Capture of the volatile carbonyl metabolite of flecainide on 2,4-dinitrophenylhydrazine cartridge for quantitation by stable-isotope dilution mass spectrometry coupled with chromatography

Carbonyl compounds are common byproducts of many metabolic processes. These volatile chemicals are usually derivatized before mass spectrometric analysis to enhance the sensitivity of their detections. The classically used reagent for this purpose is 2,4-dinitrophenylhydrazine (DNPH) that forms the corresponding hydrazones. When DNPH is immobilized on specific cartridges it permits solvent-free collection and simultaneous derivatization of aldehydes and ketones from gaseous samples. The utility of this approach was tested by assembling a simple apparatus for the in vitro generation of trifluoroacetaldehyde (TFAA) and its subsequent capture on the attached DNPH cartridge. TFAA was generated via cytochrome P450-catalyzed dealkylation of flecainide, an antiarrhythmic agent, in pooled human liver microsomes. Stable-isotope dilution mass spectrometry coupled with GC and LC using negative chemical ionization (NCI) and electrospray ionization (ESI) was evaluated for quantitative analyses. To eliminate isotope effects observed with the use of deuterium-labeled DNPH, we selected its (15)N(4)-labeled analog to synthesize the appropriate TFAA adduct, as internal standard. Quantitation by GC-NCI-MS using selected-ion monitoring outperformed LC-ESI-MS methods considering limits of detection and linearity of the assays. The microsomal metabolism of 1.5 μmol of flecainide for 1.5h resulted in 2.6 ± 0.5 μg TFAA-DNPH, corresponding to 9.3 ± 1.7 nmol TFAA, captured by the cartridge.

Simultaneous separation of 14 antiarrhythmic drugs and determination of mexiletine and flecainide by capillary zone electrophoresis

A method using capillary zone electrophoresis was developed for the simultaneous separation of 14 antiarrhythmic drugs belonging to various classes. The drugs are separated on a fused-silica capillary, 90 cm x 75 microm (72 cm effective length), with phosphate and acetate buffers as background electrolytes and UV detection at 217 nm. The effects of buffer pH, temperature, and applied voltage on the migration of the drugs were studied. The pH was found to be the most significant factor determining effective separation. The antiarrhythmic compounds are completely separated within a relatively short time (< 7 min) by using 70 mM phosphate buffer at pH 7.91, an applied voltage of 28 kV, and a temperature of 32 degrees C. Mexiletine (MEX) and flecainide (FLE) were quantified under conditions of the optimum separation. The calibration graphs were constructed over the concentration range of 4.0-14.0 microg/mL for both drugs with good correlation (r > or = 0.9999). Detection and quantitation limits were found to be 0.5 and 1.5 microg/mL for FLE and 0.7 and 2.1 microg/mL for MEX, respectively. The proposed method was used for the determination of both drugs in their commercial forms with satisfactory precision (relative standard deviations of 0.36-1.21% for FLE and 0.78-1.66% for MEX) and accuracy (relative standard errors of 0.13-1.17% for FLE and 0.35-1.18% for MEX).

Analysis of flecainide and two metabolites in biological specimens by HPLC: application to a fatal intoxication

A few days after her admittance to a hospital for a suicide attempt with benzodiazepines, a 15-year-old girl was found dead in bed. At autopsy, no specific anatomo-pathologic cause of death was identified. Systematic toxicological analysis (HPLC-DAD, GC-NPD, and GC-MS) of postmortem blood and urine revealed the presence of high concentrations of flecainide and its two major metabolites. Flecainide is a class IC anti-arrhythmic drug causing a decreased intracardiac conduction velocity in all parts of the heart. To identify and quantitate flecainide together with its metabolites in blood, urine, and other toxicologically relevant matrices, a new method was developed using high-performance liquid chromatography with diode-array detection. All compounds were separated on a Hypersil BDS phenyl column using water, methanol, and 1.5M ammonium acetate in a gradient system. Chromatographic analysis was preceded by an optimized solid-phase extraction procedure on RP-C18 extraction columns. The flecainide concentrations in blood and urine were 18.73 and 28.3 mg/L, respectively, and the metabolites were detected only in urine at the following concentrations: 9.4 mg/L for meta-O-dealkylated flecainide and 8.59 mg/L for meta-O-dealkylated flecainide lactam. Based on these results, it was concluded that the suicide was consistent with an overdose of this anti-arrhythmic drug.

Measurement of flecainide in hair as an index of drug exposure

We report a method for measuring the concentration of flecainide in hair. An animal study, in which flecainide (1, 5, and 10 mg/kg/day) was orally administered for 1, 2, and 3 weeks to pigmented rats, showed that flecainide concentration in rat hairs newly regrown after administration significantly correlated with both the daily dose and the dosing period. The part of hair containing flecainide continued to grow upward, retaining the drug within the hair structure that had been formed at the time of drug exposure. Flecainide was also determined in human scalp hairs collected from patients treated with flecainide. The drug content of white hairs was much less than that black hairs collected from the same rats and subjects, suggesting the determinant effect of hair pigment on flecainide accumulation in hair. These findings suggest that the analysis of flecainide in hair may be useful for assessing exposure to drug qualitatively.

