Determination of phenytoin at trace levels in domestic wastewater and synthetic urine samples by gas chromatography-mass spectrometry after its preconcentration by simple liquid-phase microextraction

This work presents a sensitive and accurate analytical method for the determination of phenytoin at trace levels in domestic wastewater and synthetic urine samples by gas chromatography-mass spectrometry (GC-MS) after the metal sieve-linked double syringe liquid-phase microextraction (MSLDS-LPME) method. A metal sieve was produced in our laboratory in order to disperse water-immiscible extraction solvents into aqueous media. Univariate optimization studies for the selection of proper extraction solvent, extraction solvent volume, mixing cycle, and initial sample volume were carried out. Under the optimum MSLDS-LPME conditions, mass-based dynamic range, limit of quantitation (LOQ), limit of detection (LOD), and percent relative standard deviation (%RSD) for the lowest concentration in calibration plot were figured out to be 100.5-10964.2 μg kg-1, 150.6 μg kg-1, 45.2 μg kg-1, and 9.4%, respectively. Detection power was improved as 187.7-folds by the developed MSLDS-LPME-GC-MS system while enhancement in calibration sensitivity was recorded as 188.0-folds. In the final step of this study, the accuracy and applicability of the proposed system were tested by matrix matching calibration strategy. Percent recovery results for domestic wastewater and synthetic urine samples were calculated as 95.6-110.3% and 91.7-106.6%, respectively. These results proved the accuracy and applicability of the proposed preconcentration method, and the obtained analytical results showed the efficiency of the lab-made metal sieve apparatus.

Degradation of 5,5-diphenylhydantoin by chlorination and UV/chlorination: kinetics, transformation by-products, and toxicity assessment

This study investigated the reaction kinetics and mechanism of the degradation of 5,5-diphenylhydantoin (DPH) during conventional chlorination and UV/chlorination. DPH is one of the antiepileptic drugs, which has frequently been detected in the aquatic environment. For chlorination, the second-order rate constant for the reaction between DPH and free active chlorine (FAC) was determined at pH 5 to 8. At pH 6 to 8, the efficiency of chlorination in the removal of DPH was found to be dominated by the reaction involving hypochlorous acid (HOCl). The result also showed that anionic species of DPH was more reactive toward FAC as compared with neutral DPH. For UV/chlorination, the effect of FAC dosage and pH on the degradation of DPH was evaluated. UV/chlorination is a more effective method for removing DPH as compared with conventional chlorination and UV irradiation. The DPH degradation rate was found to increase with increasing FAC concentration. On the other hand, the degradation of DPH was found to be more favorable under the acidic condition. Based on the identified transformation by-products, DPH was found to be degraded through the reaction at imidazolidine-2,4-dione moiety of DPH for both chlorination and UV/chlorination. Toxicity study on the chlorination and UV/chlorination-treated DPH solutions suggested that UV/chlorination is a more efficient method for reducing the toxicity of DPH.

Feasibility of amlodipine besylate, chloroquine phosphate, dapsone, phenytoin, pyridoxine hydrochloride, sulfadiazine, sulfasalazine, tetracycline hydrochloride, trimethoprim and zonisamide in SyrSpend(®) SF PH4 oral suspensions

The objective of this study was to evaluate the feasibility of 10 commonly used active pharmaceutical ingredients (APIs) compounded in oral suspensions using an internationally used suspending vehicle (SyrSpend(®) SF PH4 liquid): (i) amlodipine, (as besylate) 1.0mg/mL; (ii) chloroquine phosphate,15.0 mg/mL; (iii) dapsone, 2.0 mg/mL; (iv) phenytoin, 15.0 mg/mL; (v) pyridoxine hydrochloride, 50.0 mg/mL; (vi) sulfadiazine, 100.0 mg/mL; (vii) sulfasalazine, 100.0 mg/mL; (viii) tetracycline hydrochloride, 25.0 mg/mL; (ix) trimethoprim, 10.0 mg/mL; and (x) zonisamide, 10.0 mg/mL. All suspensions were stored both at controlled refrigeration (2-8 °C) and controlled room temperature (20-25 °C). Feasibility was assessed by measuring the percent recovery at varying time points throughout a 90-day period. API quantification was performed by high-performance liquid chromatography (HPLC-UV), via a stability-indicating method. Given the percentage of recovery of the APIs within the suspensions, the expiration date of the final products (API+vehicle) was at least 90 days for all suspensions with regard to both the controlled temperatures. This suggests that the vehicle is stable for compounding APIs from different pharmacological classes.

