Simultaneous determination of itraconazole and its CYP3A4-mediated metabolites including N-desalkyl itraconazole in human plasma using liquid chromatography-tandem mass spectrometry and its clinical application

Triazoles in the environment: An update on sample pretreatment and analysis methods

Triazoles, due to their high bactericidal performance, have been widely used in the agricultural, clinical, and chemical industry. However, triazoles have been proven to cause endocrine-toxic and organ impairment in humans as a potentially toxic substance. Besides, because of the improper use and difficulty of degradation, triazoles pesticide residues left in the environment could pose a threat to the environment. Therefore, the rapid, reliable, accurate, and high-sensitivity triazoles analysis methods are significantly essential to effectively monitor their presence in various samples and safeguard human health. This review aims to summarize and update the progress of the pretreatment and analytical methods of triazole fungicides in environmental samples from 2012 to 2024. Common pretreatment methods used to extract and purify targets include simple steps (e.g., protein precipitation and coated blade spray), liquid-liquid extraction, solid-phase extraction, and various microextraction methods such as liquid-phase microextraction and solid-phase microextraction, among others. Detection methods mainly include liquid chromatography-mass spectrometry, gas chromatography-mass spectrometry, supercritical fluid chromatography, sensing methods, and capillary electrophoresis. In addition, we elaborate and compare the advantages and disadvantages of different pretreatment and analytical methods, and their development prospects are discussed.

Characterization of endogenous markers of hepatic function in patients receiving itraconazole treatment for prophylaxis of deep mycosis

BACKGROUND

Long-term use of itraconazole (ITZ) is associated with a risk of inducing hepatotoxicity. This study aimed to evaluate the associations of plasma concentrations of ITZ and its hydroxylated metabolite (OH-ITZ) with endogenous markers of hepatic function.

METHODS

Thirty six patients treated with oral ITZ solution for prophylaxis of deep mycosis were enrolled. Plasma concentrations of ITZ and OH-ITZ were determined on the 14th day or later after administration of ITZ. Their associations with endogenous marker levels of hepatic function including plasma coproporphyrin (CP)-I and OATP1B1 genotypes were assessed.

RESULTS

The serum level of total bilirubin (T-Bil) was moderately correlated with the plasma concentration of total ITZ (tITZ) and OH-ITZ (tOH-ITZ). T-Bil elevation above 0.3 mg/dL was observed in 19% of patients, although statistically significant difference was not identified. The plasma concentration of tITZ had no correlation with other endogenous markers levels including AST, ALT, albumin, and plasma CP-I. The serum AST and plasma CP-I levels were correlated with the plasma concentration of free OH-ITZ (fOH-ITZ). T-Bil and plasma CP-I, a marker of OATP1B1 activity, were not correlated with each other, and neither was associated with the OATP1B1 genotypes.

CONCLUSIONS

Plasma ITZ and OH-ITZ had a positive association with T-Bil. The patients with a higher fOH-ITZ level had lower OATP1B1 activity on the basis of plasma CP-I level. ITZ and OH-ITZ have the potential to slightly increase endogenous marker levels of hepatic function, although most likely by different mechanisms.

The influence of haemorrhagic shock on the pharmacokinetic and pharmacodynamic effects of remimazolam in a swine model: A laboratory study

BACKGROUND

Haemorrhagic shock enhances the potency of several intravenous anaesthetics.

OBJECTIVE

To assess the influence of haemorrhagic shock on the pharmacokinetic and pharmacodynamic effects of remimazolam, a new short-acting benzodiazepine.

DESIGN

An animal observational study.

SETTING

An animal laboratory in Hamamatsu University School of Medicine, Hamamatsu, Japan, from 3 April to 7 June 2021.

ANIMALS

Ten pigs, 24.5 ± 0.5 (mean ± standard deviation) kg.

INTERVENTIONS

Pigs were anaesthetised with isoflurane, and raw electroencephalographic waveforms, bispectral index (BIS) and 95% spectral edge frequency (SEF) were recorded throughout the study. After isoflurane was stopped, remimazolam was administered at a rate of 150 mg h-1 for 10 min and arterial blood was collected 16 times until 180 min to measure the remimazolam concentration (baseline condition). After the baseline measurements, haemorrhagic shock was induced by 750 ml bleeding and maintained for 40 min. The same dose of remimazolam was administered again (4 h after the first remimazolam infusion) and blood samples were collected.

