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Ketola RA, Kriikku P. Drug concentrations in post‐mortem specimens. Drug Test Anal 2019; 11:1338-1357. [DOI: 10.1002/dta.2662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Raimo A. Ketola
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
| | - Pirkko Kriikku
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
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Fernandez-Lopez L, Pellegrini M, Rotolo MC, Luna A, Falcon M, Mancini R. Development and Validation of a Method for the Analysis of Bisoprolol and Atenolol in Human Bone. Molecules 2019; 24:molecules24132400. [PMID: 31261852 PMCID: PMC6651798 DOI: 10.3390/molecules24132400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022] Open
Abstract
A method based on gas chromatography–mass spectrometry (GC–MS) is described for the determination of bisoprolol and atenolol in human bone. After the addition of lobivolol as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were centrifuged, and the supernatants were subjected to solid phase extraction. Elution was achieved by using 3 mL of 2% ammonium hydroxide in 80:20 dichloromethane:isopropanol solution. Eluted samples were evaporated and derivatized. Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.1–0.3 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries were 60% for bisoprolol and 106% for atenolol, the matrix effect was 69% for bisoprolol and 70% for atenolol and process efficiency was 41% for bisoprolol and 80% for atenolol. The intra- and inter-assay accuracy values were always better than 12%. The validated method was then applied to bone samples from two real forensic cases in which toxicological analysis in blood were positive for atenolol in the first case (0.65 µg/mL) and bisoprolol in the second case (0.06 µg/mL). Atenolol was found in bone samples from the corresponding case at the approximate concentration of 148 ng/mg and bisoprolol was found at 8 ng/mg.
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Affiliation(s)
- Lucia Fernandez-Lopez
- Legal and Forensic Medicine, School of Medicine, University of Murcia,30100 Murcia, Spain
| | - Manuela Pellegrini
- National Centre on Drug Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Maria Concetta Rotolo
- National Centre on Drug Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Aurelio Luna
- Legal and Forensic Medicine, School of Medicine, University of Murcia,30100 Murcia, Spain
| | - Maria Falcon
- Legal and Forensic Medicine, School of Medicine, University of Murcia,30100 Murcia, Spain.
| | - Rosanna Mancini
- National Centre on Drug Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy
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Kacirova I, Grundmann M, Kolek M, Vyskocilova-Hrudikova E, Urinovska R, Handlos P. Lethal suicide attempt with a mixed-drug intoxication of metoprolol and propafenone — A first pediatric case report. Forensic Sci Int 2017; 278:e34-e40. [DOI: 10.1016/j.forsciint.2017.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 11/24/2022]
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Sauvageon Y, Kintz P, Dupuis N, Ameline A, Rousseau L, Lelong J, Brunet B, Mura P. Décès toxique par ingestion combinée de métoprolol et de lacosamide. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.03.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5
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Décès toxique par ingestion combinée de métoprolol et lacosamide. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Treat primary open-angle glaucoma based on needs of the individual, taking potential adherence problems into account. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-015-0270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Broadway DC, Cate H. Pharmacotherapy and Adherence Issues in Treating Elderly Patients with Glaucoma. Drugs Aging 2015; 32:569-81. [PMID: 26136215 DOI: 10.1007/s40266-015-0282-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glaucoma is a leading cause of visual morbidity throughout the world and is an age-related condition, the prevalence of which rises significantly with increasing age. Glaucoma, a condition affecting the optic nerve, has a variety of subtypes with multiple aetiological factors, the most important of which are intraocular pressure (IOP) and increasing age. Treatment by lowering of IOP is the only current method, for which there is evidence, by which the rate of progressive visual deterioration can be slowed or halted. Although there are surgical and laser treatments that are efficacious in lowering IOP, the most common manner in which patients with glaucoma control their IOP is with administration of daily topical ocular hypotensive drugs (eye drops). The variety of topical drugs utilised in the management of glaucoma all have the potential to have adverse effects and/or interactions with concomitant medications, many of which may be used for other age-related conditions. Adherence with appropriate medicines has a major effect on the outcome of medical conditions and this aspect applies to the management of glaucoma. There are certain specific issues that relate to the administration of topical agents, with respect to both adverse effects and adherence. Although many suspect poor adherence in elderly patients with glaucoma, relative to younger patients, adequate evidence for this is lacking. Furthermore, the manner by which adherence issues could be improved remains inadequately understood and poorly addressed. The aims of this article were to review, from a clinical perspective, the medical therapies currently used for glaucoma and discuss adherence issues with respect to the population of patients with glaucoma, who tend to be relatively elderly.
