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Perananthan V, Shihana F, Chiew AL, George J, Dawson A, Buckley NA. Intestinal injury in paracetamol overdose (ATOM-8). J Gastroenterol Hepatol 2024; 39:920-926. [PMID: 38149309 DOI: 10.1111/jgh.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIM Paracetamol, a widely used medication, is known for its delayed hepatotoxicity in cases of overdose. However, the potential for intestinal toxicity resulting from very high paracetamol concentrations during absorption is not well explored. This study aims to investigate the presence of intestinal toxicity and its correlation with observations in early and late paracetamol toxicity. METHODS Serial samples of 30 patients with acute paracetamol overdose (> 10 g or 200 mg/kg) were prospectively tested. Markers of enterocyte damage, including plasma intestinal fatty acid binding protein (IFABP) and selected gut-related microRNAs (miR-21, miR-122, miR-194, and miR-215), were analyzed. Sub-analysis was performed on patients presenting with hyperlactatemia defined as a lactate greater than 2 mmol/L within 12 h post ingestion. RESULTS In paracetamol overdose patients, median plasma IFABP was significantly elevated compared with healthy controls (720 μg/L [interquartile range, IQR, 533-1644] vs 270 μg/L [IQR 153-558], P < 0.001). Four patients had early hyperlactatemia and had significantly higher median plasma IFABP compared with those without early hyperlactatemia (3028 μg/L [IQR 1399-3556] vs 574 μg/L [IQR 526-943], P = 0.007). Furthermore, two microRNAs (miR-122 and miR-215) were downregulated in early hyperlactatemia (P = 0.019 and P = 0.006, respectively). Plasma IFABP concentrations correlated with paracetamol concentration (Spearman's r = 0.55) and lactate (r = 0.60). CONCLUSIONS Paracetamol overdose causes concentration-related intestinal toxicity, and this is a possible explanation for the early hyperlactatemia syndrome. Intestinal toxicity has potential impacts on pharmacokinetics of other agents ingested and on the evolution of hepatotoxicity. Further studies are required to explore the mechanisms and prognostic implications of intestinal toxicity.
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Affiliation(s)
- Varan Perananthan
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Fathima Shihana
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela L Chiew
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Emergency Department and Clinical Toxicology, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew Dawson
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nicholas A Buckley
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Stülb H, Bachmann M, Gonther S, Mühl H. Acetaminophen-Induced Liver Injury Exposes Murine IL-22 as Sex-Related Gene Product. Int J Mol Sci 2021; 22:10623. [PMID: 34638962 PMCID: PMC8509061 DOI: 10.3390/ijms221910623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Gaining detailed knowledge about sex-related immunoregulation remains a crucial prerequisite for the development of adequate disease models and therapeutic strategies enabling personalized medicine. Here, the key parameter of the production of cytokines mediating disease resolution was investigated. Among these cytokines, STAT3-activating interleukin (IL)-22 is principally associated with recovery from tissue injury. By investigating paradigmatic acetaminophen-induced liver injury, we demonstrated that IL-22 expression is enhanced in female mice. Increased female IL-22 was confirmed at a cellular level using murine splenocytes stimulated by lipopolysaccharide or αCD3/CD28 to model innate or adaptive immunoactivation. Interestingly, testosterone or dihydrotestosterone reduced IL-22 production by female but not by male splenocytes. Mechanistic studies on PMA/PHA-stimulated T-cell-lymphoma EL-4 cells verified the capability of testosterone/dihydrotestosterone to reduce IL-22 production. Moreover, we demonstrated by chromatin immunoprecipitation that testosterone impairs binding of the aryl hydrocarbon receptor to xenobiotic responsive elements within the murine IL-22 promoter. Overall, female mice undergoing acute liver injury and cultured female splenocytes upon inflammatory activation display increased IL-22. This observation is likely related to the immunosuppressive effects of androgens in males. The data presented concur with more pronounced immunological alertness demonstrable in females, which may relate to the sex-specific course of some immunological disorders.
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Affiliation(s)
| | | | | | - Heiko Mühl
- Pharmazentrum Frankfurt/ZAFES, Institute of General Pharmacology and Toxicology, Faculty of Medicine, Goethe-University Frankfurt, D-60590 Frankfurt am Main, Germany; (H.S.); (M.B.); (S.G.)
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Shklovsky-Kordi A, Gelernter R, Berkovitch M, Dagan Z, Kozer E. The Clinical Value of Routine Acetaminophen Level Screening in Pediatric Patients Presenting to the Emergency Department. Isr Med Assoc J 2020; 22:547-551. [PMID: 33236552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Acetaminophen is the most common drug involved in pediatric poisonings, both intentionally and accidentally, and is the leading cause of acute liver failure among all age groups. OBJECTIVES To define the characteristics of patients admitted to a pediatric emergency department (ED) where serum acetaminophen concentrations were measured, and to determine which variables are associated with significant risk of acetaminophen toxicity. METHODS Acetaminophen serum concentrations were measured, in a retrospective case series, of patients younger than 18 years who had been admitted to the ED at Shamir Medical Center between 1 January 2008 and 31 December 2015. RESULTS During the study period 180,174 children were admitted to the ED. Acetaminophen serum concentrations were measured in 209 (0.12%) patients. Mean age was 12.4 ± 5.9 years. Elevated liver enzymes were found in 12 patients, 5 of whom had documented acute liver injury. All five were older than 11years.Two cases of acute liver injury were attributable to acetaminophen ingestion. In both cases the cause was intentional overdose. Univariate analysis showed a significant (P < 0.05) correlation between detectable acetaminophen blood level and a positive history of drug or acetaminophen ingestion, and suicide attempt. Not all children with non-severe acetaminophen poisoning had been diagnosed during the study period. A positive history of acetaminophen ingestion was associated with a 28-fold higher risk for detectable acetaminophen blood level. CONCLUSIONS In the absence of a positive history of acetaminophen ingestion and in young children with accidental intoxication, the risk of hepatotoxicity is relatively low.
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Affiliation(s)
- Anna Shklovsky-Kordi
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Renana Gelernter
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matitiahu Berkovitch
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zahi Dagan
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Eran Kozer
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cheah KY, Mah KY, Pang LH, Ng SM, Wong JW, Tan SS, Tan HZ, Yuen KH. A randomized single-dose, two-period crossover bioequivalence study of two fixed-dose Paracetamol/Orphenadrine combination preparations in healthy volunteers under fasted condition. BMC Pharmacol Toxicol 2020; 21:45. [PMID: 32576287 PMCID: PMC7310552 DOI: 10.1186/s40360-020-00416-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paracetamol/Orphenadrine is a fixed dose combination containing 35 mg orphenadrine and 450 mg paracetamol. It has analgesic and muscle relaxant properties and is widely available as generics. This study is conducted to investigate the relative bioavailability and bioequivalence between one fixed dose paracetamol/orphenadrine combination test preparation and one fixed dose paracetamol/orphenadrine combination reference preparation in healthy volunteers under fasted condition for marketing authorization in Malaysia. METHOD This is a single-center, single-dose, open-label, randomized, 2-treatment, 2-sequence and 2-period crossover study with a washout period of 7 days. Paracetamol/Orphenadrine tablets were administered after a 10-h fast. Blood samples for pharmacokinetic analysis were collected at scheduled time intervals prior to and up to 72 h after dosing. Blood samples were centrifuged, and separated plasma were kept frozen (- 15 °C to - 25 °C) until analysis. Plasma concentrations of orphenadrine and paracetamol were quantified using liquid-chromatography-tandem mass spectrometer using diphenhydramine as internal standard. The pharmacokinetic parameters AUC0-∞, AUC0-t and Cmax were determined using plasma concentration time profile for both preparations. Bioequivalence was assessed according to the ASEAN guideline acceptance criteria for bioequivalence which is the 90% confidence intervals of AUC0-∞, AUC0-t and Cmax ratio must be within the range of 80.00-125.00%. RESULTS There were 28 healthy subjects enrolled, and 27 subjects completed this trial. There were no significant differences observed between the AUC0-∞, AUC0-t and Cmax of both test and reference preparations in fasted condition. The 90% confidence intervals for the ratio of AUC0-t (100.92-111.27%), AUC0-∞ (96.94-108.08%) and Cmax (100.11-112.50%) for orphenadrine (n = 25); and AUC0-t (94.29-101.83%), AUC0-∞ (94.77-101.68%) and Cmax (87.12-101.20%) for paracetamol (n = 27) for test preparation over reference preparation were all within acceptable bioequivalence range of 80.00-125.00%. CONCLUSION The test preparation is bioequivalent to the reference preparation and can be used interchangeably. TRIAL REGISTRATION NMRR- 17-1266-36,001; registered and approved on 12 September 2017.
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Affiliation(s)
- Kit Yee Cheah
- Clinical Research Ward, Clinical Trial Unit, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Hospital Ampang, Ampang, Selangor Malaysia
| | - Kar Yee Mah
- Clinical Research Ward, Clinical Trial Unit, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Hospital Ampang, Ampang, Selangor Malaysia
| | - Lai Hui Pang
- Clinical Research Ward, Clinical Trial Unit, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Hospital Ampang, Ampang, Selangor Malaysia
| | - Shi Min Ng
- Clinical Research Ward, Clinical Trial Unit, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Hospital Ampang, Ampang, Selangor Malaysia
| | - Jia Woei Wong
- Pharmacy-Attest Research Sdn Bhd BA/BE Centre, George Town, Pulau Pinang Malaysia
| | - Siew Siew Tan
- Pharmacy-Attest Research Sdn Bhd BA/BE Centre, George Town, Pulau Pinang Malaysia
| | - Hong Zhe Tan
- Pharmacy-Attest Research Sdn Bhd BA/BE Centre, George Town, Pulau Pinang Malaysia
| | - Kah Hay Yuen
- Pharmacy-Attest Research Sdn Bhd BA/BE Centre, George Town, Pulau Pinang Malaysia
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Shiea J, Bhat SM, Su H, Kumar V, Lee CW, Wang CH. Rapid quantification of acetaminophen in plasma using solid-phase microextraction coupled with thermal desorption electrospray ionization mass spectrometry. Rapid Commun Mass Spectrom 2020; 34 Suppl 1:e8564. [PMID: 31490602 DOI: 10.1002/rcm.8564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/11/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
RATIONALE Solid-phase microextraction coupled with thermal desorption electrospray ionization tandem mass spectrometry (SPME-TD-ESI-MS/MS) is proposed as a novel method for the rapid quantification of acetaminophen in plasma samples from a pharmacokinetics (PK) study. METHODS Traces of acetaminophen were concentrated on commercial fused-silica fibers coated with a polar polyacrylate (PA) polymer using direct immersion SPME. No agitation, heating, addition of salt, or adjustment of the pH of the sample solution was applied during the extraction. Any acetaminophen absorbed on the SPME fibers was subsequently desorbed and detected by TD-ESI-MS/MS. RESULTS Parameters of the absorption, sensitivity, reproducibility, and linearity for the SPME-TD-ESI-MS/MS method were evaluated. The time required to complete a TD-ESI-MS/MS analysis was less than 30 seconds. Matrix-matching calibration was performed to calculate the concentration of acetaminophen in the sample. A linear calibration curve with a concentration range of 100-10,000 ng/mL was constructed to calculate the quantity of acetaminophen. The SPME-TD-ESI-MS quantification results for acetaminophen in plasma were in good agreement with those obtained by the conventional LC/MS/MS method. CONCLUSIONS With the proposed method, a 10-min SPME time was enough to achieve the lower limit of quantitation (i.e. 100 ng/mL) and for a complete PK profiling of acetaminophen. A shorter extraction time could be achieved by applying agitation, heating, adding salt, or adjusting the pH of the sample solution to enhance analyte absorption efficiency. The time required to detect acetaminophen on the SPME fiber was less than 30 s, allowing the rapid quantification of acetaminophen in plasma with good accuracy.