Semi-automated alignment and quantification of peaks using parallel factor analysis for comprehensive two-dimensional liquid chromatography-diode array detector data sets

Parallel factor analysis was used to quantify the relative concentrations of peaks within four-way comprehensive two dimensional liquid chromatography-diode array detector data sets. Since parallel factor analysis requires that the retention times of peaks between each injection are reproducible, a semi-automated alignment method was developed that utilizes the spectra of the compounds to independently align the peaks without the need for a reference injection. Peak alignment is achieved by shifting the optimized chromatographic component profiles from a three-way parallel factor analysis model applied to each injection. To ensure accurate shifting, components are matched up based on their spectral signature and the position of the peak in both chromatographic dimensions. The degree of shift, for each peak, is determined by calculating the distance between the median data point of the respective dimension (in either the second or first chromatographic dimension) and the maximum data point of the peak furthest from the median. All peaks that were matched to this peak are then aligned to this common retention data point. Target analyte recoveries for four simulated data sets were within 2% of 100% recovery in all cases. Two different experimental data sets were also evaluated. Precision of quantification of two spectrally similar and partially coeluting peaks present in urine was as good as or better than 4%. Good results were also obtained for a challenging analysis of phenytoin in waste water effluent, where the results of the semi-automated alignment method agreed with the reference LC-LC MS/MS method within the precision of the methods.

An unusual case of relay pentobarbital toxicosis in a dog

Sodium pentobarbital and phenytoin are common constituents of veterinary euthanasia solutions in the United States. Relay, or secondary, barbiturate toxicosis has been reported in carnivorous animals that have fed from the carcasses of euthanized livestock. This case report presents barbiturate toxicosis in a dog. A 2-year-old female spayed Australian shepherd presented comatose 2 h after ingesting an unknown substance on the beach. The material was retrieved from the stomach by gastric lavage and visually identified as fish or other animal tissue. The dog recovered with symptomatic and supportive therapy and was released on the third day of hospitalization. Tissue found on the beach near where the dog walked and a urine sample from the dog were analyzed by gas chromatography/mass spectrometry. Both samples were positive for pentobarbital and phenytoin. The tissue was consistent with mammalian blubber based on gross and histological examination. Three weeks previously, a juvenile humpback whale had stranded on the beach where the dog had ingested the unknown substance. The whale had been euthanized with a barbiturate solution, necropsied, and removed from the beach. It was not definitively determined that the pentobarbital-containing blubber ingested by the dog was from the euthanized whale, but that was the most likely source. Although attempts were made to remove the whale's remains from the beach, practical considerations made complete removal challenging, if not impossible.

Occurrence and removal of pharmaceuticals and hormones through drinking water treatment

The occurrence of fifty-five pharmaceuticals, hormones and metabolites in raw waters used for drinking water production and their removal through a drinking water treatment were studied. Thirty-five out of fifty-five drugs were detected in the raw water at the facility intake with concentrations up to 1200 ng/L. The behavior of the compounds was studied at each step: prechlorination, coagulation, sand filtration, ozonation, granular activated carbon filtration and post-chlorination; showing that the complete treatment accounted for the complete removal of all the compounds detected in raw waters except for five of them. Phenytoin, atenolol and hydrochlorothiazide were the three pharmaceuticals most frequently found in finished waters at concentrations about 10 ng/L. Sotalol and carbamazepine epoxide were found in less than a half of the samples at lower concentrations, above 2 ng/L. However despite their persistence, the removals of these five pharmaceuticals were higher than 95%.

Free phenytoin concentration measurement in brain extracellular fluid: a pilot study

This article investigates the relationship between brain extracellular fluid free phenytoin concentration and plasma free phenytoin concentration in adults with acute brain injury. Daily cerebral microdialysate free phenytoin concentration was measured in eight adults with acute brain injury and compared with simultaneous measurement of plasma free phenytoin concentration. The group data revealed no significant correlation between microdialysate and plasma free phenytoin concentration (r = 0.34, p = 0.41). However, in two patients, with a sufficient number of samples for intra-individual analysis, there was a significant correlation between microdialysate and plasma free phenytoin concentration (r = 0.92, p < 0.001 and r = 0.88, p < 0.01). In vitro microdialysis relative recovery for phenytoin was 2.1%. In the context of acute brain injury, measurement of free plasma phenytoin concentration may not provide an accurate reflection of regional brain extracellular fluid free phenytoin concentration and may have limitations with respect to achieving reproducible brain extracellular fluid free phenytoin concentrations. This has implications for dosing regimens relying on plasma phenytoin levels.

