Application of ion-pair methods to drug extraction from biological fluids. II. Quantitative determination of biguanides in biological fluids and comparison of protein binding estimates

The Mechanism of Action of Biguanides: New Answers to a Complex Question

Biguanides are a family of antidiabetic drugs with documented anticancer properties in preclinical and clinical settings. Despite intensive investigation, how they exert their therapeutic effects is still debated. Many studies support the hypothesis that biguanides inhibit mitochondrial complex I, inducing energy stress and activating compensatory responses mediated by energy sensors. However, a major concern related to this “complex” model is that the therapeutic concentrations of biguanides found in the blood and tissues are much lower than the doses required to inhibit complex I, suggesting the involvement of additional mechanisms. This comprehensive review illustrates the current knowledge of pharmacokinetics, receptors, sensors, intracellular alterations, and the mechanism of action of biguanides in diabetes and cancer. The conditions of usage and variables affecting the response to these drugs, the effect on the immune system and microbiota, as well as the results from the most relevant clinical trials in cancer are also discussed.

Determination of antihyperglycemic biguanides in serum and urine using an ion-pair solid-phase extraction technique followed by HPLC-UV on a pentafluorophenylpropyl column and on an octadecyl column

An HPLC-UV method was established for the determination of metformin and buformin in biological fluids. Metformin was not retained on particles packed in conventional solid-phase extraction cartridges; in contrast, buformin was retained too firmly and not eluted with a solvent for recovery. However, both drugs were retained on particles that had been treated with an ion-pair reagent of heptanesulfonate or dodecylsulfate and recovered almost completely. The recovered fraction was subjected to HPLC on a pentafluorophenylpropyl column which was suitable for the determination of both biguanides in serum and in urine. Limits of quantitation were low enough for clinical use, and reproducibility was high with an RSD of 0.9-2.3%. HPLC on a conventional octadecyl column was suitable only for the determination of buformin in serum since interfering peaks appeared on the chromatograms of urine samples. The method was applied to analysis of some clinical specimens.

A new method for determination of buformin in plasma and urine by ion-paired reversed-phase HPLC with ultraviolet detection

Buformin is a widely used as an antidiabetic agent but its renal excretion is still controversial. A new HPLC method with ultraviolet (UV) detection for the determination of buformin in plasma and urine has been developed. After protein precipitation or dilution, buformin and internal standard phenformin were resolved on an octadecyl silica column and detected by UV detection at 233 nm. Intra- and inter-day coefficients of variation were <9%. The limit of quantification was around 0.05 micro g/ml for plasma and 2.5 micro g/ml for urine.

Determination of metformin in plasma by capillary electrophoresis using field-amplified sample stacking technique

A capillary electrophoresis method was described for the determination of metformin in human plasma based on the extraction of the ion-pair with bromothymol blue into chloroform. Phenformin was used as internal standard. Field-amplified sample stacking injection was employed with an electrokinetic injection voltage of 10 kV for 10 s. The running buffer was 0.1 M phosphate buffer (pH 2.5), running voltage was 20 kV and the UV absorbance detection was set at 195 nm. The limit of quantitation was 0.25 microg/ml. Linearity range of calibration curve was 0.25 to 3.5 microg/ml. Recoveries for three levels (0.25, 1 and 2 microg/ml) were 80.24%, 67.44% and 58.97% (n = 5 for each level), respectively. The intra-day precisions for the three levels were 11.9%, 3.09% and 4.33% and the inter-day precisions were 12.4%, 4.57% and 4.94%, respectively. The concentrations of metformin hydrochloride in human plasma of eight volunteers were measured after orally administrating metformin enteric-capsule and tablet.