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Affiliation(s)
- David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK,
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8
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Li N, Li CL, Lu NW, Dong YM. A novel micellar per aqueous liquid chromatographic method for simultaneous determination of diltiazem hydrochloride, metoprolol tartrate and isosorbide mononitrate in human serum. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 967:90-7. [DOI: 10.1016/j.jchromb.2014.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/09/2014] [Accepted: 07/13/2014] [Indexed: 12/31/2022]
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9
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Hasanzadeh M, Pournaghi-Azar MH, Shadjou N, Jouyban A. Magnetic nanoparticles incorporated on functionalized mesoporous silica: an advanced electrochemical sensor for simultaneous determination of amiodarone and atenolol. RSC Adv 2014. [DOI: 10.1039/c3ra45433a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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A validated micellar LC method for simultaneous determination of furosemide, metoprolol and verapamil in human plasma. Bioanalysis 2012; 4:41-8. [DOI: 10.4155/bio.11.294] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An accurate and precise micellar LC method coupled with UV and fluorimetric detectors was developed and validated for the simultaneous analysis of furosemide, metoprolol and verapamil in human plasma. The total analysis time was 25 min (12 min for sample preparation and 13 min for drug separation). All drugs possessed linear behavior (r > 0.999 for calibration curves) in their therapeutic concentrations. The mean drug recoveries were 101.9, 100.1 and 100.2% for furosemide, metoprolol and verapamil, respectively. The accuracies (relative error %) were less than 15% for all drugs. Intra- and inter-day precisions (RSD%) were less than 15% and the stability data were acceptable according to the US FDA guideline for bioanalytical method validation.
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Oertel R, Pietsch J, Arenz N, Zeitz S, Goltz L, Kirch W. Distribution of metoprolol, tramadol, and midazolam in human autopsy material. J Chromatogr A 2011; 1218:4988-94. [DOI: 10.1016/j.chroma.2010.12.113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/03/2010] [Accepted: 12/31/2010] [Indexed: 11/27/2022]
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Kanno S, Watanabe K, Yamagishi I, Hirano S, Minakata K, Gonmori K, Suzuki O. Simultaneous analysis of cardiac glycosides in blood and urine by thermoresponsive LC-MS-MS. Anal Bioanal Chem 2010; 399:1141-9. [DOI: 10.1007/s00216-010-4405-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/29/2010] [Accepted: 10/31/2010] [Indexed: 11/30/2022]
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Is the Intra-Aortic Balloon Pump a Method of Brain Protection During Cardiogenic Shock After Drug Intoxication? J Emerg Med 2010; 38:162-7. [DOI: 10.1016/j.jemermed.2007.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 08/30/2007] [Accepted: 10/28/2007] [Indexed: 11/20/2022]
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Elston Lafata J, Simpkins J, Kaatz S, Horn JR, Raebel MA, Schultz L, Smith DH, Yood MU. What Do Medical Records Tell Us About Potentially Harmful Co-Prescribing? Jt Comm J Qual Patient Saf 2007; 33:395-400. [PMID: 17711141 DOI: 10.1016/s1553-7250(07)33045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous efforts document drug-drug interactions in ambulatory care. Yet little is known about medical record documentation or clinical management when interacting medications are received. METHODS The study population was identified from the HMO Research Network's Centers for Education and Research on Therapeutics (n = 2,020,037). A random subsample of patients > or = 18 years of age with drug coverage in 2000 initiating a co-dispensing for (1) warfarin with a nonsteroidal anti-inflammatory drug (n = 97), (2) digoxin with verapamil or diltiazem (n = 100), or (3) lovastatin/simvastatin with diltiazem or verapamil (n = 89) was identified. RESULTS The majority (63%-74%) of patients had documentation indicating receipt of both drugs during a single office visit. Documentation of risks and patient education was less common (< or = 14%, with all corresponding upper bounds of the 95% CIs < 23%). Clinical management changes were more frequently documented, ranging from 64% (95% CI: 47-81%) for lovastatin/simvastatin patients to 79% (95% CI: 60-99%) for warfarin patients. CONCLUSIONS The findings, although indicating that clinicians are likely aware of concomitant receipt of interacting medications, call into question the adequacy of medical record documentation as well as clinical management when interacting drugs are co-prescribed in the ambulatory setting.
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Abstract
Verapamil blocks the rapid influx of calcium into the cardiac myocytes of the cardiac conduction system and smooth muscle of the vasculature, resulting in decreased myocardial contractility, prolonged conduction time, and vascular relaxation. A sustained-release form, verapamil SR (or ER), is available that contains higher levels of medication and requires only once-daily dosing. The majority of reported fatal cases of verapamil toxicity are due to massive, intentional overdoses. Herein, we present an unusual case of fatal verapamil SR toxicity in a 57-year-old female that resulted from accidental overdose of only 3 tablets (720 mg), as witnessed by the decedent's daughter. In spite of the low dose ingested, the postmortem cardiac blood verapamil level was clearly toxic (6000 ng/mL, or 6 mg/L). Her preexisting medical conditions included hypercholesterolemia, hypertension, iron deficiency anemia, diabetes mellitus, and associated mild chronic renal failure. Complicating factors, which likely include the decedent's preexisting renal and cardiac disease, and a review of the available literature will be discussed.
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Affiliation(s)
- Nick I Batalis
- Medical University of South Carolina, Forensic Section, Charleston, South Carolina, USA.