Degradation of selected pharmaceuticals in aqueous solution with UV and UV/H(2)O(2)

The degradation of four pharmaceutical compounds (PhACs), ibuprofen (IBU), diphenhydramine (DP), phenazone (PZ), and phenytoin (PHT) was investigated via ultraviolet (UV) photolysis and UV/H(2)O(2) process with a low-pressure (LP) UV lamp. For each PhAC tested, direct photolysis quantum yields at 254 nm were found to be ranging from 6.32 x 10(-2) to 2.79 x 10(-1)molE(-1) at pH 7. The second-order rate constants of the reaction between the PhACs and OH were determined to be from 4.86 x 10(9) to 6.67 x 10(9)M(-1)s(-1) by using a competition kinetic model which utilized para-chlorobenzoic acid (pCBA) as a reference compound. The overall effect of OH radical scavenging from humic acid (HA) and anions HCO(3)(-), NO(3)(-) was measured utilizing R(OH,UV) method through examining the aqueous photodegradation of pCBA as a probe compound. Moreover, these fundamental direct and indirect photolysis parameters were applied in the model prediction for oxidation rate constants of the PhACs in UV/H(2)O(2) process. It was found that the predicted oxidation rate constants approximated the observed ones. The results indicated that the new R(OH,UV) probe compound method was applicable for measuring background OH radical scavenging effects in water treatment process of UV/H(2)O(2). Furthermore, by GC-MS analysis, most of the intermediates created during the photodegradation of the selected PhACs in UV/H(2)O(2) process were identified. For the photodegradation of PZ, a competition mechanism existed between the direct UV photolysis and the oxidation of OH. An appropriate dosage of H(2)O(2) could hinder the occurrence of the direct photolysis.

Concentration gradient immunoassay. 1. An immunoassay based on interdiffusion and surface binding in a microchannel

We describe a novel microfluidic immunoassay method based on the diffusion of a small-molecule analyte into a parallel-flowing stream containing a cognate antibody. This interdiffusion results in a steady-state gradient of antibody binding site occupancy transverse to convective flow. In contrast to the diffusion immunoassay (Hatch, A.; Kamholz, A. E.; Hawkins, K. R.; Munson, M. S.; Schilling, E. A.; Weigl, B. H.; Yager, P. Nat. Biotechnol. 2001, 19, 461-465.), this antibody occupancy gradient is interrogated by a sensor surface coated with a functional analogue of the analyte. Antibodies with at least one unoccupied binding site may specifically bind to this functionalized surface, leading to a quantifiable change in surface coverage by the antibody. SPR imaging is used to probe the spatial distribution of antibody binding to the surface and, therefore, the outcome of the assay. We show that the pattern of antibody binding to the SPR sensing surface correlates with the concentration of a model analyte (phenytoin) in the sample stream. Using an inexpensive disposable microfluidic device, we demonstrate assays for phenytoin ranging in concentration from 75 to 1000 nM in phosphate buffer. At a total volumetric flow rate of 90 nL/s, the assays are complete within 10 min. Inclusion of an additional flow stream on the side of the antibody stream opposite to that of the sample enables simultaneous calibration of the assay. This assay method is suitable for rapid quantitative detection of low molecular weight analytes for point-of-care diagnostic instrumentation.

An ImmunoChip prototype for simultaneous detection of antiepileptic drugs using an enhanced one-step homogeneous immunoassay

The development and characterization of a one-step homogeneous immunoassay-based multiwell ImmunoChip is reported for the simultaneous detection and quantitation of antiepileptic drugs (AEDs). The assay platform uses a cloned enzyme donor immunoassay (CEDIA) and a Beta-Glo assay system for generation of bioluminescent signal. Results of the one-step CEDIA for three AEDs (carbamazepine, phenytoin, and valproic acid), in the presence of serum, correlate well with the values determined by fluorescence polarization immunoassay. CEDIA intra- and interassay coefficients of variation are less than 10%. A microfabrication process, xurography, was used to produce the multiwell ImmunoChip. Assay reagents were dispensed and lyophilized in a three-layer pattern. The multiwell ImmunoChip prototype was used to detect and quantify AEDs in serum samples containing all three drugs. Luminescent signals generated from each well were recorded with a charge-coupled device (CCD) camera. The assays performed on an ImmunoChip were fast (5 min), requiring only small volumes of both the reagents (<1 microl/well) and the serum sample. The ImmunoChip assay platform described in this article may be well suited for therapeutic monitoring of drugs and metabolites at the point-of-care setting.