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Affiliation(s)
- Jentaie Shiea
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Medical and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Hung Su
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Vinoth Kumar
- Department of Medical and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Lee
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chin-Hsiung Wang
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Chen KF, Chan LN, Senn TD, Oelschlager BK, Flum DR, Shen DD, Horn JR, Lin YS. The Impact of Proximal Roux-en-Y Gastric Bypass Surgery on Acetaminophen Absorption and Metabolism. Pharmacotherapy 2020; 40:191-203. [PMID: 31960977 DOI: 10.1002/phar.2368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGBS), a surgery that creates a smaller stomach pouch and reduces the length of small intestine, is one of the most common medical interventions for the treatment of obesity. AIM The aim of this study was to determine how RYGBS affects the absorption and metabolism of acetaminophen. MATERIALS AND METHODS Ten morbidly obese patients received 1.5 g of liquid acetaminophen (APAP) orally on three separate pharmacokinetic study days (i.e., pre-RYGBS baseline and 3 and 12 months post-RYGBS). Plasma was collected at pre-specified timepoints over 24 hours, and the samples were analyzed using liquid chromatography-mass spectrometry for APAP, APAPglucuronide (APAP-gluc), APAP-sulfate (APAP-sulf), APAP-cysteine (APAP-cys), and APAP-Nacetylcysteine (APAP-nac). RESULT Following RYGBS, peak APAP concentrations at the 3-month and 12-month visits increased by 2.0-fold compared to baseline (p=0.0039 and p=0.0078, respectively) and the median time to peak concentration decreased from 35 to 10 minutes. In contrast, peak concentrations of APAP-gluc, APAP-sulf, APAP-cys, and APAP-nac were unchanged following RYGBS. The apparent oral clearance of APAP and the ratios of metabolite area under the curve (AUC)-to-APAP AUC for all four metabolites decreased at 3 and 12 months post-RYGBS compared to the presurgical baseline. In a simulation of expected steady-state plasma concentrations following multiple dosing of 650 mg APAP every 4 hours, post-RYGBS patients had higher steady-state peak APAP concentrations compared to healthy individuals and obese pre-RYGBS patients, though APAP exposure was unchanged compared to healthy individuals. CONCLUSION Following RYGBS, the rate and extent of APAP absorption increased and decreased formation of APAP metabolites was observed, possibly due to downregulation of Phase II and cytochrome P450 2E1 enzymes.
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Affiliation(s)
- Kuan-Fu Chen
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | | | - Taurence D Senn
- Department of Medicinal Chemistry, University of Washington, Seattle, Washington
| | | | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | - Danny D Shen
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - John R Horn
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Yvonne S Lin
- Department of Pharmaceutics, University of Washington, Seattle, Washington
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Holzhütter HG, Wuensch T, Gajowski R, Berndt N, Bulik S, Meierhofer D, Stockmann M. A novel variant of the 13C-methacetin liver function breath test that eliminates the confounding effect of individual differences in systemic CO 2 kinetics. Arch Toxicol 2020; 94:401-415. [PMID: 32020249 DOI: 10.1007/s00204-020-02654-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022]
Abstract
The principle of dynamic liver function breath tests is founded on the administration of a 13C-labeled drug and subsequent monitoring of 13CO2 in the breath, quantified as time series delta over natural baseline 13CO2 (DOB) liberated from the drug during hepatic CYP-dependent detoxification. One confounding factor limiting the diagnostic value of such tests is that only a fraction of the liberated 13CO2 is immediately exhaled, while another fraction is taken up by body compartments from which it returns with delay to the plasma. The aims of this study were to establish a novel variant of the methacetin-based breath test LiMAx that allows to estimate and to eliminate the confounding effect of systemic 13CO2 distribution on the DOB curve and thus enables a more reliable assessment of the hepatic detoxification capacity compared with the conventional LiMAx test. We designed a new test variant (named "2DOB") consisting of two consecutive phases. Phase 1 is initiated by the intravenous administration of 13C-bicarbonate. Phase 2 starts about 30 min later with the intravenous administration of the 13C-labelled test drug. Using compartment modelling, the resulting 2-phasic DOB curve yields the rate constants for the irreversible elimination and the reversible exchange of plasma 13CO2 with body compartments (phase 1) and for the detoxification and exchange of the drug with body compartments (phase 2). We carried out the 2DOB test with the test drug 13C-methacetin in 16 subjects with chronic liver pathologies and 22 normal subjects, who also underwent the conventional LiMAx test. Individual differences in the systemic CO2 kinetics can lead to deviations up to a factor of 2 in the maximum of DOB curves (coefficient of variation CV ≈ 0.2) which, in particular, may hamper the discrimination between subjects with normal or mildly impaired detoxification capacities. The novel test revealed that a significant portion of the drug is not immediately metabolized, but transiently taken up into a storage compartment. Intriguingly, not only the hepatic detoxification rate but also the storage capacity of the drug, turned out to be indicative for a normal liver function. We thus used both parameters to define a scoring function which yielded an excellent disease classification (AUC = 0.95) and a high correlation with the MELD score (RSpearman = 0.92). The novel test variant 2DOB promises a significant improvement in the assessment of impaired hepatic detoxification capacity. The suitability of the test for the reliable characterization of the natural history of chronic liver diseases (fatty liver-fibrosis-cirrhosis) has to be assessed in further studies.
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Affiliation(s)
- Hermann-Georg Holzhütter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biochemistry, Computational Systems Biochemistry Group, Charitéplatz 1, 10117, Berlin, Germany.
| | - Tilo Wuensch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Gajowski
- Max Planck Institute of Molecular Genetics, Mass Spectroscopy Facility, Ihnestraße 63-73, 14195, Berlin, Germany
- Department of Biology, Chemistry, and Pharmacy, Free University Berlin, Takustraße 3, 14195, Berlin, Germany
| | - Nikolaus Berndt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biochemistry, Computational Systems Biochemistry Group, Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Computational and Imaging Science in Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sascha Bulik
- Federal Institute of Risk Assessment, Diedersdorfer Weg 1, 12277, Berlin, Germany
| | - David Meierhofer
- Max Planck Institute of Molecular Genetics, Mass Spectroscopy Facility, Ihnestraße 63-73, 14195, Berlin, Germany
| | - Martin Stockmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
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Nordmark Grass J, Elmgren A, Helander A. [Improved and harmonised laboratory analysis of paracetamol provides safer assessment of poisoning cases]. Lakartidningen 2019; 116:FPMA. [PMID: 31361324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Toxicological analysis is an important part of the acute treatment of various intoxications. Rapid laboratory responses are important for the patient to be assessed and treated correctly, and also to exclude poisoning and thus avoid unjustified and costly overtreatment. In Sweden, paracetamol (acetaminophen) is one of the most common pharmaceuticals in drug poisoning. Paracetamol overdose can cause severe liver damage unless treated early with the antidote acetylcysteine. A nation-wide initiative for improved laboratory measurement of paracetamol in plasma/serum samples has resulted in a marked reduction in the inter-laboratory coefficient of variation to generally below 10%. The introduction of a harmonized national reporting range for plasma/serum paracetamol covering at least 50-5 000 µmol/l was also recommended. This initiative will hopefully contribute to better healthcare from both a patient and health resource perspective in cases of paracetamol poisoning.
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Affiliation(s)
- Johanna Nordmark Grass
- Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden
| | - Anders Elmgren
- Sahlgrenska Universitetssjukhuset - Klinisk kemi Göteborg, Sweden Sahlgrenska Universitetssjukhuset - Klinisk kemi Göteborg, Sweden
| | - Anders Helander
- Karolinska Institutet - Labmed Stockholm, Sweden Karolinska Institutet - Labmed Stockholm, Sweden
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Soltani N, Tavakkoli N, Shahdost-Fard F, Salavati H, Abdoli F. A carbon paste electrode modified with Al 2O 3-supported palladium nanoparticles for simultaneous voltammetric determination of melatonin, dopamine, and acetaminophen. Mikrochim Acta 2019; 186:540. [PMID: 31317272 DOI: 10.1007/s00604-019-3541-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022]
Abstract
The authors have modified a carbon paste electrode with Al2O3-supported palladium nanoparticles (PdNP@Al2O3) to obtain a sensor for simultaneous voltammetric determination of melatonin (MT), dopamine (DA) and acetaminophen (AC). The PdNP@Al2O3 was characterized by scanning electron microscopy and energy-dispersive X-ray spectra. The sensor can detect DA, AC, MT and their mixtures by giving distinct signals at working voltages of typically 236, 480 and 650 mV (vs. Ag/AgCl), respectively. Differential pulse voltammetric peak currents of DA, AC and MT increase linearly in the 50 nmol L-1 - 1.45 mmol L-1, 40 nmol L-1 -1.4 mmol L-1, and 6.0 nmol L-1 - 1.4 mmol L-1 concentration ranges. The limits of detection are 36.5 nmol L-1 for DA, 36.5 nmol L-1 for AC, and 21.6 nmol L-1 for MT. The sensor was successfully used to detect the analytes in (spiked) human serum and drug samples. Graphical abstract Schematic presentation of Al2O3-supported palladium nanoparticles (PdNP@Al2O3) for modification of a carbon paste electrode (CPE) to develop a voltammetric sensor for the simultaneous determination of dopamine (DA), acetaminophen (AC) and melatonin (MT).
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Affiliation(s)
- Nasrin Soltani
- Chemistry Department, Payame Noor University, Tehran, 19395-4697, Iran.
| | - Nahid Tavakkoli
- Chemistry Department, Payame Noor University, Tehran, 19395-4697, Iran
| | - Faezeh Shahdost-Fard
- Department of Chemistry, University of Ilam, Ilam, 69315-516, Iran
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, 69391-77143, Iran
| | - Hossein Salavati
- Chemistry Department, Payame Noor University, Tehran, 19395-4697, Iran
| | - Fatemeh Abdoli
- Chemistry Department, Payame Noor University, Tehran, 19395-4697, Iran
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10
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Hao W, Zhang Y, Fan J, Liu H, Shi Q, Liu W, Peng Q, Zang G. Copper Nanowires Modified with Graphene Oxide Nanosheets for Simultaneous Voltammetric Determination of Ascorbic Acid, Dopamine and Acetaminophen. Molecules 2019; 24:E2320. [PMID: 31238523 PMCID: PMC6631772 DOI: 10.3390/molecules24122320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022] Open
Abstract
Copper nanowires (Cu NWs) were modified with graphene oxide (GO) nanosheets to obtain a sensor for simultaneous voltammetric determination of ascorbic acid (AA), dopamine (DA) and acetaminophen (AC). The nanocomposite was obtained via sonication, and its structures were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDS). The electrochemical oxidation activity of the materials (placed on a glassy carbon electrode) was studied by cyclic voltammetry and differential pulse voltammetry. Due to the synergistic effect of Cu NWs and GO, the specific surface, electrochemical oxidation performance and conductivity are improved when compared to each individual component. The peaks for AA (-0.08 V), DA (+0.16 V), and AC (+0.38 V) are well separated. The sensor has wide linear ranges which are from 1-60 μM, 1-100 μM, and 1-100 μM for AA, DA, and AC, respectively, when operated in the differential pulse voltammetric mode. The detection limits are 50, 410 and 40 nM, respectively. Potential interferences by uric acid (20 μM), glucose (10 mM), NaCl (1 mM), and KCl (1 mM) were tested for AA (1 μΜ), DA (1 μΜ), and AC (1 μΜ) and were found to be insignificant. The method was successfully applied to the quantification of AA, DA, and AC in spiked serum samples.
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Affiliation(s)
- Wanting Hao
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Yuchan Zhang
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Jingchuan Fan
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Handeng Liu
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Qi Shi
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Weichi Liu
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Qianyu Peng
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
| | - Guangchao Zang
- Institute of Life Science, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing 400016, China.
- Key Laboratory of Laboratory Medical Diagnostics of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China.
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11
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Guzmán NAN, Molina DR, Núñez BF, Soto-Sosa JC, Abarca JEH. Bioequivalence and Pharmacokinetic Evaluation Study of Acetaminophen vs. Acetaminophen Plus Caffeine Tablets in Healthy Mexican Volunteers. Drugs R D 2018; 16:339-345. [PMID: 27734219 PMCID: PMC5114203 DOI: 10.1007/s40268-016-0145-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this clinical trial was to establish the bioequivalence of two tablets containing acetaminophen 650 mg (reference) and acetaminophen 650 mg plus caffeine 65 mg (test), administered orally, in fasting conditions in healthy Mexican volunteers. Methods Blood samples were taken from 21 male and five female individuals, during a 24-h period, to characterize the pharmacokinetic profile of acetaminophen. Plasma samples were quantified by ultra-performance liquid chromatography, tandem mass spectrometry. Pharmacokinetic metrics (maximum plasma concentration, area under the curve from time zero to the last sampling time, and area under the curve from time zero to infinity) were used to determine the 90 % confidence interval of the test/reference coefficient. Results The geometric mean values for maximum plasma concentration obtained for the reference and test products were 9.46 ± 34.21 and 9.72 ± 32.38 µg/mL, respectively, whereas for the area under the curve from time zero to the last sampling time the values obtained were 34.93 ± 32.58 and 35.89 ± 31.03 µg h/mL for the reference and test formulations, respectively. The 90 % confidence intervals were within the acceptance range (80–125 %). Conclusions The test product was bioequivalent to the reference product. A faster absorption was seen in the test formulation in the Mexican population.