MAIN OUTCOME MEASURES

Pharmacokinetic variables were quantified using a three-compartment model and the pharmacodynamic variables were estimated using an inhibitory sigmoid maximal effect model.

RESULTS

The peak remimazolam concentration increased from 1.0 ± 0.3 to 1.5 ± 0.4 μg ml-1. Haemorrhagic shock decreased the central compartment volume, elimination clearance, and fast distribution clearance by 30 to 50%. The effect-site concentration producing 50% of the maximal BIS effect was 0.10 ± 0.09 μg ml-1 at baseline and 0.11 ± 0.09 μg ml-1 during haemorrhagic shock (P = 0.78), and that of SEF was 0.09 ± 0.03 and 0.11 ± 0.04 μg ml-1, respectively (P = 0.28).

CONCLUSION

Haemorrhagic shock alters the pharmacokinetics of remimazolam, but does not enhance the end-organ sensitivity. Because the impact of haemorrhagic shock is small, remimazolam might be a suitable sedative/hypnotic for the management of patients who have massive bleeding.

Fluorescence switchable sensor enabled by a calix[4]arene-Cu(II) complex system for selective determination of itraconazole in human serum and aqueous solution

A switchable fluorescence sensor based on a calix (Monapathi et al., 2021) [4]arene:Cu²⁺ complex (FLCX/Cu) has been developed for the detection of itraconazole (ITZ) with high sensitivity and specificity. For the development of the sensor, the selective complexation of a fluorescent calix (Monapathi et al., 2021) [4]arene derivative (FL-CX) with the Cu²⁺ ion causing fluorescence quenching was utilized. In addition, the sensor properties of the FLCX/Cu prepared were investigated. For this purpose, various substances (selected anions, cations, and drugs) with which ITZ can be found together were studied in an aqueous solution. Limit of detection (LOD) and limit of quantification (LOQ) values were determined in the range of 1.00-60.0 μg/L as 3.34 μg/L and 11.1 μg/L for ITZ, respectively. Moreover, the real sample analyses were performed in human serum and tablet form. Furthermore, the effect of some possible serum contents on sensor performance was also studied. All these studies confirmed the development of a simple, precise, accurate, reproducible, highly sensitive, and very stable fluorescence sensor.

Associations between plasma hydroxylated metabolite of itraconazole and serum creatinine in patients with a hematopoietic or immune-related disorder

PURPOSE

Serum markers of renal function have not been characterized in patients treated with itraconazole (ITZ). This study aimed to evaluate the associations between plasma ITZ and its hydroxylated metabolite (OH-ITZ) concentrations and serum markers of renal function in patients with hematopoietic or immune-related disorder.

METHODS

This study enrolled 40 patients with hematopoietic or immune-related disorder who are receiving oral ITZ solution. Plasma concentrations of ITZ and OH-ITZ at 12 h after dosing were determined at steady state. Their relationships with serum levels of creatinine and cystatin C and their estimated glomerular filtration rate (eGFR) were evaluated.

RESULTS

The free plasma concentration of ITZ had no correlation with serum creatinine and serum creatinine-based estimated glomerular filtration rate (eGFR-cre). The free plasma concentration of OH-ITZ was positively and negatively correlated with serum creatinine and eGFR-cre, respectively. The free plasma concentrations of ITZ and OH-ITZ had no association with serum cystatin C and serum cystatin C-based eGFR. Serum creatinine was higher by 16% after than before starting ITZ treatment, while eGFR-cre was lower by 9.3%. The serum creatinine ratio after/before ITZ treatment was positively correlated with the free plasma concentration of OH-ITZ. The patients co-treated with trimethoprim-sulfamethoxazole had higher serum creatinine. Concomitant glucocorticoid administration did not significantly alter serum cystatin C.

CONCLUSIONS

Patients with hematopoietic or immune-related disorder treated with oral ITZ had a higher level of serum creatinine. Although serum creatinine potentially increases in conjunction with the free plasma concentration of OH-ITZ, concomitant ITZ administration has a slight impact on the eGFR-cre level in clinical settings.