Clinical pharmacokinetics of metformin

The biguanide metformin (dimethylbiguanide) is an oral antihyperglycaemic agent widely used in the management of non-insulin-dependent diabetes mellitus (NIDDM). Considerable renewal of interest in this drug has been observed in recent years. Metformin can be determined in biological fluids by various methods, mainly using high performance liquid chromatography, which allows pharmacokinetic studies in healthy volunteers and diabetic patients. Metformin disposition is apparently unaffected by the presence of diabetes and only slightly affected by the use of different oral formulations. Metformin has an absolute oral bioavailability of 40 to 60%, and gastrointestinal absorption is apparently complete within 6 hours of ingestion. An inverse relationship was observed between the dose ingested and the relative absorption with therapeutic doses ranging from 0.5 to 1.5 g, suggesting the involvement of an active, saturable absorption process. Metformin is rapidly distributed following absorption and does not bind to plasma proteins. No metabolites or conjugates of metformin have been identified. The absence of liver metabolism clearly differentiates the pharmacokinetics of metformin from that of other biguanides, such as phenformin. Metformin undergoes renal excretion and has a mean plasma elimination half-life after oral administration of between 4.0 and 8.7 hours. This elimination is prolonged in patients with renal impairment and correlates with creatinine clearance. There are only scarce data on the relationship between plasma metformin concentrations and metabolic effects. Therapeutic levels may be 0.5 to 1.0 mg/L in the fasting state and 1 to 2 mg/L after a meal, but monitoring has little clinical value except when lactic acidosis is suspected or present. Indeed, when lactic acidosis occurs in metformin-treated patients, early determination of the metformin plasma concentration appears to be the best criterion for assessing the involvement of the drug in this acute condition. After confirmation of the diagnosis, treatment should rapidly involve forced diuresis or haemodialysis, both of which favour rapid elimination of the drug. Although serious, lactic acidosis due to metformin is rare and may be minimised by strict adherence to prescribing guidelines and contraindications, particularly the presence of renal failure. Finally, only very few drug interactions have been described with metformin in healthy volunteers. Plasma levels may be reduced by guar gum and alpha-glucosidase inhibitors and increased by cimetidine, but no data are yet available in the diabetic population.

Pharmacokinetic-pharmacodynamic relationships of oral hypoglycaemic agents. An update

Oral hypoglycaemic drugs, sulphonylureas and biguanides, occupy an important place in the treatment of Type II (non-insulin-dependent) diabetic patients who fail to respond satisfactorily to diet therapy and physical exercise. Although the precise mechanisms of action of these compounds are still poorly understood, there is sufficient agreement that sulphonylureas have both pancreatic and extrapancreatic effects, whereas biguanides have predominantly extrapancreatic actions. By using labelled compounds or measuring the circulating concentrations, the main pharmacokinetic properties of oral hypoglycaemic agents have been assessed and, in some cases, their pharmacokinetic-pharmacodynamic relationships have been evaluated. A correlation between diabetes control and plasma sulphonylurea or biguanide concentrations is generally lacking at the steady-state, with the possible exception of long-acting agents; after either oral or intravenous dosing, the reduction of plasma glucose is usually related to the increased circulating drug concentrations. The toxic effects of oral hypoglycaemic drugs are more frequent in the elderly and in the presence of conditions that may lead to drug accumulation or potentiation (increased dosage, use of long-acting compounds, hepatic and renal disease, interaction with other drugs); however, a relationship between toxic effects and drug plasma levels has been reported only for biguanides.

Combined ion-pair extraction and high-performance liquid chromatography for the determination of the biogenic amines and their major metabolites in single brain tissue samples

A combined procedure based on reversed-phase liquid chromatography with electrochemical detection has been developed for the determination in the picomole range of the monoamines dopamine, norepinephrine, epinephrine and serotonin, and their major metabolites 3,4-dihydroxyphenylacetic acid, homovanillic acid, 3-methoxy-4-hydroxyphenylethylene glycol, 5-hydroxyindoleacetic acid, normetanephrine, metanephrine and 3-methoxytyramine. Sample pretreatment consists of the extraction of the neutral and acidic metabolites with ethyl acetate, followed by the extraction into heptane of the catecholamines with tetraoctylammonium bromide as counter-ion in the presence of diphenylborate. The residual supernatant is directly injected in the chromatographic system for quantification of serotonin, normetanephrine, metanephrine and 3-methoxytyramine.