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Affiliation(s)
- Nora Angélica Núñez Guzmán
- Clínica de Enfermedades Crónicas y de Procedimientos Especiales, Fray Bernardino de Sahagún #101, Fraccionamiento Mirador del Punhuato, Morelia, Michoacán, Mexico.
| | - Daniel Ruiz Molina
- Clínica de Enfermedades Crónicas y de Procedimientos Especiales, Fray Bernardino de Sahagún #101, Fraccionamiento Mirador del Punhuato, Morelia, Michoacán, Mexico
| | - Benigno Figueroa Núñez
- Clínica de Enfermedades Crónicas y de Procedimientos Especiales, Fray Bernardino de Sahagún #101, Fraccionamiento Mirador del Punhuato, Morelia, Michoacán, Mexico
| | - Juan Carlos Soto-Sosa
- Clínica de Enfermedades Crónicas y de Procedimientos Especiales, Fray Bernardino de Sahagún #101, Fraccionamiento Mirador del Punhuato, Morelia, Michoacán, Mexico
| | - Jorge Eduardo Herrera Abarca
- Clínica de Enfermedades Crónicas y de Procedimientos Especiales, Fray Bernardino de Sahagún #101, Fraccionamiento Mirador del Punhuato, Morelia, Michoacán, Mexico
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12
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Dear JW, Clarke JI, Francis B, Allen L, Wraight J, Shen J, Dargan PI, Wood D, Cooper J, Thomas SHL, Jorgensen AL, Pirmohamed M, Park BK, Antoine DJ. Risk stratification after paracetamol overdose using mechanistic biomarkers: results from two prospective cohort studies. Lancet Gastroenterol Hepatol 2018; 3:104-113. [PMID: 29146439 PMCID: PMC5777094 DOI: 10.1016/s2468-1253(17)30266-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/08/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Paracetamol overdose is common but patient stratification is suboptimal. We investigated the usefulness of new biomarkers that have either enhanced liver specificity (microRNA-122 [miR-122]) or provide mechanistic insights (keratin-18 [K18], high mobility group box-1 [HMGB1], and glutamate dehydrogenase [GLDH]). The use of these biomarkers could help stratify patients for their risk of liver injury at hospital presentation. METHODS Using data from two prospective cohort studies, we assessed the potential for biomarkers to stratify patients who overdose with paracetamol. We completed two independent prospective studies: a derivation study (MAPP) in eight UK hospitals and a validation study (BIOPAR) in ten UK hospitals. Patients in both cohorts were adults (≥18 years in England, ≥16 years in Scotland), were diagnosed with paracetamol overdose, and gave written informed consent. Patients who needed intravenous acetylcysteine treatment for paracetamol overdose had circulating biomarkers measured at hospital presentation. The primary endpoint was acute liver injury indicating need for continued acetylcysteine treatment beyond the standard course (alanine aminotransferase [ALT] activity >100 U/L). Receiver operating characteristic (ROC) curves, category-free net reclassification index (cfNRI), and integrated discrimination index (IDI) were applied to assess endpoint prediction. FINDINGS Between June 2, 2010, and May 29, 2014, 1187 patients who required acetylcysteine treatment for paracetamol overdose were recruited (985 in the MAPP cohort; 202 in the BIOPAR cohort). In the derivation and validation cohorts, acute liver injury was predicted at hospital presentation by miR-122 (derivation cohort ROC-area under the curve [AUC] 0·97 [95% CI 0·95-0·98]), HMGB1 (0·95 [0·93-0·98]), and full-length K18 (0·95 [0·92-0·97]). Results were similar in the validation cohort (miR-122 AUC 0·97 [95% CI 0·95-0·99], HMGB1 0·98 [0·96-0·99], and full-length K18 0·93 [0·86-0·99]). A combined model of miR-122, HMGB1, and K18 predicted acute liver injury better than ALT alone (cfNRI 1·95 [95% CI 1·87-2·03], p<0·0001 in the MAPP cohort; 1·54 [1·08-2·00], p<0·0001 in the BIOPAR cohort). INTERPRETATION Personalised treatment pathways could be developed by use of miR-122, HMGB1, and full-length K18 at hospital presentation for patient stratification. This prospective study supports their use for hepatic safety assessment of new medicines. FUNDING Edinburgh and Lothians Health Foundation, UK Medical Research Council.
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Affiliation(s)
- James W Dear
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Joanna I Clarke
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Ben Francis
- Department of Biostatistics Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Lowri Allen
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jonathan Wraight
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jasmine Shen
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jamie Cooper
- Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Simon H L Thomas
- Medical Toxicology Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Andrea L Jorgensen
- Department of Biostatistics Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - B Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Daniel J Antoine
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK.
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13
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Bornehag CG, Reichenberg A, Hallerback MU, Wikstrom S, Koch HM, Jonsson BA, Swan SH. Prenatal exposure to acetaminophen and children's language development at 30 months. Eur Psychiatry 2018; 51:98-103. [PMID: 29331486 DOI: 10.1016/j.eurpsy.2017.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine prenatal APAP exposure in relation to language development in offspring at 30 months of age. METHOD A population-based pregnancy cohort study including 754 women who enrolled in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study in pregnancy week 8-13. Two exposure measures were used: (1) maternally reported number of APAP tablets taken between conception and enrollment; (2) APAP urinary concentration at enrollment. Language development at 30 months was assessed by nurse's evaluation and parental questionnaire, including the number of words the child used (<25, 25-50 and >50). Main study outcome; parental report of use of fewer than 50 words, termed language delay (LD). RESULTS 59.2% of women enrolled in weeks 8-13 reported taking APAP between conception and enrollment. APAP was measurable in all urine samples and urinary APAP was correlated with the number of APAP taken during pregnancy (P<0.01). Language delay was more prevalent in boys (12.6%) than girls (4.1%) (8.5% in total). Both the number of APAP tablets and urinary APAP concentration were associated with greater LD in girls but not in boys. The adjusted odds ratio (OR) for LD among girls whose mothers reported >6 vs. 0 APAP tablets was 5.92 (95% confidence interval (CI) 1.10-31.94). The OR for LD in girls whose mothers' urinary APAP was in the highest compared to the lowest quartile was 10.34 (95% CI 1.37-77.86). While it cannot be ruled out, our available data do not support confounding by indication. CONCLUSIONS Given the prevalence of prenatal APAP use and the importance of language development, these findings, if replicated, would suggest that pregnant women should limit their use of this analgesic during pregnancy.
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Affiliation(s)
- C-G Bornehag
- Karlstad University, Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, NY, USA.
| | | | | | | | - H M Koch
- Institute of the Ruhr-University, Bochum, Germany
| | | | - S H Swan
- Icahn School of Medicine at Mount Sinai, NY, USA
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14
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Yue Y, Collaku A, Liu DJ. Evaluation of a 12-Hour Sustained-Release Acetaminophen (Paracetamol) Formulation: A Randomized, 3-Way Crossover Pharmacokinetic and Safety Study in Healthy Volunteers. Clin Pharmacol Drug Dev 2018; 7:95-101. [PMID: 28816026 PMCID: PMC6084333 DOI: 10.1002/cpdd.367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/15/2017] [Indexed: 11/09/2022]
Abstract
Acetaminophen (paracetamol) is a first-line treatment for mild and moderate pain. A twice-daily sustained-release (SR) formulation may be more convenient for chronic users than standard immediate-release (IR) acetaminophen. This randomized, 3-way crossover study evaluated pharmacokinetics and safety of single-dose 1500- and 2000-mg SR acetaminophen formulations and 2 doses of IR acetaminophen 1000 mg given 6 hours apart in healthy adults (n = 14). Primary outcome was time that plasma acetaminophen concentration was ≥4 μg/mL (TC≥4μg/mL ). Key secondary outcomes were area under the plasma concentration-time curve (AUC) from time 0 to time t, when plasma acetaminophen was detectable (AUC0-t ), AUC from 0 to infinity (AUC0-inf ), and maximum plasma acetaminophen concentration (Cmax ). TC≥4μg/mL from 2000-mg SR acetaminophen was similar to that from 2 doses of IR acetaminophen, whereas TC≥4μg/mL for 1500-mg SR acetaminophen was significantly shorter than that for IR acetaminophen (P = .004). The extent of acetaminophen absorption from 2000-mg SR and 2 doses of the IR formulation was similar and within bioequivalence limits with regard to AUC0-12 , AUC0-t , and AUC0-inf . The extent of acetaminophen absorption from 1500-mg SR was significantly lower than that from IR acetaminophen. The 2000-mg SR represents a potential candidate formulation for 12-hour dosing with acetaminophen.
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Affiliation(s)
- Yong Yue
- GlaxoSmithKline Consumer HealthcareParsippanyNJUSA
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15
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Höjer J, Salmonson H, Sjöberg G, Tellerup M, Brogren J. [Overdose of modified-release paracetamol calls for changed treatment routines. New guidelines from the Swedish Poisons Information Centre]. Lakartidningen 2016; 113:D93C. [PMID: 27845815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Overdose of modified-release paracetamol calls for changed treatment routines. New guidelines from the Swedish Poisons Information Centre The sales of modified-release paracetamol tablets are steadily increasing in Sweden as are the number of overdose cases with this formulation. The Swedish Poisons Information Centre has noted that the standard treatment protocol with N-acetylcysteine (NAC), which is based on overdoses with immediate-release paracetamol formulations, is often inadequate in this setting. In this paper, an adult who overdosed on 66.5 grams of modified-release paracetamol tablets and developed severe liver impairment (max ALT 6,660 U/l) despite timely and rigorous NAC treatment is presented. The patient's peak S-paracetamol of 2,800 µmol/l was delayed to 19 hours post-ingestion. Moreover, a pharmacokinetic and clinical study of similar cases showed that seven (21%) of the 34 patients who received NAC treatment within 8 hours after ingestion developed liver impairment. Finally, new Swedish guidelines for management of these cases are presented. The guidelines are also available on www.giftinfo.se.
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Affiliation(s)
| | - Helene Salmonson
- Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden
| | - Gunilla Sjöberg
- Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden
| | - Markus Tellerup
- Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden
| | - Jacob Brogren
- Enheten för Effekt och säkerhet 3, Läkemedelsverket - Uppsala, Sweden Enheten för Effekt och säkerhet 3, Läkemedelsverket - Uppsala, Sweden
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16
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Baj-Rossi C, Cavallini A, Kilinc EG, Stradolini F, Rezzonico Jost T, Proietti M, De Micheli G, Grassi F, Dehollain C, Carrara S. In-Vivo Validation of Fully Implantable Multi-Panel Devices for Remote Monitoring of Metabolism. IEEE Trans Biomed Circuits Syst 2016; 10:955-962. [PMID: 28113177 DOI: 10.1109/tbcas.2016.2584239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper presents the in-vivo tests on a Fully Implantable Multi-Panel Devices for Remote Monitoring of endogenous and exogenous analytes. To investigate issues on biocompatibility, three different covers have been designed, realized and tested in mice for 30 days. ATP and neutrophil concentrations have been measured, at the implant site after the device was explanted, to assess the level of biocompatibility of the device. Finally, fully working prototypes of the device were implanted in mice and tested. The implanted devices were used to detect variations in the physiological concentrations of glucose and paracetamol. Data trends on these analytes have been successfully acquired and transmitted to the external base station. Glucose and paracetamol (also named acetaminophen) have been proposed in this research as model molecules for applications to personalized and translational medicine.
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Abstract
We report on two teenage girls presenting following significant paracetamol overdoses (>28 g paracetamol). Both presented within 4 h of the overdose and both were treated with N-acetylcysteine, in accordance with the National Poisons Information Service protocol. Within 8 h of presentation both had developed significant hypokalaemia with serum potassium concentrations <3.0 mmol/L and were treated with intravenous potassium chloride. Potassium concentrations returned to within reference limits (>3.5 mmol/L) after commencing potassium chloride supplementation. An audit of potassium concentrations in 254 patients presenting with significant paracetamol overdose (paracetamol >0.5 mmol/L) admitted through four A&E departments in the West of Scotland showed a significant decline in mean serum potassium from 3.9 mmol/L on admission to 3.6 mmol/L ( P = <0.001) over the next 36 h. The mechanism for this hypokalaemia in these two individuals is unclear, however regular monitoring of potassium is advocated in such patients during their initial treatment.