Application of highly accurate nephelometric titration in the assaying of phenytoin sodium

AIM

To determine phenytoin sodium by a highly accurate nephelometric titration.

METHODS

The titration operating conditions were optimized and the solubility product constant of phenytoin silver precipitation was determined.

RESULTS

The result of the titration is comparable to those of control experiments.

CONCLUSION

The proposed method has been found to be accurate, precise, specific, reproducible, and linear.

Determination of phenytoin sodium injection and tablets by highly accurate nephelometric titration

A highly accurate nephelometric titration method was developed for the quantitative analysis of phenytoin sodium injection and tablets. The titration operating conditions and the validation of the method were studied. Five batches of phenytoin sodium injection and tablets were determined by the proposed method and the control experiment methods, respectively. The results of the titration are comparable to those of control experiments. The proposed method is accurate and reproducible, which is considered suitable for the quantitative analysis of a large number of samples.

Mathematical representation of analyte's capacity factor in binary solvent mobile phases using the Jouyban-Acree model

Applicability of a solution model, namely the Jouyban-Acree model, for mathematical representation of capacity factors of phenobarbital, phenytoin and carbamazepine in mobile phases containing water and the organic modifiers: methanol, acetonitrile, acetone and tetrahydrofuran and also a number of data sets collected from the literature has been shown. The accuracy of the proposed model is compared with those of the linear model and the quadratic equation using average percentage deviation (APD) as an accuracy criterion. The obtained mean and standard deviation of APDs of the Jouyban-Acree, linear and quadratic models are 8.1 +/- 8.4, 25.2 +/- 18.0 and 14.5 +/- 16.2%, respectively. The results showed that the Jouyban-Acree model provided more accurate calculations than the previously published models and the mean differences were statistically significant (p < 0.002).

Simultaneous determination of phenytoin, barbital and caffeine in pharmaceuticals by absorption (zero-order) UV spectra and first-order derivative spectra--multivariate calibration methods

The quantitative predictive abilities of partial least squares (PLS-1) and principle component regression (PCR) on absorption (zero-order) UV spectra are compared with the results obtained by the use of these multivariate calibration methods on first-order derivative spectra. Both approaches were satisfactorily applied to the simultaneous determination of these drugs in synthetic and pharmaceutical mixtures. Significant advantages were found in the simultaneous determination of phenytoin, barbital and caffeine in binary and ternary mixtures, by application of different multivariate calibration methods when the calibration matrix was performed using the first-order derivative spectra. The proposed method was validated by applying it to the analysis of binary and ternary mixtures of phenytoin, barbital and caffeine. Determinations were made over the concentration ranges of 0.24-22.0, 0.01-27.0 and 0.049-27.0 microg ml(-1) for phenytoin, barbital and caffeine, respectively, in the binary and 0.45-22.0, 0.05-26.0 and 0.05-20.0 microg ml(-1) for phenytoin, barbital and caffeine, respectively, in the ternary mixtures. The relative standard errors in the determinations were less than 3% in most cases.

A comparison of two methods to determine the solubility of compounds in aerosol propellants

A new on-line reverse phase HPLC method for determining the solubility of compounds in propellant based metered dose inhaler (MDI) formulations was compared with a conventional method. The new method employs a direct injection from a MDI vial into the needle injector port of a manual injector. To evaluate the two methods, beclomethasone dipropionate (BDP), 5,5-diphenyl hydantoin and 3,3'-diindolylmethane, were used as model compounds in propellant HFA-134a. Comparison was performed by analyzing known and unknown concentrations of BDP in various combinations of HFA-134a and ethanol. In addition, the solubility of 5,5-diphenyl hydantoin and 3,3'-diindolylmethane were determined in HFA-134a using both the new and the conventional methods. The two methods were found to be in good agreement with each other, with the new direct injection technique offering enhanced precision and accuracy along with considerable reduction in analysis time.