Fatal flecainide intoxication

A fatal case attributed to flecainide acetate (Tambocor), a class Ic antiarrythmic drug, is presented. Flecainide was detected by GC/MS in gastric contents, blood and liver as well. The urine analysis revealed the presence of its dealkylated metabolite. Body fluids and tissue concentrations determined by GC/ECD were 7.7 mg/kg in femoral blood, 0.26 mg/kg in bile, 18 mg/kg in liver, 0.17 mg/kg in cerebrospinal fluid, 0.22 mg/kg in brain cortex and 28.9 mg/kg in urine. The total amount of flecainide in gastric contents was about 43 mg. Even taking into account the postmortem redistribution of flecainide, its blood level still remains in the toxic range.

Quantitative determination of disopyramide, verapamil and flecainide enantiomers in rat plasma and tissues by high-performance liquid chromatography

Enantiomers of disopyramide (DP), flecainide (FLC) and verapamil (VP) were extracted from rat plasma and tissues (brain, lung, heart, liver, kidney and muscle), followed by quantitative determination using enantioselective high-performance liquid chromatography with chiral stationary-phase columns. The recoveries of S-(+)- and R-(-)-DP from tissues were higher than 69%, and the within- and between-day coefficients of variation were very low (0.5 - 5.7%). The lower limits of detection in each tissue were less than 289 ng/g tissue. The recoveries of S-(+)- and R-(-)-FLC from tissues were higher than 88%, and the within- and between-day coefficients of variation were 1.2-6.0%. The lower limits of detection in each tissue were less than 37 ng/g tissue. The recoveries of S-(-)- and R-(+)-VP from tissues were higher than 80%, and the within- and between-day coefficients of variation were 0.5-6.2%. The lower limits of detection in each tissue were less than 51 ng/g tissue. The analytical methods established in this study will be suitable for determining the concentrations of the enantiomers of these anti-arrhythmic agents in rat plasma and tissues.

Chromatographic (TLC) analysis of diltiazem in pharmaceutical form in presence of other antiarrhythmics

Diltiazem was identified by TLC method on silica gel by ascending technique, in presence of five another antiarrhythmic drugs (disopyramide, flecainide, lidocaine, lorcainide, procainamide). Suitable conditions for separation of diltiazem were established using ethanol-benzene-dioxane-ammonia (2:20:16:3) as the mobile phase. When using acidified iodoplatinate solution or Dragendorff reagent as indicators, the amount of diltiazem as small as 100 ng can be identified. The TLC method is simple and sensitive and it was used to identify diltiazem in tablets.

Unsuspected self-poisoning with flecainide and alcohol

The death of a 23-year-old man by suicidal flecainide and alcohol poisoning is reported. Flecainide was identified by ultraviolet (UV) spectrophotometry and gas chromatography-mass spectrometry (GC-MS). Flecainide levels, quantitated by high performance liquid chromatography (HPLC) with UV detection were: femoral blood 7.3 mg/L, urine 117 mg/L, stomach contents 19 mg and liver 302 mg/kg. Ethanol levels in femoral blood, urine and vitreous humor were 107, 136 and 113 mg%, respectively. The importance of carefully considering all the available pathological and toxicological data, together with the past medical history and circumstances surrounding the death in poisoning cases is emphasized.

Fatal flecainide intoxication

Two fatalities resulting from suicidal ingestion of flecainide are described. The decedents, ages 33 and 15, were otherwise healthy; both took their mothers' medications. In one case, from electrocardiographic data, there was found a high-grade conduction block with idioventricular rhythm. Blood and tissue samples from autopsy were analyzed for flecainide by gas chromatography/nitrogen-phosphorous detection and gas chromatography/mass spectrometry. Blood concentrations of 93.7 and 100 mg/L flecainide were found.

Stability of flecainide acetate in an extemporaneously compounded oral suspension

The stability of flecainide acetate in an oral diluent stored for 45 days under various conditions was studied. A suspension was prepared by triturating 100-mg tablets of flecainide acetate with a commercially available oral diluent. The final theoretical drug concentration was 5 mg/mL. The suspension was poured into 12 2-oz amber glass prescription bottles for a per-bottle volume of 60 mL. Three bottles were refrigerated at 5 degrees C and shaken before analysis, three were stored at room temperature and shaken, three were refrigerated and not shaken, and three were kept at room temperature and not shaken. On days 0, 15, 30, and 45, flecainide acetate concentrations were determined by stability-indicating high-performance liquid chromatography. The concentration of flecainide acetate in the sediment in each bottle was determined on day 46. On day 45, the mean flecainide acetate concentration for each group of bottles remained above 90% of the initial concentration. Mean +/- S.D. flecainide acetate concentrations in sediment ranged from 0.53 +/- 0.30 to 1.18 +/- 0.36 mg per gram. Eight of the 12 samples contained microbial growth on at least one of the test days. Flecainide acetate 5 mg/mL oral suspension was stable for up to 45 days under the conditions investigated.