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Affiliation(s)
- Ian M Godber
- Biochemistry Department, Wishaw General Hospital, Wishaw, Lanarkshire, UK.
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18
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Abstract
A rapid gas liquid chromatography method has been developed which is suitable for emergency estimations of paracetamol in overdose. The method is compared with a standard ultraviolet method.
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Affiliation(s)
- M J Stewart
- Department of Clinical Chemistry, Ninewells Hospital and Medical School, Dundee DD2 1UD
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Atkinson HC, Stanescu I, Frampton C, Salem II, Beasley CPH, Robson R. Pharmacokinetics and Bioavailability of a Fixed-Dose Combination of Ibuprofen and Paracetamol after Intravenous and Oral Administration. Clin Drug Investig 2016; 35:625-32. [PMID: 26334726 PMCID: PMC4579261 DOI: 10.1007/s40261-015-0320-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 12/02/2022]
Abstract
Background and Objectives Previously published studies have suggested the lack of a
pharmacokinetic interaction between ibuprofen and paracetamol when they are delivered as a fixed-dose oral combination. The aim of this study was to determine the pharmacokinetic profile and safety of a fixed-dose intravenous (IV) combination, containing 3 mg/mL ibuprofen and 10 mg/mL paracetamol, in comparison with its individual components. The study also assessed the relative bioavailability of the same doses of the active ingredients when they were administered as an oral formulation. Methods A single-dose, open-label, randomized, five-period cross-over sequence pharmacokinetic study was undertaken in 30 healthy volunteers. Serial plasma samples were assayed for both paracetamol and ibuprofen concentrations, using validated liquid chromatography–tandem mass spectrometry methods. Pharmacokinetic parameters were computed using standard non-compartmental analyses. Adverse events were also assessed. The ratios of the maximum measured plasma concentration (Cmax), the area under the plasma concentration–time curve (AUC) from time zero to the time of the last measurable plasma concentration (AUCt) and AUC from time zero to infinity (AUC∞) were analysed for bioequivalence as determined by 90 % confidence intervals. Results The pharmacokinetic parameters of ibuprofen and paracetamol were very similar for the combination and monotherapy IV preparations; the ratios of the Cmax, AUCt and AUC∞ values fell within the 80–125 % acceptable bioequivalence range. Precise dose proportionality for both compounds was also determined for the half dose of the IV formulation in comparison with the full dose. The relative bioavailability of paracetamol (93.78 %) and ibuprofen (96.45 %) confirmed the pharmacokinetic equivalence of the oral and IV formulations of the fixed-dose combination. Conclusion Concomitant administration of 3 mg/mL ibuprofen and 10 mg/mL paracetamol in a fixed-dose IV combination does not alter the pharmacokinetic profiles of either drug. The IV and oral dose forms of such a combination are pharmacokinetically equivalent.
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Affiliation(s)
- Hartley C Atkinson
- AFT Pharmaceuticals Ltd, PO Box 33203, Takapuna, Auckland, 0740, New Zealand
| | - Ioana Stanescu
- AFT Pharmaceuticals Ltd, PO Box 33203, Takapuna, Auckland, 0740, New Zealand
| | - Chris Frampton
- University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Isam I Salem
- International Pharmaceutical Research Centre, 1 Queen Rania Street-Sport City Circle, Amman, 11196, Jordan
| | - Charles P H Beasley
- AFT Pharmaceuticals Ltd, PO Box 33203, Takapuna, Auckland, 0740, New Zealand.
| | - Richard Robson
- Christchurch Clinical Studies Trust Ltd, PO Box 2856, Christchurch, 8140, New Zealand.
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Cairney DG, Beckwith HKS, Al-Hourani K, Eddleston M, Bateman DN, Dear JW. Plasma paracetamol concentration at hospital presentation has a dose-dependent relationship with liver injury despite prompt treatment with intravenous acetylcysteine. Clin Toxicol (Phila) 2016; 54:405-10. [PMID: 27108714 DOI: 10.3109/15563650.2016.1159309] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Paracetamol (acetaminophen) overdose is a common reason for emergency hospital admission in the UK and the leading cause of acute liver failure in the Western world. Currently, the antidote acetylcysteine (NAC) is administered at a dose determined only by body weight without regard for the body burden of paracetamol. OBJECTIVE To determine whether higher plasma paracetamol concentrations are associated with increased risk of liver injury despite prompt treatment with intravenous NAC. METHODS Patients admitted to hospital for treatment with intravenous NAC following a single acute paracetamol overdose entered the study if NAC was commenced within 24 h of drug ingestion (N = 727 hospital presentations). Based on the plasma paracetamol concentration at first presentation to hospital, a series of nomograms were created: 0-100, 101-150, 151-200, 201-300, 301-500 and over 501 mg/L. The primary endpoints were acute liver injury (ALI - peak serum ALT activity >150 U/L and double the admission value) and hepatotoxicity (peak ALT >1000 U/L). RESULTS ALI and hepatotoxicity were more common in patients with higher admission plasma paracetamol concentrations despite NAC treatment (ALI: nomogram 0-100: 6%, 101-150: 3%, 151-200: 3%, 201-300: 9%, 301-500: 13%, over 501 mg/dL: 27%. p < 0.0001). This dose-response relationship between paracetamol concentration and ALI persisted even in patients treated with NAC within 8 h of overdose (nomogram 0-100: 0%, 101-150: 0.8%, 151-200: 2%, 201-300: 3.6%, 301-500: 12.5%, over 501mg/L: 33%. p < 0.0001) and in patients with normal ALT activity at first presentation (nomogram: 0-100: 0%, 101-150: 1.2%, 151-200: 1.5%, 201-300: 5.3%, 301-500: 10.8% p < 0.0001). DISCUSSION Patients with increased concentrations of plasma paracetamol at hospital presentation are at higher risk of liver injury even when intravenous NAC is promptly administered before there is biochemical evidence of toxicity. CONCLUSION This study supports theoretical concerns that the current intravenous dose of NAC may be too low in the setting of higher paracetamol exposure.
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Affiliation(s)
- David G Cairney
- a NPIS Edinburgh , Royal Infirmary of Edinburgh , Edinburgh , UK
| | | | | | - Michael Eddleston
- a NPIS Edinburgh , Royal Infirmary of Edinburgh , Edinburgh , UK
- c Pharmacology, Toxicology and Therapeutics , University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | | | - James W Dear
- a NPIS Edinburgh , Royal Infirmary of Edinburgh , Edinburgh , UK
- c Pharmacology, Toxicology and Therapeutics , University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
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Basu A, Veettil S, Dyer R, Peyser T, Basu R. Direct Evidence of Acetaminophen Interference with Subcutaneous Glucose Sensing in Humans: A Pilot Study. Diabetes Technol Ther 2016; 18 Suppl 2:S243-7. [PMID: 26784129 PMCID: PMC4717519 DOI: 10.1089/dia.2015.0410] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recent advances in accuracy and reliability of continuous glucose monitoring (CGM) devices have focused renewed interest on the use of such technology for therapeutic dosing of insulin without the need for independent confirmatory blood glucose meter measurements. An important issue that remains is the susceptibility of CGM devices to erroneous readings in the presence of common pharmacologic interferences. We report on a new method of assessing CGM sensor error to pharmacologic interferences using the example of oral administration of acetaminophen. MATERIALS AND METHODS We examined the responses of several different Food and Drug Administration-approved and commercially available CGM systems (Dexcom [San Diego, CA] Seven(®) Plus™, Medtronic Diabetes [Northridge, CA] Guardian(®), and Dexcom G4(®) Platinum) to oral acetaminophen in 10 healthy volunteers without diabetes. Microdialysis catheters were placed in the abdominal subcutaneous tissue. Blood and microdialysate samples were collected periodically and analyzed for glucose and acetaminophen concentrations before and after oral ingestion of 1 g of acetaminophen. We compared the response of CGM sensors with the measured acetaminophen concentrations in the blood and interstitial fluid. RESULTS Although plasma glucose concentrations remained constant at approximately 90 mg/dL (approximately 5 mM) throughout the study, CGM glucose measurements varied between approximately 85 to 400 mg/dL (from approximately 5 to 22 mM) due to interference from the acetaminophen. The temporal profile of CGM interference followed acetaminophen concentrations measured in interstitial fluid (ISF). CONCLUSIONS This is the first direct measurement of ISF concentrations of putative CGM interferences with simultaneous measurements of CGM performance in the presence of the interferences. The observed interference with glucose measurements in the tested CGM devices coincided temporally with appearance of acetaminophen in the ISF. The method applied here can be used to determine the susceptibility of current and future CGM systems to interference from acetaminophen or other exogenous pharmacologic agents.
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Affiliation(s)
- Ananda Basu
- Endocrine Research Unit, Saint Mary's Hospital, Mayo Clinic, Rochester, Minnesota
| | - Sona Veettil
- Endocrine Research Unit, Saint Mary's Hospital, Mayo Clinic, Rochester, Minnesota
| | - Roy Dyer
- Immunochemical Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Thomas Peyser
- Automated Glucose Control LLC, Palo Alto, California
| | - Rita Basu
- Endocrine Research Unit, Saint Mary's Hospital, Mayo Clinic, Rochester, Minnesota
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22
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Klimek-Turek A, Sikora M, Rybicki M, Dzido TH. Frontally eluted components procedure with thin layer chromatography as a mode of sample preparation for high performance liquid chromatography quantitation of acetaminophen in biological matrix. J Chromatogr A 2016; 1436:19-27. [PMID: 26839178 DOI: 10.1016/j.chroma.2016.01.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 11/18/2022]
Abstract
A new concept of using thin-layer chromatography to sample preparation for the quantitative determination of solute/s followed by instrumental techniques is presented Thin-layer chromatography (TLC) is used to completely separate acetaminophen and its internal standard from other components (matrix) and to form a single spot/zone containing them at the solvent front position (after the final stage of the thin-layer chromatogram development). The location of the analytes and internal standard in the solvent front zone allows their easy extraction followed by quantitation by HPLC. The exctraction procedure of the solute/s and internal standard can proceed from whole solute frontal zone or its part without lowering in accuracy of quantitative analysis.
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Affiliation(s)
- A Klimek-Turek
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland.
| | - M Sikora
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland
| | - M Rybicki
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland
| | - T H Dzido
- Medical University of Lublin, Department of Physical Chemistry, Chodźki 4a Str., 20-098 Lublin, Poland
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Bagger JI, Holst JJ, Hartmann B, Andersen B, Knop FK, Vilsbøll T. Effect of Oxyntomodulin, Glucagon, GLP-1, and Combined Glucagon +GLP-1 Infusion on Food Intake, Appetite, and Resting Energy Expenditure. J Clin Endocrinol Metab 2015; 100:4541-52. [PMID: 26445112 DOI: 10.1210/jc.2015-2335] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT The gut hormone, oxyntomodulin, is a proglucagon product with body weight-lowering potential. It binds to both the glucagon-like peptide-1 (GLP-1) receptor and the glucagon receptor; however, the mechanism behind the body weight-lowering effect remains elusive. OBJECTIVE We wanted to delineate the contributions of separate and combined GLP-1 receptor and glucagon receptor activation to the body weight-reducing mechanisms of oxyntomodulin. DESIGN This was a double-blinded, randomized, crossover study. SETTING The study was conducted at a specialized research unit. PARTICIPANTS Fifteen young healthy male volunteers (aged 22 [range 18-32] y; body mass index 23 [21-26] kg/m(2); fasting plasma glucose 5.1 [4.4-5.4] mmol/L; and glycated hemoglobin A1c 40 (37-42) mmol/mol). INTERVENTIONS Five 4-hour liquid meal tests during the infusion of saline, GLP-1 (1 pmol × kg(-1) × min(-1)), glucagon (0.86 pmol × kg(-1) × min(-1)), oxyntomodulin (3 pmol × kg(-1) × min(-1)), or glucagon+GLP-1 (same doses). MAIN OUTCOME MEASURES We evaluated resting energy expenditure (measured as oxygen uptake, gastric emptying (GE), composite appetite scores (CAS), and food intake. RESULTS Oxyntomodulin, GLP-1, and GLP-1+glucagon slowed GE and reduced CAS, whereas glucagon did not affect GE and CAS. All infusions caused a similar decrease in food intake compared with saline (total intake (g [95% confidence interval]), saline 811 [729, 892], GLP-1 669 [586, 750], glucagon 686 [604, 768], oxyntomodulin 689 [608, 771], and glucagon+GLP-1 688 [606, 769]). Oxygen uptake did not change significantly from baseline in response to any peptide infusion compared with saline. CONCLUSIONS Oxyntomodulin, GLP-1, and glucagon decreased food intake but with no additional effect of combining GLP-1 and glucagon.