Highly Accurate Nephelometric Titrimetry

A method that accurately indicates the end-point of precipitation reactions by the measurement of the relative intensity of the scattered light in the titrate is presented. A new nephelometric titrator with an internal nephelometric sensor has been devised. The work of the titrator including the sensor and change in the turbidity of the titrate and intensity of the scattered light are described. The accuracy of the nephelometric titrimetry is discussed theoretically. The titration of NaCl with AgNO(3) serves as a model. A relative error as well as deviation is within 0.2% under the experimental conditions. The applicability of the titrimetry in pharmaceutical analyses, for example, phenytoin sodium and procaine hydrochloride, is generally illustrated.

Recovery of phenytoin from feeding formulas and protein mixtures

The recovery of phenytoin from mixtures containing different phenytoin formulations and protein mixtures was studied. Three phenytoin solutions (40 mg/microL) were prepared, each in triplicate, from phenytoin tablets, phenytoin suspension, and bulk phenytoin powder. These solutions were mixed with equivalent volumes of two commercially available feeding formulas (Replete and Ultracal) and two isolated protein mixtures (casein protein mixture and why protein isolates mixture) and placed in ultrafiltration tubes. The mixtures were centrifuged, and phenytoin recovery was determined by using high-performance liquid chromatography. Control data were also obtained before and after the experiment. There was no difference in phenytoin recovery when comparing phenytoin tablets versus phenytoin suspension in any of the protein media. There was a significant difference in phenytoin recovery when comparing the standard phenytoin solution mixed with Replete (32.51%) versus Ultracal (37.71%). There was also a significant difference in recovery when comparing the standard solution mixed with the calcium caseinate mixture (48.41%) versus the whey protein isolates mixture (82.01%). While the difference in recovery between Replete and Ultracal was expected, the significantly higher recovery of phenytoin from the whey protein mixture versus the calcium caseinate mixture indicated a much lower binding affinity between phenytoin and whey protein than with phenytoin and casein. The recovery of unbound phenytoin from feeding formulas and solutions of protein isolates did not differ with phenytoin formulations. Ultracal had a lower level of binding to phenytoin than Replete; whey protein had a lower level of binding than casein.

[Highly-accurate nephelometric titrimetry]

AIM

To indicate the titration end-point of precipitation reaction by measuring the relative intensity of the scattered light in the titrate for use in pharmaceutical analysis.

METHODS

A visible light-emitting diode (LED) was used as a light source and a photodiode was used as the optical detector. Light on the detector creates an electric current through the diode. With the addition of the titrant, the titrate became turbid and the intensity of the scattered light in the solution increased gradually. If the precipitation reaction proceeded the completion and the solubility of the precipitate was small enough, the intensity of the scattered light will reach maximum at the stoichiometric point; thus, the titration end-point can be indicated. The accuracy of nephelometric titrimetry was discussed theoretically and the titration of NaCl with AgNO3 was used as a model. To demonstrate the applicability of the new titrimetry in pharmaceutical analysis, phenytoin sodium and procaine hydrochloride were titrated with AgNO3 and NaOH solutions, respectively.

RESULTS

With our new titrator and nephelometric sensor, the accuracy and precision of our new titrimetry can be better than 0.2% under suitable conditions.

CONCLUSION

This new titrimetry can be used for pharmaceutical analysis.

Determination of two ternary mixtures containing phenobarbitone by second derivative of the ratio spectrum-zero-crossing and HPLC methods

A spectrophotometric method is developed for the determination of ternary mixtures with overlapping spectra. The method is based on the use of the second derivative of the ratio spectrum with a zero-crossing technique. The ratio spectrum was obtained by dividing the absorption spectrum of the mixture by that of one of the components. The concentration of the other components are then determined from their respective calibration graphs treated similarly. The method is accurate, non-destructive and do not require resolutions of equations. The method has been applied for the resolution of two ternary mixtures, namely, phenobarbitone, methylphenobarbitone and phenytoin (1), and phenobarbitone, papaverine HCl and piperazine acefyllinate (2). Also, a HPLC method was developed for determination of phenobarbitone, papaverine and HCL and piperazine acefyllinate. The HPLC method depends upon using ODS column with a mobile phase consisting of acetonitrile-5 mM aqueous heptane sulfonic acid sodium salt (50:50, v/v) and adjusted to apparent pH 4 using acetic acid. Quantitation was achieved with UV detection at 220 nm based on peak area. The proposed methods were applied for the determination of the two ternary combinations in synthetic mixtures and in commercial pharmaceutical products. The results obtained were precise and accurate.