Determination of the biogenic amines and their major metabolites in single human brain tissue samples using a combined extraction procedure and high-performance liquid chromatography with electrochemical detection

A combined extraction system for the selective and quantitative isolation of the monoamines norepinephrine, epinephrine, dopamine, serotonin (5-hydroxytryptamine) and their metabolites 3-methoxy-4-hydroxyphenylethylene glycol, 3,4-dihydroxyphenylacetic acid, 5-hydroxyindoleacetic acid, homovanillic acid and 3-methoxytyramine from one single brain tissue sample is described. The extraction system is a combination of an ethyl acetate extraction for 3-methoxy-4-hydroxyphenylethylene glycol, 3,4-dihydroxyphenylacetic acid, 5-hydroxyindoleacetic acid and homovanillic acid, and two successive ion-pair extractions. In a first step, the catecholamines are quantitatively isolated by extracting with heptane--octanol (99:1) containing 0.25% tetraoctylammonium bromide as an ion-pairing agent in the presence of 0.2% diphenylborate. In a second step, 3-methoxytyramine and 5-hydroxytryptamine are isolated from the aqueous phase with di(2-ethylhexyl)phosphoric acid as counter-ion in chloroform. Dihydroxybenzylamine, isohomovanillic acid and 5-hydroxy-N-methyltryptamine are used as the internal standards.

Development of a standardized analysis strategy for basic drugs using ion-pair extraction and high-performance liquid chromatography — VII. Determination of drugs in plasma

A standardized analysis strategy for basic drugs which had been applied previously to pharmaceutical dosage forms, cosmetics and saliva has been applied to plasma. Low extraction recoveries that were obtained at first were shown by protein binding studies to be due to interactions between plasma proteins, the drug and the organic ion-pairing reagent. These interactions could be avoided by removal of the plasma proteins from the sample prior to addition of the counterion solution. The standardized analysis strategy was shown to be applicable to the determination of both polar and non-polar drugs in plasma.

Pharmacokinetics of metformin after intravenous and oral administration to man

The kinetics of 14C-metformin have been studied in five healthy subjects after oral and intravenous administration. The intravenous dose was distributed to a small central compartment of 9.9 +/- 1.61 (X +/- SE), from which its elimination could be described using three-compartment open model. The elimination half-life from plasma was 1.7 +/- 0.1 h. Urinary excretion data revealed a quantitatively minor terminal elimination phase with a half-life of 8.9 +/- 0.7 h. After the intravenous dose, metformin was completely excreted unchanged in urine with a renal clearance of 454 +/- 47 ml/min. Metformin was not bound to plasma proteins. The concentration of metformin in saliva was considerably lower than in plasma and declined more slowly. The bioavailability of metformin tablets averaged 50--60%. The rate of absorption was slower than that of elimination, which resulted in a plasma concentration profile of "flip-flop" type for oral metformin.

Determination of oral anti-diabetic agents in human body fluids using high-performance liquid chromatography

Two widely prescribed anti-diabetic agents for which no simple assay method was previously available can now be determined by high-performance liquid chromatography using a UV detection system. The two drugs investigated were tolbutamide (a sulphonylurea) and phenformin (a biguanide). Tolbutamide can be assayed directly, after a single extraction step, on a reversed-phase system, illustrating the simplicity of the technique for carrying out analyses on underivatised drug compared with gas chromatography. Phenformin was not so easily chromatographhed using straightforward partition systems; however, by the choice of a suitable ion-pair agent it was possible to chromatograph the underivatised drug in a relatively simple reversed-phase system.

Pharmacokinetics of phenformin in man

Phenformin was assayed in urine, plasma, and sputum specimens, obtained from two healthy volunteers during the four-day period following oral administration of a single therapeutic dose. Approximately one third of the drug was excreted unchanged in the urine. Phenformin profiles were obtained for urinary excretion rates and for plasma and saliva concentrations. The terminal exponential declines indicate a half-life of approximately 11 hours. At 37 degrees C, plasma bound 19 per cent of added phenformin.