Corneal deposits associated with flecainide

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Flecainide intoxication

A fatal case attributed to flecainide intoxication is presented. Quantitation was by capillary gas chromatography with nitrogen-phosphorus detection. The flecainide concentration in the blood was 13 mg/L as compared to a therapeutic range in serum of 0.2-1.0 mg/L. Flecainide concentrations in other specimens were as follows: bile, 160 mg/L; urine, 54 mg/L; vitreous humor, 7.4 mg/L; liver, 180 mg/kg; kidney, 74 mg/kg; and stomach contents, 120 mg.

Flecainide excretion in human breast milk

Healthy human volunteers who intended not to breast feed were placed on a regimen of 100 mg oral flecainide every 12 hours for 5 1/2 days beginning 1 day after parturition. Milk and blood samples were collected during the dosing period and for 2 days after the last dose. Concentrations of flecainide in milk and plasma were assayed by HPLC. Apparent steady-state levels of flecainide in both milk and plasma were achieved in most cases by day 4 of the study. Highest daily average concentration of flecainide in milk ranged from 270 to 1529 ng/ml for the 11 subjects. Mean +/- SD milk to plasma flecainide ratios were 3.7 +/- 3.5, 3.2 +/- 2.3, 3.5 +/- 2.1, and 2.6 +/- 0.7 on study days 2, 3, 4, and 5, respectively. After the last dose of flecainide, peak milk levels of the drug occurred at 3 to 6 hours and then declined monoexponentially. The half-life for elimination of flecainide from milk was 14.7 +/- 3.5 hours and is very similar to the plasma elimination half-life of flecainide in healthy human subjects. The mean milk to plasma ratios for flecainide after the last dose were 2.3 +/- 1.0 and 2.9 +/- 1.1 at 24 and 48 hours after the dose, respectively. Based on the pharmacokinetics of flecainide in infants, the expected average steady-state plasma concentration of flecainide in a newborn infant consuming all of the milk production of its mother (approximately 700 ml/day) would not be expected to exceed about 62 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

High-performance liquid chromatographic determination of the enantiomers of flecainide in human plasma and urine

A stereospecific high-performance liquid chromatographic method for the determination of (R,S)-flecainide acetate [(R,S)-N-(2-piperidylmethyl)-2,5-bis-(2,2,2-trifluoroethoxy)benzam ide acetate] in human plasma and urine is described. After addition of the internal standard [IS; (R,S)-N-(2-piperidylmethyl)-2,3-bis(2,2,2-trifluoroethoxy)- benzamide hydrochloride], a single-step extraction of alkalinized samples was performed with distilled diethyl ether. The organic layer was evaporated and the drug and IS were derivatized with 1-[(4-nitrophenyl)sulfonyl]-L-propyl chloride at 80 degrees C for 2 h. The diastereomeric derivatives of flecainide and IS were chromatographed on a C18 reversed-phase column with a mobile phase consisting of acetonitrile: water:triethylamine (45:55:0.2) at a flow rate of 1 mL/min. Flecainide diastereomers were separated with a resolution factor of 1.25 and detected by UV spectroscopy at a wavelength of 280 nm. An excellent linearity was observed between the peak area ratios (flecainide derivatives:IS) and plasma concentrations, and the intra- and interday coefficients of variation were always less than 9.8%. The lowest quantifiable concentration was set at 50 ng/mL for each enantiomer (CV of 4.9 and 4.4%), while the lowest limit of detection (signal:noise, 3:1) was on the order of a few nanograms. The assay was used to study the pharmacokinetics of flecainide enantiomers in a patient receiving (R,S)-flecainide therapy. The steady-state plasma time courses for the enantiomers were found to be parallel, but the difference between (R)- and (S)-flecainide concentrations was significant. The urinary excretion data were consistent with the plasma results. The method is suitable for therapeutic monitoring of flecainide enantiomers and for stereoselective pharmacokinetic studies in humans.

Comparison of gas-liquid chromatography and fluorescence polarization immunoassay for therapeutic drug monitoring of flecainide acetate

A gas chromatographic (GC) method for quantitation of flecainide acetate in human plasma is described and compared with a fluorescence polarization immunoassay (FPIA) for therapeutic drug monitoring. The GC method includes a solid-phase extraction procedure and electron capture detection (ECD) without the need of derivatization. Within-day and between-day coefficients of variation were less than 7% of GC and FPIA. Recovery was between 89-101% for the GC method. Plasma from 36 patients were analysed by both GC and FPIA and the results showed a good correlation (slope = 0.96; intercept = 0.009 micrograms ml-1; r = 0.987).