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Affiliation(s)
- Jonatan Ising Bagger
- Center for Diabetes Research (J.I.B., F.K.K., T.V.), Gentofte Hospital, and NNF Center for Basic Metabolic Research and Department of Biomedical Sciences (J.I.B., J.J.H., B.H., F.K.K.), Faculty of Health Sciences, University of Copenhagen, DK-2900 Hellerup, Denmark; and Diabetes Research Unit (B.A.), Novo Nordisk A/S, DK-2760 Måløv, Denmark
| | - Jens Juul Holst
- Center for Diabetes Research (J.I.B., F.K.K., T.V.), Gentofte Hospital, and NNF Center for Basic Metabolic Research and Department of Biomedical Sciences (J.I.B., J.J.H., B.H., F.K.K.), Faculty of Health Sciences, University of Copenhagen, DK-2900 Hellerup, Denmark; and Diabetes Research Unit (B.A.), Novo Nordisk A/S, DK-2760 Måløv, Denmark
| | - Bolette Hartmann
- Center for Diabetes Research (J.I.B., F.K.K., T.V.), Gentofte Hospital, and NNF Center for Basic Metabolic Research and Department of Biomedical Sciences (J.I.B., J.J.H., B.H., F.K.K.), Faculty of Health Sciences, University of Copenhagen, DK-2900 Hellerup, Denmark; and Diabetes Research Unit (B.A.), Novo Nordisk A/S, DK-2760 Måløv, Denmark
| | - Birgitte Andersen
- Center for Diabetes Research (J.I.B., F.K.K., T.V.), Gentofte Hospital, and NNF Center for Basic Metabolic Research and Department of Biomedical Sciences (J.I.B., J.J.H., B.H., F.K.K.), Faculty of Health Sciences, University of Copenhagen, DK-2900 Hellerup, Denmark; and Diabetes Research Unit (B.A.), Novo Nordisk A/S, DK-2760 Måløv, Denmark
| | - Filip Krag Knop
- Center for Diabetes Research (J.I.B., F.K.K., T.V.), Gentofte Hospital, and NNF Center for Basic Metabolic Research and Department of Biomedical Sciences (J.I.B., J.J.H., B.H., F.K.K.), Faculty of Health Sciences, University of Copenhagen, DK-2900 Hellerup, Denmark; and Diabetes Research Unit (B.A.), Novo Nordisk A/S, DK-2760 Måløv, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research (J.I.B., F.K.K., T.V.), Gentofte Hospital, and NNF Center for Basic Metabolic Research and Department of Biomedical Sciences (J.I.B., J.J.H., B.H., F.K.K.), Faculty of Health Sciences, University of Copenhagen, DK-2900 Hellerup, Denmark; and Diabetes Research Unit (B.A.), Novo Nordisk A/S, DK-2760 Måløv, Denmark
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Hira T, Yahagi A, Nishimura S, Sakaino M, Yamashita T, Hara H. Diunsaturated Aldehyde, trans,trans-2,4-Decadienal in the Intestinal Lumen Suppresses Gastric Emptying through Serotonin Signaling in Rats. J Agric Food Chem 2015; 63:8177-8181. [PMID: 26322627 DOI: 10.1021/acs.jafc.5b03126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We recently demonstrated that a diunsaturated aldehyde, trans,trans-2,4-decadienal (2,4-decadienal), potently stimulated secretion of cholecystokinin in the enteroendocrine cell line. Gut hormones such as cholecystokinin and serotonin play critical roles in reducing postprandial gastric emptying. In the present study, we first demonstrated that oral administration of 2,4-decadienal (50-100 mg/kg) reduced gastric emptying rate in rats, assessed by both the acetaminophen absorption test and the phenol red recovery method. In contrast, saturated aldehyde, alcohol, and fatty acids having the same chain length as 2,4-decadienal did not affect the gastric emptying rate. Duodenal administration of 2,4-decadienal potently reduced gastric emptying rate, but intraperitoneal administration did not. Furthermore, the gastric inhibitory effect of 2,4-decadienal was attenuated by treatment with a serotonin receptor antagonist. These results demonstrated that 2,4-decadienal in the small intestinal lumen has a potent inhibitory effect on gastric emptying, possibly through stimulation of the serotonin-producing enteroendocrine cells.
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Affiliation(s)
- Tohru Hira
- Research Faculty of Agriculture, Hokkaido University , Sapporo 060-8589, Japan
| | - Asuka Yahagi
- Graduate School of Agriculture, Hokkaido University , Sapporo 060-8589, Japan
| | - Saki Nishimura
- Fundamental Research Laboratory, Research and Development Division, J-Oil Mills, Inc. , Yokohama 104-0044, Japan
| | - Masayoshi Sakaino
- Fundamental Research Laboratory, Research and Development Division, J-Oil Mills, Inc. , Yokohama 104-0044, Japan
| | - Takatoshi Yamashita
- Fundamental Research Laboratory, Research and Development Division, J-Oil Mills, Inc. , Yokohama 104-0044, Japan
| | - Hiroshi Hara
- Research Faculty of Agriculture, Hokkaido University , Sapporo 060-8589, Japan
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Becker RHA, Stechl J, Steinstraesser A, Golor G, Pellissier F. Lixisenatide reduces postprandial hyperglycaemia via gastrostatic and insulinotropic effects. Diabetes Metab Res Rev 2015; 31:610-8. [PMID: 25773712 PMCID: PMC4744661 DOI: 10.1002/dmrr.2647] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/04/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lixisenatide is a once-daily, prandial, short-acting glucagon-like peptide-1 receptor agonist. Its main antidiabetic effect is to delay gastric emptying to control postprandial plasma glucose excursions. The dose-response relationship of the integrated insulinotropic and gastrostatic response to lixisenatide in healthy volunteers after a standardized liquid meal was investigated. METHODS Twenty healthy subjects received acetaminophen 1000 mg with a standardized liquid meal 60 min after a single subcutaneous injection of placebo or lixisenatide 2.5, 5, 10 or 20 µg in randomized order separated by a 2- to 7-day washout. Acetaminophen pharmacokinetics served as a surrogate to assess rate of gastric emptying. Postprandial plasma glucose, insulin, C-peptide and glucagon were assessed for 5 h after the meal test, and lixisenatide pharmacokinetics were determined for 6 h. RESULTS After lixisenatide administration and prior to the standardized meal, insulin and C-peptide transiently increased, while fasting plasma glucose decreased in a dose-dependent manner. After the meal, postprandial plasma glucose, insulin and C-peptide were dose proportionally reduced with lixisenatide versus placebo for up to 6 h. Compared with placebo, glucagon levels were transiently lower after any lixisenatide dose, with more sustained reductions after the meal and no apparent dose-related trends. Acetaminophen absorption was significantly reduced and delayed compared with placebo for lixisenatide doses ≥5 µg and demonstrated dose-dependent slowing of gastric emptying. Lixisenatide displayed near dose-proportional exposure, with gastrointestinal events increasing with dose. CONCLUSIONS Lixisenatide reduced fasting plasma glucose via stimulation of glucose-dependent insulin release and controlled postprandial plasma glucose by delaying gastric emptying, demonstrating it to be a valuable option for overall glycaemic control.
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Affiliation(s)
| | - Jens Stechl
- Diabetes DivisionSanofi‐Aventis Deutschland GmbHFrankfurt am MainGermany
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26
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Garner CR, Park KB, French NS, Earnshaw C, Schipani A, Selby AM, Byrne L, Siner S, Crawley FP, Vaes WHJ, van Duijn E, deLigt R, Varendi H, Lass J, Grynkiewicz G, Maruszak W, Turner MA. Observational infant exploratory [(14)C]-paracetamol pharmacokinetic microdose/therapeutic dose study with accelerator mass spectrometry bioanalysis. Br J Clin Pharmacol 2015; 80:157-67. [PMID: 25619398 PMCID: PMC4500335 DOI: 10.1111/bcp.12597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 12/13/2022] Open
Abstract
AIMS The aims of the study were to compare [(14)C]-paracetamol ([(14)C]-PARA) paediatric pharmacokinetics (PK) after administration mixed in a therapeutic dose or an isolated microdose and to develop further and validate accelerator mass spectrometry (AMS) bioanalysis in the 0-2 year old age group. METHODS [(14)C]-PARA concentrations in 10-15 µl plasma samples were measured after enteral or i.v. administration of a single [(14)C]-PARA microdose or mixed in with therapeutic dose in infants receiving PARA as part of their therapeutic regimen. RESULTS Thirty-four infants were included in the PARA PK analysis for this study: oral microdose (n = 4), i.v. microdose (n = 6), oral therapeutic (n = 6) and i.v. therapeutic (n = 18). The respective mean clearance (CL) values (SDs in parentheses) for these dosed groups were 1.46 (1.00) l h(-1), 1.76 (1.07) l h(-1), 2.93 (2.08) l h(-1) and 2.72 (3.10) l h(-1), t(1/2) values 2.65 h, 2.55 h, 8.36 h and 7.16 h and dose normalized AUC(0-t) (mg l(-1) h) values were 0.90 (0.43), 0.84 (0.57), 0.7 (0.79) and 0.54 (0.26). CONCLUSIONS All necessary ethical, scientific, clinical and regulatory procedures were put in place to conduct PK studies using enteral and systemic microdosing in two European centres. The pharmacokinetics of a therapeutic dose (mg kg(-1)) and a microdose (ng kg(-1)) in babies between 35 to 127 weeks post-menstrual age. [(14)C]-PARA pharmacokinetic parameters were within a two-fold range after a therapeutic dose or a microdose. Exploratory studies using doses significantly less than therapeutic doses may offer ethical and safety advantages with increased bionalytical sensitivity in selected exploratory paediatric pharmacokinetic studies.
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Affiliation(s)
- Colin R Garner
- Hull York Medical School, University of YorkHeslington York, YO1 5DD, United Kingdom
- United Kingdom and Garner Consulting5 Hall Drive, Sand Hutton, York, YO41 1LA, United Kingdom
| | - Kevin B Park
- Institute of Translational Medicine, University of LiverpoolCrown Street, Liverpool, L69 3BX, United Kingdom
| | - Neil S French
- Institute of Translational Medicine, University of LiverpoolCrown Street, Liverpool, L69 3BX, United Kingdom
| | - Caroline Earnshaw
- Institute of Translational Medicine, University of LiverpoolCrown Street, Liverpool, L69 3BX, United Kingdom
| | - Alessandro Schipani
- Institute of Translational Medicine, University of LiverpoolCrown Street, Liverpool, L69 3BX, United Kingdom
| | - Andrew M Selby
- Alder Hey Children's NHS Foundation TrustEaton Road, West Derby, Liverpool, L12 2AP, United Kingdom
| | - Lindsay Byrne
- Alder Hey Children's NHS Foundation TrustEaton Road, West Derby, Liverpool, L12 2AP, United Kingdom
| | - Sarah Siner
- Alder Hey Children's NHS Foundation TrustEaton Road, West Derby, Liverpool, L12 2AP, United Kingdom
| | - Francis P Crawley
- Good Clinical Practice Alliance – EuropeSchoolbergenstraat 47, BE-3010, Kessel-Lo, Belgium
| | - Wouter H J Vaes
- TNO ZeistUtrechtseweg 48, PO Box 360, 3700, AJ Zeist, The Netherlands
| | - Esther van Duijn
- TNO ZeistUtrechtseweg 48, PO Box 360, 3700, AJ Zeist, The Netherlands
| | - Rianne deLigt
- TNO ZeistUtrechtseweg 48, PO Box 360, 3700, AJ Zeist, The Netherlands
| | - Heili Varendi
- Department of Paediatrics, Tartu University Hospital, University of Tartu51014, Tartu, Estonia
| | - Jane Lass
- Department of Paediatrics, Tartu University Hospital, University of Tartu51014, Tartu, Estonia
| | | | - Wioletta Maruszak
- Pharmaceutical Research Institute8 Rydygiera Street, 01-793, Warsaw, Poland
| | - Mark A Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, University of LiverpoolLiverpool, L69 3BX, United Kingdom
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27
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Mao A, Li H, Jin D, Yu L, Hu X. Fabrication of electrochemical sensor for paracetamol based on multi-walled carbon nanotubes and chitosan-copper complex by self-assembly technique. Talanta 2015; 144:252-7. [PMID: 26452818 DOI: 10.1016/j.talanta.2015.06.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/04/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022]
Abstract
An electrochemical sensor for paracetamol based on multi-walled carbon nanotubes and chitosan-copper complex (MWCNTs/CTS-Cu) was fabricated by self-assembly technique. The MWCNTs/CTS-Cu modified GCE showed an excellent electrocatalytic activity for the oxidation of paracetamol, and accelerated electron transfer between the electrode and paracetamol. Under optimal experimental conditions, the differential pulse peak current was linear with the concentration of paracetamol in the range of 0.1-200 μmol L(-1) with a detection limit of 0.024 μmol L(-1). The sensitivity was found to be 0.603 A/mol L(-1). The proposed sensor also showed a high selectivity for paracetamol in the presence of ascorbic acid and dopamine. Moreover, the proposed electrode revealed good reproducibility and stability. The proposed method was successfully applied for the determination of paracetamol in tablet and human serum samples.