Polarographic determination of phenytoin and benzophenone (as impurity) in pharmaceutical preparations

A differential pulse polarographic method is described for detection and trace determination of benzophenone (the main impurity) in phenytoin powder. The method depends upon the polarographic activity of benzophenone in Britton-Robinson buffer pH 5.6. The limit of detection was found to be 2.5 x 10(-6) microg ml(-1). Phenytoin has been analysed polarographically after oxidation with alkaline permanganate to give benzophenone; the limit of detection was found to be 6 x 10(-6) microg ml(-1).

Construction and application of phenytoin anion-selective electrode based on bulk acoustic wave (BAW) sensing technique

This paper describes the construction of an anion-selective bulk acoustic wave (BAW) sensor for the direct determination of phenytoin sodium for the first time. Based on the sensitive mass response of a piezoelectric quartz crystal (PQC) and selective adsorption-desorption across the modified film, the BAW sensor was fabricated by coating a polyvinylchloride (PVC) film containing activator on one side of a PQC. The method was found to be sensitive, rapid and easy to handle without pretreatment of the sample. The logarithm of the frequency shift of the PQC shows a linear relationship to the logarithm of the concentration of phenytoin over the range 6.7 x 10(-8)-8.0 x 10(-4) M with a detection limit of 1.0 x 10(-8) M at pH 10.0. Recoveries were in the range 98.5-102.0%. Influencing factors were examined and optimized. Also discussed is the preliminary application of the phenytoin BAW sensor in serum and injection. The results for real samples obtained by the proposed method agreed with those obtained by conventional methods.

A novel microphysiometer based on MLAPS for drugs screening

This paper presents a novel microphysiometer for simultaneous measurements of several extracellular ions concentrations in living cells based on MLAPS (multi-light addressable potentiometric sensor). In the microphysiometer, different sensitive membranes are illuminated in parallel with n light sources at different frequencies, the response amplitudes of each frequency component can be measured on-line by parallel processing algorithm. By the experiments, we can analyze the relations of the extracellular environmental H(+), Na(+), K(+), Ca(2+) under the effects of western medicines (dilantin, phenobarbital sodium, penicillin sodium) and Chinese drugs (scutellaria, medlar, hemlock parsley), and estimate the effects of several drugs. As the novel microphysiometer works under regular cell culture conditions, cells can be repeatedly simulated with drugs to complete dose-response curve within a few hours. With the detection of a general parameter (extruded protons and ions), the system can be used to monitor the real-time process of the cells' metabolism, observe the functional responses of different kinds of membrane-bound receptors, evaluate the drugs.

A rapid diffusion immunoassay in a T-sensor

We have developed a rapid diffusion immunoassay that allows measurement of small molecules down to subnanomolar concentrations in <1 min. This competitive assay is based on measuring the distribution of a labeled probe molecule after it diffuses for a short time from one region into another region containing antigen-specific antibodies. The assay was demonstrated in the T-sensor, a simple microfluidic device that places two fluid streams in contact and allows interdiffusion of their components. The model analyte was phenytoin, a typical small drug molecule. Clinically relevant levels were measured in blood diluted from 10- to 400-fold in buffer containing the labeled antigen. Removal of cells from blood samples was not necessary. This assay compared favorably with fluorescence polarization immunoassay (FPIA) measurements. Numerical simulations agree well with experimental results and provide insight for predicting assay performance and limitations. The assay is homogeneous, requires <1 microl of reagents and sample, and is applicable to a wide range of analytes.