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Kristoffersen L, Øiestad EL, Opdal MS, Krogh M, Lundanes E, Christophersen AS. Simultaneous determination of 6 beta-blockers, 3 calcium-channel antagonists, 4 angiotensin-II antagonists and 1 antiarrhytmic drug in post-mortem whole blood by automated solid phase extraction and liquid chromatography mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 850:147-60. [PMID: 17175206 DOI: 10.1016/j.jchromb.2006.11.030] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 11/10/2006] [Accepted: 11/14/2006] [Indexed: 01/21/2023]
Abstract
A method for the simultaneous determination of the beta-blockers atenolol, sotalol, metoprolol, bisoprolol, propranolol and carvedilol, the calcium-channel antagonists diltiazem, amlodipine and verapamil, the angiotensin-II antagonists losartan, irbesartan, valsartan and telmisartan, and the antiarrhythmic drug flecainide, in whole blood samples from forensic autopsies was developed. Sample clean-up was achieved by precipitation and solid phase extraction (SPE) with a mixed-mode column. Quantification was performed by reversed phase high performance liquid chromatography with positive electrospray ionization mass spectrometric detection (HPLC-MS). The method has been developed and robustness tested by systematically searching for satisfactory conditions using experimental designs including factorial and response surface designs. With the exception of amlodipine, the concentration limit of quantification (cLOQ) covered low therapeutic concentration levels for all the compounds. Within assay precisions and accuracies (bias) were 3.4-21% RSD and from -24 to 21% for the concentration range 1.00-5.00 microM, respectively. Between assay precisions were 4.4-28% RSD for the concentration range from 0.1 to 5 microM and recoveries varied from 9 to 103%. The method is used for determination of cardiovascular drugs in post-mortem whole blood samples from forensic autopsy cases.
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Affiliation(s)
- Lena Kristoffersen
- Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway.
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Rambla-Alegre M, Gil-Agustí MT, Capella-Peiró ME, Carda-Broch S, Esteve-Romero JS. Direct determination of verapamil in urine and serum samples by micellar liquid chromatography and fluorescence detection. J Chromatogr B Analyt Technol Biomed Life Sci 2006; 839:89-94. [PMID: 16621741 DOI: 10.1016/j.jchromb.2006.03.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 03/28/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
Verapamil, a calcium channel antagonist, is one of the most commonly prescribed drugs in the treatment of hypertension. In this work, it was determined in serum and urine samples by a sensitive and precise chromatographic procedure without any pre-treatment step in a C18 column using a micellar mobile phase of 0.15M sodium dodecyl sulfate and 5% pentanol at pH 7. Fluorescence detection set at 230 nm (excitation) and 312 nm (emission) was used. Verapamil is eluted at 12.5 min with no interference by the protein band or endogenous compounds. Linearities (r > 0.998), as well as intra- and inter-day precision, were studied in the validation of the method. LODs were also calculated to be 11.0, 18.5 and 20.2 ng/mL in micellar solution, serum and urine, respectively. Recoveries in the biological matrices were in the 97-99% range. Drug excretion in urine was studied in a volunteer receiving treatment for hypertension, and verapamil, as an unchanged drug, was separated from other metabolites. The procedure developed can be useful in the field of toxicology and clinical analysis.
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Affiliation(s)
- M Rambla-Alegre
- Area de Química Analítica, CCEE, ESTCE, Universitat Jaume I, 12080 Castelló, Spain
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Lafata JE, Schultz L, Simpkins J, Chan KA, Horn JR, Kaatz S, Long C, Platt R, Raebel MA, Smith DH, Xi H, Yood MU. Potential Drug–Drug Interactions in the Outpatient Setting. Med Care 2006; 44:534-41. [PMID: 16708002 DOI: 10.1097/01.mlr.0000215807.91798.25] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although medication safety research has tended to focus on inpatients, the safety of drug use among outpatients is also a concern. OBJECTIVE We estimate the frequency of potentially interacting concomitant medication dispensing among outpatients. RESEARCH DESIGN We report the number and percent of patients annually dispensed an object drug of interest (ie, warfarin, digoxin, cyclosporine, or lovastatin/simvastatin) with a potentially interacting drug among a random sample of insured adults receiving care from 10 integrated delivery systems. We use 2 definitions of concomitant dispensing: medications dispensed: 1) during the time period for which the patient had the other medication available ('days supply') and 2) on the same day. We also estimate the number of insured U.S. population codispensed these medication pairs. RESULTS Among patients dispensed a drug of interest, between 17.8% (95% confidence interval [CI]=17.1-18.6%) and 28.0% (95% CI=24.0-32.1%) were concomitantly dispensed a potentially interacting drug using the "days supply" definition, and between 7.1% (95% CI=6.6-7.7%) and 17.7% (95% CI=14.4-21.1%) using the "same day" definition. Extrapolating to the insured U.S. population, between 1.29 (95% CI=1.25-1.33; same day) and 2.67 (95% CI=2.62-2.72; days supply) million insured adults are dispensed 1 of these 4 potentially interacting pairs. CONCLUSIONS We found evidence of potentially interacting concomitant medication dispensing among outpatients. An opportunity exists to better understand how such dispensing translates into adverse events and ultimately to improved medication safety.
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Affiliation(s)
- Jennifer Elston Lafata
- Henry Ford Health System, Detroit, Michigan 48202, Channing Laboratory, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
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