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Affiliation(s)
- Airong Mao
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, China; School of Chemistry and Chemical Engineering, Yancheng Institute of Technology, Yancheng 224051, China
| | - Hongbo Li
- School of Chemistry and Chemical Engineering, Yancheng Institute of Technology, Yancheng 224051, China
| | - Dangqin Jin
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, China; Department of Chemical Engineering, Yangzhou Polytechnic Institute, Yangzhou 225127, China
| | - Liangyun Yu
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, China; School of Chemistry and Chemical Engineering, Yancheng Institute of Technology, Yancheng 224051, China
| | - Xiaoya Hu
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, China.
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Li CN, Sun SJ, Shen ZF. [Determination of serum acetaminophen based on the diazo reaction and its application in the evaluation of gastric emptying]. Yao Xue Xue Bao 2015; 50:560-564. [PMID: 26234136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study aims to establish a method to determine the serum acetaminophen concentration based on diazo reaction, and apply it in the gastric emptying evaluation. Theoretically, acetaminophen could take hydrolysis reaction in hydrochloric acid solution to produce p-aminophenol, which could then take diazo reaction resulting in a product with special absorption peak at 312 nm. Then the serum acetaminophen concentration and recovery rate were calculated according to the standard curve drawn with absorbance at 312 nm. ICR mice were given a dose of acetaminophen (500 mg x kg(-1)) by gavage and the serum acetaminophen was dynamically measured through the diazo reaction. Besides, ICR mice were subcutaneously injected with the long-acting GLP-1 analog GW002 before the gavage of acetaminophen, and serum acetaminophen concentration was measured as above to study how GW002 could influence the gastric emptying. The data showed acetaminophen ranging from 0 to 160 μg x mL(-1) could take diazo reaction with excellent linear relationship, and the regression equation was y = 0.0181 x +0.0104, R2 = 0.9997. The serum acetaminophen was also measured with good linear relationship (y = 0.0045 x + 0.0462, R = 0.9982) and the recovery rate was 97.4%-116.7%. The serum concentration of acetaminophen reached peak at about 0.5 h after gavage, and then gradually decreased. GW002 could significantly lower the serum acetaminophen concentration and make the area under the concentration-time curve (AUC) decrease by 28.4%. In conclusion, a method for the determination of serum acetaminophen based on the diazo reaction was established with good accuracy and could be used in the evaluation of gastric emptying.
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Koppen A, van Riel A, de Vries I, Meulenbelt J. Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine. Neth J Med 2014; 72:251-257. [PMID: 24930458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Treatment of paracetamol intoxication consists of administration of N-acetylcysteine, preferably shortly after paracetamol ingestion. In most countries, the decision to treat patients with N-acetylcysteine depends on the paracetamol plasma concentration. In the literature, different arguments are given regarding when to treat paracetamol overdose. Some authors do not recommend treatment with N-acetylcysteine at low paracetamol plasma concentrations since unnecessary adverse effects may be induced. But no treatment with N-acetylcysteine at higher paracetamol plasma concentrations may lead to unnecessary severe morbidity and mortality. In this review, we provide an overview on the severity and prevalence of adverse side effects after N-acetylcysteine administration and the consequences these side effects may have for the treatment of paracetamol intoxication. The final conclusion is to continue using the guidelines of the Dutch National Poisons Information Centre for N-acetylcysteine administration in paracetamol intoxication.
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Affiliation(s)
- A Koppen
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, the Netherlands
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30
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Rašković A, Cvejić J, Stilinović N, Goločorbin-Kon S, Vukmirović S, Mimica-Dukić N, Mikov M. Interaction between different extracts of Hypericum perforatum L. from Serbia and pentobarbital, diazepam and paracetamol. Molecules 2014; 19:3869-82. [PMID: 24686576 PMCID: PMC6272045 DOI: 10.3390/molecules19043869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/16/2022] Open
Abstract
Herb-drug interactions are an important safety concern and this study was conducted regarding the interaction between the natural top-selling antidepressant remedy Hypericum perforatum (Hypericaceae) and conventional drugs. This study examined the influence of acute pretreatment with different extracts of Hypericum perforatum from Serbia on pentobarbital-induced sleeping time, impairment of motor coordination caused by diazepam and paracetamol pharmacokinetics in mice. Ethanolic extract, aqueous extract, infusion, tablet and capsule of Hypericum perforatum were used in this experiment. The profile of Hypericum perforatum extracts as well as paracetamol plasma concentration was determined using RP-HPLC analysis. By quantitative HPLC analysis of active principles, it has been proven that Hypericum perforatum ethanolic extract has the largest content of naphtodianthrones: hypericin (57.77 µg/mL) and pseudohypericin (155.38 µg/mL). Pretreatment with ethanolic extract of Hypericum perforatum potentiated the hypnotic effect of pentobarbital and impairment of motor coordination caused by diazepam to the greatest extent and also increased paracetamol plasma concentration in comparison to the control group. These results were in correlation with naphtodianthrone concentrations. The obtained results have shown a considerable influence of Hypericum perforatum on pentobarbital and diazepam pharmacodynamics and paracetamol pharmacokinetics.
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Affiliation(s)
- Aleksandar Rašković
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia.
| | - Jelena Cvejić
- Laboratory for Pharmaceutical and Natural Products Analysis, Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia.
| | - Nebojša Stilinović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia.
| | - Svetlana Goločorbin-Kon
- Laboratory for Pharmaceutical and Natural Products Analysis, Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia.
| | - Saša Vukmirović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia.
| | - Neda Mimica-Dukić
- Department of Chemistry, Biochemistry and Environmental Protection, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad 21000, Serbia.
| | - Momir Mikov
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia.
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Nozawa M. [Practical analysis of toxic substances useful for clinical toxicology (5). Introduction of a new simple analysis of acetaminophen; ZAP tox Acetaminophen Test]. Chudoku Kenkyu 2014; 27:54-57. [PMID: 24724363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Snyder A, Koeller G, Seiwert B, Abraham G, Schusser GF. Influence of laxatives on gastric emptying in healthy warmblood horses evaluated with the acetaminophen absorption test. Berl Munch Tierarztl Wochenschr 2014; 127:170-175. [PMID: 24693665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The use of laxatives is crucial in the treatment of horses with caecal or large colon impaction.To reach the large intestinal contents and resolve the impaction, laxatives must leave the stomach and pass through the small intestine.The aim of this study was to prove whether isotonic solutions of saline cathartics do not affect gastric emptying rate in contrast to hypertonic solutions. Six, fasted, healthy, adult Warmblood horses were used in a randomized study design with 1.8% sodium sulfate (1.8% Na2SO4), 4.2% magnesium sulfate (4.2% MgSO4), 25% sodium sulfate (25% Na2SO4), 25% magnesium sulfate (25% MgSO4) and water at either 20 ml/kg BW (Water 20) or 4 ml/kg BW (Water 4), administered via nasogastric intubation. For indirect measurement of liquid-phase gastric emptying, the liquid-phase passage marker acetaminophen (20 mg/kg BW in 200 ml water) was added to each trial. Serum samples were collected at predetermined time points for pharmacokinetic analysis. The time to reach maximum serum concentration (Tmax) was considered as gastric emptying rate. Compared to Water 4, Tmax of 25% Na2SO4 and 25% MgSO4 was reached significantly later, the maximum serum concentration (Cmax) of acetaminophen was significantly lower and the area under the curve determined up to 90 min (AUC90) was significantly smaller. Isotonic solutions of saline cathartics (1.8% Na2SO4, 4.2% MgSO4) did not influence the gastric emptying rate. Hypertonic solutions of saline cathartics (25% Na2SO4, 25% MgSO4) significantly delayed the gastric emptying rate.
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Inoue Y. [Blood concentration useful in the diagnosis and treatment of poisoning]. Chudoku Kenkyu 2014; 27:47-53. [PMID: 24724362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Jiang L, Gu S, Ding Y, Jiang F, Zhang Z. Facile and novel electrochemical preparation of a graphene-transition metal oxide nanocomposite for ultrasensitive electrochemical sensing of acetaminophen and phenacetin. Nanoscale 2014; 6:207-214. [PMID: 24201458 DOI: 10.1039/c3nr03620k] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A facile and novel preparation strategy based on electrochemical techniques for the fabrication of electrodeposited graphene (EGR) and zinc oxide (ZnO) nanocomposite was developed. The morphology and structure of the EGR-based nanocomposite were investigated by scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy dispersive X-ray spectroscopy (XPS) and Raman spectroscopy. Meanwhile, the electrochemical performance of the nanocomposite was demonstrated with cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Due to the synergistic effect of EGR and ZnO nanoparticles, an ultrasensitive electrochemical sensor for acetaminophen (AC) and phenacetin (PCT) was successfully fabricated. The linearity ranged from 0.02 to 10 μM for AC and 0.06 to 10 μM for PCT with high sensitivities of 54,295.82 μA mM(-1) cm(2) for AC and 21,344.66 μA mM(-1) cm(2) for PCT, respectively. Moreover, the practical applicability was validated to be reliable and desirable in pharmaceutical detections. The excellent results showed the promise of the proposed preparation strategy of EGR-transition metal oxide nanocomposite in the field of electroanalytical chemistry.
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Affiliation(s)
- Lin Jiang
- Department of Chemistry, Shanghai University, Shanghai 200444, P. R. China.
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Rashnavadi M, Nouri M, Haji Hajikolaei MR, Najafzadeh H, Constable PD. Effect of spiramycin and tulathromycin on abomasal emptying rate in milk-fed calves. Can J Vet Res 2014; 78:61-7. [PMID: 24396182 PMCID: PMC3878010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/08/2012] [Indexed: 06/03/2023]
Abstract
Impaired abomasal motility is common in cattle with abomasal disorders. The macrolide erythromycin has been demonstrated to be an effective prokinetic agent in healthy calves and in adult cattle with abomasal volvulus or left displaced abomasum. We hypothesized that 2 structurally related macrolides, spiramycin and tulathromycin, would also be effective prokinetic agents in cattle. Six milk-fed, male, Holstein-Friesian calves were administered each of the following 4 treatments: spiramycin, 75 000 IU/kg BW, IM, this dose approximates 25 mg/kg BW, IM; tulathromycin, 2.5 mg/kg BW, SC; 2 mL of 0.9% NaCl (negative control); and erythromycin, 8.8 mg/kg BW, IM (positive control). Calves were fed 2 L of cow's milk containing acetaminophen (50 mg/kg body weight) 30 min after each treatment was administered and jugular venous blood samples were obtained periodically after the start of sucking. Abomasal emptying rate was assessed by the time to maximal plasma acetaminophen concentration. Spiramycin, tulathromycin, and the positive control erythromycin increased abomasal emptying rate compared to the negative control. We conclude that the labeled antimicrobial dose of spiramycin and tulathromycin increases the abomasal emptying rate in healthy milk-fed calves. Additional studies investigating whether spiramycin and tulathromycin exert a prokinetic effect in adult cattle with abomasal hypomotility appear indicated.