Performance characteristics of four free phenytoin immunoassays

The measurement of the unbound or free phenytoin concentration is indicated in several situations, including uremia. In patients with uremia, metabolites of phenytoin and other substances accumulate and can displace phenytoin from its protein binding sites, with a consequent increase in the free fraction of drug. Some of the phenytoin metabolites that accumulate in uremia can cross-react with phenytoin immunoassays. In this study the authors evaluated four free phenytoin immunoassays compared with a high-performance liquid chromatography (HPLC) method: the Roche COBAS Integra, the Syva EMIT 2000, the Opus INNOFLUOR, and the Abbott TDx. All four methods demonstrated good precision, with interday coefficients of variation of < or = 5% and comparable recoveries using quality control material. Two of the methods, the EMIT 2000 and COBAS Integra, showed excellent agreement with the HPLC method using samples from patients both with normal renal function and with renal insufficiency. The other two methods, the INNOFLUOR and TDx, showed average positive biases for the therapeutic range of 3-7% and 21-22%, respectively, compared with the HPLC method for samples from patients with normal renal function, and average positive biases of 24-32% and 75-81%, respectively, with samples from patients with uremia.

Simultaneous spectrophotometric determination of phenobarbital, phenytoin and methylphenobarbital in pharmaceutical preparations by using partial least-squares and principal component regression multivariate calibration

Two multivariate calibration methods, partial least squares (PLS-2) and principal component regression (PCR) have been applied to the simultaneous spectrophotometric analysis of ternary mixtures of phenytoin (DPH), phenobarbital (PBT) and methylphenobarbital (MPBT) in the Comital-L pharmaceutical formulation. The PLS-2 and PCR procedures were employed to evaluate the data of a variable number of calibration solutions measured over the wavelength range 400-700 nm. The concentration ranges used to construct the calibration matrix were varied between 5 and 30 microg ml(-1). The proposed methods were validated by applying them to the analysis of the Comital-L pharmaceutical formulation and the average relative errors were less than 6% for each one of the analyzed compounds. The results obtained by both proposed methods have been compared with the results obtained by application of a RPLC reference method.

Phenytoin concentration in head hair sections: a method to evaluate the history of drug use

Phenytoin (PHT) levels were determined in sections of head hair taken from 60 patients (34 males and 26 females), aged 5 to 69 years, who were regularly receiving the drug. The hair sectional analysis included dissolution, liquid phase extraction procedures, and immunoassay (Abbott TDx) or high-pressure liquid chromatography (HPLC) analytical techniques. The values of PHT levels in the hair from the first section (close to the hair root) to the fifth section for female patients were 18.0, 15.2, 13.1, 11.6, and 10.7 microg/g, respectively, according to HPLC measurements. There were no significantly different results obtained using the immunoassay technique, according to which the mean values of PHT in the hair sections were 17.9, 15.2, 13.1, 11.9, and 10.9 microg/g, respectively, from the first to the fifth sections. The corresponding mean values for male patients by HPLC and immunoassay techniques, respectively, were 17.9, 15.0, 12.5, 12.1, and 12.3 microg/g and 17.8, 14.9, 12.2, 11.9, and 121 microg/g. Generally, a reduction of drug concentrations in hair from the first to the subsequent segments was observed. The hair PHT concentrations were found to be dependent on the dosage (by fluorescence polarization immunoassay: r = 0.987, p < or = 0.02; by HPLC: r = 0.988, p < or = 0.02). Mean dose and assay outcome values by hair color and correlation between hair PHT mean values, daily mean doses of the drug, and patients' age are presented. The differences among doses according to hair color were significant. PHT hair profiles from female and male patients compared with the mean +/- SD concentrations of the hair sections are discussed. The data indicate the possible use of hair section testing as a marker of the dosage history and the compliance of patients receiving long-term treatment with PHT.

Linker-mediated modulation of the chemiluminescent signal from N(10)-(3-Sulfopropyl)-N-sulfonylacridinium-9-carboxamide tracers

Four chemiluminescent N-sulfonylacridinium-9-carboxamide active esters (17-20) were prepared from the corresponding acids and coupled to both of the aminated phenobarbital (13) and N-(6-aminohexyl)phenytoin (16) haptens. The level of signal produced by chemiluminescent N-sulfonylacridinium-9-carboxamide phenobarbital and phenytoin tracers in a solid-phase immunoassay format was found to be modulated by at least 20-fold by the judicious choice of the reactive acridinium-hapten linking group.

