanil, cefazolin, doxapram and its active metabolite keto‐doxapram. The internal standard was fentanyl‐d5 for all analytes. Chromatographic separation was achieved with a reversed‐phase Acquity UPLC HSS T3 column with a run‐time of only 5.0 min per injected sample. Gradient elution was performed with a mobile phase consisting of ammonium acetate or formic acid in Milli‐Q ultrapure water or in methanol with a total flow rate of 0.4 mL min−1. A plasma volume of only 50 μL was required to achieve adequate accuracy and precision. Calibration curves of all five analytes were linear. All analytes were stable for at least 48 h in the autosampler. The method was validated according to US Food and Drug Administration guidelines. This method allows quantification of fentanyl, sufentanil, cefazolin, doxapram and keto‐doxapram, which is useful for research as well as therapeutic drug monitoring, if applicable. The strength of this method is the combination of a small sample volume, a short run‐time, a deuterated internal standard, an easy sample preparation method and the ability to simultaneously quantify all analytes in one run.
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Affiliation(s)
- Robert B Flint
- Erasmus University Medical Center, Department of Pharmacy, Rotterdam, the Netherlands.,Erasmus University Medical Center-Sophia, Department of Pediatrics, Division of Neonatology, Rotterdam, the Netherlands.,Department of Pharmacy and Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Soma Bahmany
- Erasmus University Medical Center, Department of Pharmacy, Rotterdam, the Netherlands
| | | | - Birgit C P Koch
- Erasmus University Medical Center, Department of Pharmacy, Rotterdam, the Netherlands
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van der Nagel BCH, Versmissen J, Bahmany S, van Gelder T, Koch BCP. High-throughput quantification of 8 antihypertensive drugs and active metabolites in human plasma using UPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1060:367-373. [PMID: 28666228 DOI: 10.1016/j.jchromb.2017.06.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND To assess drug adherence of patients with hypertension, an analytical method was developed and validated using ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The method includes eight frequently prescribed antihypertensive drugs from four classes and their active metabolites: angiotensin converting enzyme inhibitors enalapril and perindopril (active metabolites respectively enalaprilate and perindoprilate), angiotensin II receptor blockers losartan (with the active metabolite losartan carboxylic acid) and valsartan, calcium channel blockers amlodipine and nifedipine and diuretics hydrochlorothiazide and spironolactone (with the active metabolite canrenone). METHODS The antihypertensive drugs were analyzed using a simple and fast sample preparation protocol with protein precipitation followed by chromatographic separation using a gradient elution on a reversed phase column. Mass spectrometric detection was conducted by applying both positive and negative electrospray ionization (ESI+/ESI-) and selected reaction monitoring mode (MS/MS). Only 50μl of plasma sample is needed for the simultaneous quantification of all 12 compounds within 6min run-to-run analysis time. Enalapril-d5 was applied as internal standard for all compounds except hydrochlorothiazide (internal standard: Hydrochlorothiazide-13C,d2). RESULTS The method was validated according to FDA guidelines. Matrix effects were examined using the method of Matuszewski. Correlation coefficients were higher than 0.995 for all compounds. Intra- and inter-day accuracies were <15% for all analytes except spironolactone (-16.8%) in the established linear range. Intra- and inter-day precision were <15% for all analytes. As a result of the lower sensitivity of hydrochlorothiazide, the lowest three calibration levels were excluded. DISCUSSION/CONCLUSIONS The described method is suitable for the simultaneous quantitative analysis of the most commonly used antihypertensive drugs and their corresponding active metabolites. Major advantages are minimal sample volume and clean up and a short runtime. The method is now available to monitor drug adherence of patients with resistant hypertension in our hospital.
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Affiliation(s)
| | - Jorie Versmissen
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Soma Bahmany
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands.
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Wijma RA, van der Nagel BCH, Dierckx B, Dieleman GC, Touw DJ, van Gelder T, Koch BCP. Identification and quantification of the antipsychotics risperidone, aripiprazole, pipamperone and their major metabolites in plasma using ultra-high performance liquid chromatography-mass spectrometry. Biomed Chromatogr 2015; 30:794-801. [PMID: 26447610 DOI: 10.1002/bmc.3610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/12/2015] [Accepted: 08/31/2015] [Indexed: 01/07/2023]
Abstract
The antipsychotics risperidone, aripiprazole and pipamperone are frequently prescribed for the treatment in children with autism. The aim of this study was to validate an ultra-high performance liquid chromatography-mass spectrometry method for the quantification of these antipsychotics in plasma. An ultra-high performance liquid chromatography-mass spectrometry assay was developed for the determination of the drugs and metabolites. Gradient elution was performed on a reversed-phase column with a mobile phase consisting of ammonium acetate, formic acid in methanol or in Milli-Q ultrapure water at a flow rate of 0.5 mL/min. The method was validated according to the US Food and Drug Administration guidelines. The analytes were found to be stable enough after reconstitution and injection of only 5 μL improved the accuracy and precision in combination with the internal standard. Calibration curves of all five analytes were linear. All analytes were stable for at least 72 h in the autosampler and the high quality control of 9-OH-risperidone was stable for 48 h. The method allows quantification of all analytes. The advantage of this method is the combination of a minimal injection volume, a short run-time, an easy sample preparation method and the ability to quantify all analytes in one run. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rixt A Wijma
- Department of Hospital Pharmacy, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bart C H van der Nagel
- Department of Hospital Pharmacy, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry, Erasmus MC, Postal box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry, Erasmus MC, Postal box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
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