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Affiliation(s)
- Mehdi Rashnavadi
- Department of Clinical Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran (Rashnavadi, Nouri, Haji Hajikolaei); Department of Basic Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz Iran (Najafzadeh); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA (Constable)
| | - Mohammad Nouri
- Department of Clinical Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran (Rashnavadi, Nouri, Haji Hajikolaei); Department of Basic Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz Iran (Najafzadeh); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA (Constable)
| | - Mohammad R. Haji Hajikolaei
- Department of Clinical Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran (Rashnavadi, Nouri, Haji Hajikolaei); Department of Basic Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz Iran (Najafzadeh); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA (Constable)
| | - Housain Najafzadeh
- Department of Clinical Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran (Rashnavadi, Nouri, Haji Hajikolaei); Department of Basic Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz Iran (Najafzadeh); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA (Constable)
| | - Peter D. Constable
- Department of Clinical Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran (Rashnavadi, Nouri, Haji Hajikolaei); Department of Basic Sciences, College of Veterinary Medicine, Shahid Chamran University, Ahvaz Iran (Najafzadeh); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA (Constable)
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Kulo A, Van Calsteren K, van de Velde M, Mulabegovic N, Verbesselt R, de Hoon JN, Verhaeghe J, Allegaert K. Weight, pregnancy and oral contraceptives affect intravenous paracetamol clearance in young women. Eur Rev Med Pharmacol Sci 2014; 18:599-604. [PMID: 24668698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Because of the extensive variability in paracetamol clearance in young women, published data were pooled with newly collected observations in search of covariates of paracetamol pharmacokinetics (PK) within this specific population. SUBJECTS AND METHODS PK estimates and clinical characteristics [pregnant, weight, exposure to oral contraceptives (OC)] in young women following IV loading dose (2 g paracetamol) were pooled, using a non-compartmental linear disposition model in individual time-concentration profiles. Data were reported by median and range. Rank correlation was used to link clearance (l/h) to weight, Mann Whitney U test to compare clearance (l/h.m-2) between subgroups (pregnant, OC exposure). Finally, a multiple regression model with clearance (l/h) in all women and all non-pregnant women was performed. RESULTS Based on 73 paracetamol PK estimates, a 8-fold variability in clearance (range 7.1-62.2 l/h) was documented, in part explained by a correlation (r2=0.36) between clearance (l/h) and weight. Clearance (l/h and l/h.m-2) and distribution volume (l) at delivery (n=36) were higher compared to non-pregnant observations. In non-pregnant women, women on OC (n=20) had a higher paracetamol clearance (l/h.m-2) compared to women (n=17) not on OC (p = 0.023). Weight (p = 0.0043) and pregnancy (p = 0.02) were independent variables (r=0.56) of paracetamol clearance (l/h). In non-pregnant women, weight (p = 0.009) and OC exposure (p = 0.03) were independent variables (r=0.51). CONCLUSIONS Weight, pregnancy and OC result in higher clearance of IV paracetamol in young women. Besides compound specific relevance, these findings also unveil covariates of drug metabolism in young women.
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Affiliation(s)
- A Kulo
- Department of Pharmaceutical and Pharmacological Sciences and Center for Clinical Pharmacology, University Hospitals Leuven, Leuven, Belgium.
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Prasad VGNV, Vivek C, Anand Kumar P, Ravi Kumar P, Rao GS. Turpentine oil induced inflammation decreases absorption and increases distribution of phenacetin without altering its elimination process in rats. Eur J Drug Metab Pharmacokinet 2013; 40:23-8. [PMID: 24356809 DOI: 10.1007/s13318-013-0172-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022]
Abstract
Plasma concentrations and pharmacokinetics of phenacetin, a CYP1A2 substrate were determined in normal and experimentally induced inflamed rats by turpentine oil to know the role of inflammation on the pharmacokinetics of phenacetin and formation of its active metabolite (paracetamol) by CYP1A2 in wistar albino rats, weighing about 200-250 g that were randomly divided into two groups consisting six in each group. Rats in group I (control) received phenacetin (150 mg kg(-1), PO) where as group II received phenacetin 12 h after induction of inflammation by turpentine oil (0.4 mL, i.m). Blood samples were collected from retro orbital plexus at pre-determined time intervals prior to and at 0.166, 0.33, 0.67, 1.5, 2, 4, 8 and 12 h post-administration of phenacetin. Plasma was separated and analyzed for phenacetin and its metabolite paracetamol by HPLC assay. Based on plasma concentrations of phenacetin and its metabolite paracetamol, the pharmacokinetic parameters were determined by compartmental methods. C(max) of phenacetin was significantly (p < 0.01) decreased to 19.50 ± 2.74 μg mL(-1) in inflamed conditions compared to 38.13 ± 2.20 μg mL(-1) obtained in normal rats. Except, for significant (p < 0.001) increase in volume of distribution at steady state (V(dss)) from 2.87 ± 0.37 to 8.03 ± 1.26 L kg(-1) and increased the rate of absorption with shorter absorption half-life (t(1/2ka)) for phenacetin in inflammation. None of the pharmacokinetic parameters of either phenacetin or its metabolite paracetamol were affected. It can be concluded that turpentine oil induced inflammation has no role on the activity of CYP1A2 in rats, as the plasma concentrations and pharmacokinetic parameters of paracetamol were found unaltered.
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Affiliation(s)
- V G N V Prasad
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science, Rajendranagar, 500030, Hyderabad, India,
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Kim JW, Ryu SH, Kim S, Lee HW, Lim MS, Seong SJ, Kim S, Yoon YR, Kim KB. Pattern recognition analysis for hepatotoxicity induced by acetaminophen using plasma and urinary 1H NMR-based metabolomics in humans. Anal Chem 2013; 85:11326-34. [PMID: 24127682 DOI: 10.1021/ac402390q] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Drug-induced liver injury (DILI) is currently an increasingly relevant health issue. However, available biomarkers do not reliably detect or quantify DILI risk. Therefore, the purpose of this study was to comparatively evaluate plasma and urinary biomarkers obtained from humans treated with acetaminophen (APAP) using a metabolomics approach and a proton nuclear magnetic resonance (NMR) platform. APAP (3 g/day, two 500 mg tablets every 8 h) was administered to 20 healthy Korean males (age, 20-29 years) for 7 days. Urine was collected daily before and during dosing and 6 days after the final dose. NMR spectra of these urine samples were analyzed using principal component analysis (PCA) and partial least-squares-discrimination analysis. Although the activities of aspartate aminotransferase and lactate dehydrogenase were significantly increased 7 days post-APAP treatment, serum biochemical parameters of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, γ-glutamyl transpeptidase, and lactate dehydrogenase were within normal range of hepatic function. However, urine and plasma (1)H NMR spectroscopy revealed different clustering between predosing and after APAP treatment for global metabolomic profiling through PCA. Urinary endogenous metabolites of trimethylamine-N-oxide, citrate, 3-chlorotyrosine, phenylalanine, glycine, hippurate, and glutarate as well as plasma endogenous metabolites such as lactate, glucose, 3-hydroxyisovalerate, isoleucine, acetylglycine, acetone, acetate, glutamine, ethanol, and isobutyrate responded significantly to APAP dosing in humans. Urinary and plasma endogenous metabolites were more sensitive than serum biochemical parameters. These results might be applied to predict or screen potential hepatotoxicity caused by other drugs using urinary and plasma (1)H NMR analyses.
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Affiliation(s)
- Ji Won Kim
- Department of Smart Food and Drug, Inje University , Obang-dong, Gimhae, Gyungnam 621-749, Republic of Korea
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De-Giorgio F, Lodise M, Chiarotti M, d'Aloja E, Carbone A, Valerio L. Possible fatal acetaminophen intoxication with atypical clinical presentation. J Forensic Sci 2013; 58:1397-1400. [PMID: 23822653 DOI: 10.1111/1556-4029.12205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 08/07/2012] [Accepted: 09/29/2012] [Indexed: 11/25/2022]
Abstract
Acetaminophen or paracetamol, a commonly used over-the-counter analgesic, is known to elicit severe adverse reactions when taken in overdose, chronically at therapeutic dosage or, sporadically, following single assumptions of a therapeutic dose. Damage patterns including liver damage and, rarely, acute tubular necrosis or a fixed drug exanthema. We present a case of fatal acetaminophen toxicity with postmortem blood concentration 78 μg/mL and unusual clinical features, including a visually striking and massive epidermolysis and rhabdomyolysis, disseminated intravascular coagulation and myocardial ischemia. This case is compared with the most similar previous reports in terms of organ damage, clinical presentation, and cause of death. We conclude that a number of severe patterns of adverse effects to acetaminophen are emerging that were previously greatly underestimated, thus questioning the adequacy of the clinical spectrum traditionally associated with acetaminophen intoxication and leading to the need to review this spectrum and the associated diagnostic criteria.
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Affiliation(s)
- Fabio De-Giorgio
- Institute of Legal Medicine Catholic University, School of Medicine, L.go F. Vito, 1 00168, Rome, Italy
| | - Maria Lodise
- Institute of Legal Medicine Catholic University, School of Medicine, L.go F. Vito, 1 00168, Rome, Italy
| | - Marcello Chiarotti
- Institute of Legal Medicine Catholic University, School of Medicine, L.go F. Vito, 1 00168, Rome, Italy
| | - Ernesto d'Aloja
- Department of Public Health, Forensic Medicine Section, Cagliari University, Km 4.500 SS. 554 Bivio per Sestu, 09042, Monserrato, Italy
| | - Arnaldo Carbone
- Institute of Pathologic Anatomy, School of Medicine, Catholic University, L.go F. Vito, 1 00168, Rome, Italy
| | - Luca Valerio
- Department of Social Medicine & Department of Vascular Medicine, University of Amsterdam, Academic Medical Center. Meibergdreef 9, 1105 Az, Amsterdam, The Netherlands
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McGill MR, Jaeschke H. Metabolism and disposition of acetaminophen: recent advances in relation to hepatotoxicity and diagnosis. Pharm Res 2013; 30:2174-87. [PMID: 23462933 DOI: 10.1007/s11095-013-1007-6] [Citation(s) in RCA: 431] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/06/2013] [Indexed: 12/11/2022]
Abstract
Acetaminophen (APAP) is one of the most widely used drugs. Though safe at therapeutic doses, overdose causes mitochondrial dysfunction and centrilobular necrosis in the liver. The first studies of APAP metabolism and activation were published more than 40 years ago. Most of the drug is eliminated by glucuronidation and sulfation. These reactions are catalyzed by UDP-glucuronosyltransferases (UGT1A1 and 1A6) and sulfotransferases (SULT1A1, 1A3/4, and 1E1), respectively. However, some is converted by CYP2E1 and other cytochrome P450 enzymes to a reactive intermediate that can bind to sulfhydryl groups. The metabolite can deplete liver glutathione (GSH) and modify cellular proteins. GSH binding occurs spontaneously, but may also involve GSH-S-transferases. Protein binding leads to oxidative stress and mitochondrial damage. The glucuronide, sulfate, and GSH conjugates are excreted by transporters in the canalicular (Mrp2 and Bcrp) and basolateral (Mrp3 and Mrp4) hepatocyte membranes. Conditions that interfere with metabolism and metabolic activation can alter the hepatotoxicity of the drug. Recent data providing novel insights into these processes, particularly in humans, are reviewed in the context of earlier work, and the effects of altered metabolism and reactive metabolite formation are discussed. Recent advances in the diagnostic use of serum adducts are covered.
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Affiliation(s)
- Mitchell R McGill
- Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, Kansas 66160, USA
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Winnicka R, Kołaciński Z, Brzeznicki S, Wesołowski W, Kucharska M, Krakowiak A. [Intoxication or false-positive acetaminophen result of toxicological determinations? Two case reports]. Przegl Lek 2013; 70:695-697. [PMID: 24466725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to show the diagnostic procedure used in the two cases with false-positive serum acetaminophen results in suspected acetaminophen poisoning. The determination of serum acetaminophen were carried out using a UV/VIS spectrophotometer (Specord 40 Analytik Jena), coupled with an analytic computer station WinASPECT. The employed method of determination was based on the acetaminophen reaction with sodium nitrite, which yields yellow colour of solution in the presence of sodium hydrate. The intensity of the yellow colour depends on the concentration of acetaminophen in serum. The relationship between absorbance and concentration was linear at concentrations in the range 50-600 microg/mL, with relative standard deviation of +/- 2.1% and detection limit of 30 microg/mL. To confirm or reject the doubtful results of colorimetric assays, the serums of patients were measured with high performance liquid chromatography with mass spectrometry detection and gas chromatography with mass spectrometry detection. The analysis of presented cases leads to a conclusion that acetaminophen results should be confirmed either by scanning urine for p-aminophenol presence (which is a routine procedure in our laboratory) or by using a different method of measuring acetaminophen serum levels.
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Affiliation(s)
- Renata Winnicka
- Pracownia Diagnostyki Toksykologicznej, Instytut Medycyny Pracy w Łodzi.
| | - Zbigniew Kołaciński
- Oddzial Toksykologii, Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy w Łodzi
| | | | | | | | - Anna Krakowiak
- Oddzial Toksykologii, Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy w Łodzi
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Zhang Y, Jia Y, Yang M, Yang P, Tian Y, Xiao A, Wen A. The impaired disposition of probe drugs is due to both liver and kidney dysfunctions in CCl(4)-model rats. Environ Toxicol Pharmacol 2012; 33:453-458. [PMID: 22407168 DOI: 10.1016/j.etap.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 12/27/2011] [Accepted: 01/06/2012] [Indexed: 05/31/2023]
Abstract
The carbon tetrachloride (CCl(4))-treated model involving mature Sprague-Dawley rats has been historically relied upon to study liver injury and regeneration and to test drug efficacy and disposition. However, there few studies about phase II metabolic enzymes changes in CCl(4)-model rats. The metabolic and excretion tests of phenacetin and acetaminophen (APAP), and the mRNA test of cytochrome P4501A2 (CYP1A2) and phase II metabolic enzymes [sulfotransferase 1A1 (SULT1A1) and UDP-glucuronosyltransferase 1A6 (UGT1A6)] were studied in model rats after CCl(4) pretreatment. The result showed that the function and structure of liver and kidney was impaired by CCl(4) pretreatment, and a significant difference has been observed in the mRNA content of CYP1A2 (p<0.01) in model group, but there was no significant difference on the mRNA content of SULT1A1 and UGT1A6 in both groups. Compared to the control group, a significant higher content of phenacetin (p<0.01) and sulfate-APAP (AS, p<0.01) was observed in the metabolic tests of phenacetin and APAP. Statistically significant differences in cumulative urinary excretion levels of APAP, AG and AS for CCl(4) model rats were observed also. We have shown that impaired disposition of probe drugs in this model was due to both liver and kidney dysfunction in CCl(4)-model rats and we should consider the development of a new liver damage model without renal impairment.
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Affiliation(s)
- Yan Zhang
- Department of Pharmacy, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
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Li F, Ploch S, Fast D, Michael S. Perforated dried blood spot accurate microsampling: the concept and its applications in toxicokinetic sample collection. J Mass Spectrom 2012; 47:655-67. [PMID: 22576879 DOI: 10.1002/jms.3015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Dried blood spot (DBS) sampling has gained considerable interest as a microsampling technique to support drug discovery and development owing to its enormous ethical and practical benefits. Quantitative determinations of drugs and/or their metabolites collected in DBS matrix in its current format, however, have encountered technical challenges and regulatory uncertainty. The challenges of DBS bioanalysis are largely ascribed to the way how samples are collected and analyzed. Currently, an uncontrolled amount of a blood sample, e.g. 20 µl, is collected per time point per sample and spotted onto cellulose paper. Quantitation is based on removal of a fixed area of the DBS sample, resulting in sample waste, a need for mechanical punching and concomitant potential punching carryover, uncertainty in recovery assessment and the adverse impact of hematocrit on accurate quantitation. Here, we describe the concept and applications of a novel concept, namely perforated dried blood spot (PDBS), for accurate microsampling that addresses previous challenges. Advantages of PDBS are enumerated and compared with conventional DBS in the context of microsampling and liquid chromatography tandem mass spectrometry bioanalysis. Two approaches for accurate microsampling of a small volume of blood (5 µl) are proposed and demonstrated, i.e. Microsafe® pipettes and the Drummond incremental pipette. Two online sample enrichment techniques to enhance liquid chromatography tandem mass spectrometry sensitivity for microsampling bioanalysis are discussed. The PDBS concept was successfully applied for accurate sample collection (5 µl) in a toxicokinetic study in rats given a single oral gavage dose of acetaminophen. Perspectives on bioanalytical method validation for regulated DBS/PDBS microsampling are also presented.
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Affiliation(s)
- Fumin Li
- Covance Laboratories, Inc, Bioanalytical Chemistry, 3301 Kinsman Boulevard, Madison, Wisconsin 53704, USA.
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45
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Lai DP, Ren XH, Yao JP, Liu ML, Xu G, Chen ZJ, Ling GL. [Study on the effect using hemoperfusion to treat tylenol poisoned patients]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2012; 30:310-312. [PMID: 22804947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore the effect of hemoperfusion (HP) on tylenol poisoned patients. METHODS Urgently established the blood access by transfemoral catheterization of femoral vein, we used charcoal hemoperfusion by blood pump and dynamically monitored the plasma concentration of tylenol active ingredients for the 2 patients and the content of tylenol active ingredients in the charcoal was determined. RESULTS Plasma concentration of tylenol active ingredients of the 2 patients was declined gradually during and after the HP management. The acetaminophen serum concentration of the case 1 was declined from the 13.4 µg/L at the start of HP to the 5.81 µg/L at the end of HP; and the case 2 was declined from 51.1 µg/L to 22.3 µg/L. The adsorption amount of acetaminophen in the blood perfusion device are respectively 119 542 µg of case 1 and 33 2154 µg of case 2. CONCLUSION Early hemoperfusion should be carried out for acute tylenol poisoning patients if there were indications, hemoperfusion can clear the tylenol active ingredients and this is an effective measure to eliminate tylenol active ingredients.
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Affiliation(s)
- Deng-pan Lai
- Emergency Department of The Affiliated Hospital of Hangzhou Normal University Hangzhou 310015, China
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Tominaga A, Toyoguchi T, Takahashi N, Hosoya J, Suzuki T, Shiraishi T, Iseki K. [Study of the serum concentrations of acetaminophen overdose]. Chudoku Kenkyu 2012; 25:59-64. [PMID: 22568348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Acetaminophen (APAP) is a commonly used nonsteroidal analgesic because it is considered safe. However, APAP is a major cause of acute poisoning because of its easy availability. APAP overdose causes hepatic failure. A previous study reported a case of death occurring 3-4 days after APAP overdose. Serum APAP level is an index for administration of N-acetyl-L-cysteine (NAC). We investigated cases of APAP overdose to determine the correlation between serum APAP level and estimated APAP dosage, NAC medication, hepatic failure, etc. In one case, we found that the use of estimated APAP dosage alone led to inappropriate NAC medication. Moreover, there were cases in which serum APAP level increased 4 hr after APAP overdose. Repeated cases of APAP overdose suggested that the presence of NAC medication caused a difference in liver function test values.
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Affiliation(s)
- Aya Tominaga
- Department of Pharmacy, Yamagata University Hospital
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Pujos-Guillot E, Pickering G, Lyan B, Ducheix G, Brandolini-Bunlon M, Glomot F, Dardevet D, Dubray C, Papet I. Therapeutic paracetamol treatment in older persons induces dietary and metabolic modifications related to sulfur amino acids. Age (Dordr) 2012; 34:181-193. [PMID: 21340541 PMCID: PMC3260351 DOI: 10.1007/s11357-011-9218-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/30/2011] [Indexed: 05/30/2023]
Abstract
Sulfur amino acids are determinant for the detoxification of paracetamol (N-acetyl-p-aminophenol) through sulfate and glutathione conjugations. Long-term paracetamol treatment is common in the elderly, despite a potential cysteine/glutathione deficiency. Detoxification could occur at the expense of anti-oxidative defenses and whole body protein stores in elderly. We tested how older persons satisfy the extra demand in sulfur amino acids induced by long-term paracetamol treatment, focusing on metabolic and nutritional aspects. Effects of 3 g/day paracetamol for 14 days on fasting blood glutathione, plasma amino acids and sulfate, urinary paracetamol metabolites, and urinary metabolomic were studied in independently living older persons (five women, five men, mean (±SEM) age 74 ± 1 years). Dietary intakes were recorded before and at the end of the treatment and ingested sulfur amino acids were evaluated. Fasting blood glutathione, plasma amino acids, and sulfate were unchanged. Urinary nitrogen excretion supported a preservation of whole body proteins, but large-scale urinary metabolomic analysis revealed an oxidation of some sulfur-containing compounds. Dietary protein intake was 13% higher at the end than before paracetamol treatment. Final sulfur amino acid intake reached 37 mg/kg/day. The increase in sulfur amino acid intake corresponded to half of the sulfur excreted in urinary paracetamol conjugates. In conclusion, older persons accommodated to long-term paracetamol treatment by increasing dietary protein intake without any mobilization of body proteins, but with decreased anti-oxidative defenses. The extra demand in sulfur amino acids led to a consumption far above the corresponding population-safe recommendation.
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Affiliation(s)
- Estelle Pujos-Guillot
- Plateforme d’Exploration du Métabolisme, INRA, Centre Clermont-Ferrand—Theix, UMR 1019 Nutrition Humaine, Saint-Genès-Champanelle, 63122 France
| | - Gisèle Pickering
- Centre de Pharmacologie Clinique, Inserm CIC 501, INSERM U766, Faculté de Médecine, Clermont-Ferrand, 63003 France
| | - Bernard Lyan
- Plateforme d’Exploration du Métabolisme, INRA, Centre Clermont-Ferrand—Theix, UMR 1019 Nutrition Humaine, Saint-Genès-Champanelle, 63122 France
| | - Gilles Ducheix
- Centre de Pharmacologie Clinique, Inserm CIC 501, INSERM U766, Faculté de Médecine, Clermont-Ferrand, 63003 France
| | | | - Françoise Glomot
- INRA, Centre Clermont-Ferrand—Theix, UMR 1019 Unité de Nutrition Humaine, 63122 Saint-Genès-Champanelle, France
- Univ Clermont 1, UFR Médecine, UMR 1019, Unité Nutrition Humaine, 63001 Clermont-Ferrand, France
| | - Dominique Dardevet
- INRA, Centre Clermont-Ferrand—Theix, UMR 1019 Unité de Nutrition Humaine, 63122 Saint-Genès-Champanelle, France
- Univ Clermont 1, UFR Médecine, UMR 1019, Unité Nutrition Humaine, 63001 Clermont-Ferrand, France
| | - Claude Dubray
- Centre de Pharmacologie Clinique, Inserm CIC 501, INSERM U766, Faculté de Médecine, Clermont-Ferrand, 63003 France
| | - Isabelle Papet
- INRA, Centre Clermont-Ferrand—Theix, UMR 1019 Unité de Nutrition Humaine, 63122 Saint-Genès-Champanelle, France
- Univ Clermont 1, UFR Médecine, UMR 1019, Unité Nutrition Humaine, 63001 Clermont-Ferrand, France
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Porta R, Sánchez L, Nicolás M, García C, Martínez M. Lack of toxicity after paracetamol overdose in a extremely preterm neonate. Eur J Clin Pharmacol 2012; 68:901-2. [PMID: 22227961 DOI: 10.1007/s00228-011-1165-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/02/2011] [Indexed: 12/22/2022]
MESH Headings
- Abdominal Pain/drug therapy
- Abdominal Pain/etiology
- Acetaminophen/administration & dosage
- Acetaminophen/blood
- Acetaminophen/pharmacokinetics
- Acetaminophen/poisoning
- Acetylcysteine/administration & dosage
- Acetylcysteine/therapeutic use
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/blood
- Analgesics, Non-Narcotic/pharmacokinetics
- Analgesics, Non-Narcotic/poisoning
- Chemical and Drug Induced Liver Injury/prevention & control
- Drug Overdose
- Female
- Free Radical Scavengers/administration & dosage
- Free Radical Scavengers/therapeutic use
- Half-Life
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/prevention & control
- Infusions, Intravenous
- Medication Errors
- Metabolic Clearance Rate
- Sepsis/physiopathology
- Treatment Outcome
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Bihari S, Verghese S, Bersten AD. Delayed and prolonged elevated serum paracetamol level after an overdose - possible causes and implications. CRIT CARE RESUSC 2011; 13:275-277. [PMID: 22129290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report the case of a 29-year-old man who ingested about 50 g of standard-preparation paracetamol plus other medications. The serum paracetamol level remained low in the first 24 hours. It peaked 54 hours after ingestion and remained high for 5 days. An N-acetylcysteine (NAC) infusion was started at admission, but was ceased 36 hours later as the clinical and laboratory signs were reassuring. On Day 3, the patient's liver function deteriorated and a rising serum paracetamol level was noted; hence, an NAC infusion was reinitiated. Despite this, the patient developed fulminant hepatic failure. This case underlines the importance of monitoring paracetamol levels and liver function for at least 72 hours after a suspected large overdose of paracetamol before discontinuing NAC infusion.
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Affiliation(s)
- Shailesh Bihari
- Intensive Care Unit, Flinders Medical Centre, Adelaide, SA, Australia.
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Claridge LC. Detection of acetaminophen-cysteine adducts in cases of indeterminate liver failure is not diagnostic of intentional overdose. Hepatology 2011; 54:746-7. [PMID: 21360569 DOI: 10.1002/hep.24251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2011] [Indexed: 12/07/2022]
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