Mathematical models to calculate fosphenytoin concentrations in the presence of phenytoin using phenytoin immunoassays and alkaline phosphatase

Under certain circumstances, it is necessary to measure both fosphenytoin and phenytoin concentrations. We describe equations by which fosphenytoin concentrations can be calculated accurately by using phenytoin immunoassays. We supplemented aliquots of drug-free serum with fosphenytoin and measured the phenytoin equivalent concentrations (reading a) using fluorescence polarization immunoassay and a chemiluminescent assay. Then 10 microL of alkaline phosphatase (ALP) solution was added to the specimen, and after incubation for 5 minutes at room temperature, total phenytoin concentration was measured (reading b). ALP completely converts fosphenytoin to phenytoin in 5 minutes. Therefore, the delta reading (b-a) represents increased observed value due to complete conversion of fosphenytoin to phenytoin for a particular fosphenytoin concentration. By using the x-axis as the delta reading and the y-axis as the target fosphenytoin concentrations, we observed equations that can be used to calculate the concentration of fosphenytoin in the presence of phenytoin. To test the validity of our equations, we prepared 2 serum pools from patients receiving phenytoin and supplemented them with known concentrations of fosphenytoin. Then initial (reading a) and final (after addition of ALP and incubation, reading b) concentrations were measured by immunoassay. We can accurately predict fosphenytoin and phenytoin concentrations from the delta reading.

The effect of multiple anticonvulsant therapy on the expression of phenytoin-induced gingival overgrowth

The potential effect of co-medication with phenobarbitone, primidone and carbamazepine on plasma and saliva concentrations of 5-(4-hydroxyphenyl)-5-phenylhydantoin (4-HPPH), the major metabolite of phenytoin in man and on the incidence of phenytoin-induced gingival overgrowth was investigated in a group of 36 adult epileptic patients. There were no significant differences in plasma or saliva concentrations of 4-HPPH or phenytoin in patients prescribed phenytoin alone, compared to those who received phenytoin with either phenobarbitone, primidone, or carbamazepine. In addition, the extent and the incidence of gingival overgrowth were similar in the 2 groups. The results suggest that chronic co-medication with other anti-convulsant drugs which induce phenytoin metabolism, does not affect the plasma or saliva 4-HPPB steady-state levels, nor the degree of gingival overgrowth in adult epileptic patients on therapy with phenytoin.

Synthesis of CpFe(CO)(L) complexes of hydantoin anions (Cp = eta5-C5H5, L = CO, PPh3), and the use of the 5,5-diphenylhydantoin anion complexes as tracers in the nonisotopic immunoassay CMIA of this antiepileptic drug

As part of our ongoing development of the CMIA nonisotopic immunoassay method, in which the tracers are metal carbonyl complexes and detection is by Fourier transform infrared spectroscopy, we examined the potential use as tracers of the complexes CpFe(CO)2(5,5-diphenylhydantoin) 2d and CpFe(CO)(PPh3)(5, 5-diphenylhydantoin) 3. The present study involved the synthesis of a series of hydantoin complexes (2a-2d), in particular that of the derivative of 5,5-diphenylhydantoin 2d. The structure of 2d was confirmed by X-ray crystallography. The infrared analysis, establishing the position and intensity of the characteristic metal-carbonyl peaks of complexes 2d and 3 in the 1850-2200 cm-1 region, shows that measurement of the absorbance values of these characteristic peaks will permit quantitative analysis in the picomole range, the norm for routine use in immunoassay and thus suitable for use as CMIA tracers. Cross-reaction rates of these tracers with anti-DPH specific antibodies show that 2d and 3 are both recognized by anti-DPH antibodies (cross-reaction rates 43 and 20%, respectively). In developing a CMIA of DPH with these tracers, it was found that 3, with a single, intense band at 1977 cm-1, had very promising IR characteristics for use in multiassay CMIA, but probably owing to its relatively weak affinity for the antibodies, it was not possible to develop a CMIA for DPH using this tracer. Complex 2d, however, showed better recognition by the antibodies, and using this complex as a tracer, it was possible to develop a particularly sensitive monoassay of DPH by the CMIA method.

Phenytoin penetration into brain after administration of phenytoin or fosphenytoin

PURPOSE

This study was designed to measure the brain penetration of phenytoin (PHT) after intravenous (i.v.) administration of either standard PHT or fosphenytoin (FPHT), a PHT prodrug. The study was formulated to answer the question whether the time required for FPHT to be converted to PHT in the bloodstream would delay the accumulation of PHT in brain.

METHODS

Four rats were sampled at various times after intravenous infusion of 30 mg/kg PHT i.v. or 30 mg/kg PHT equivalents of FPHT i.v. PHT was measured in serum, protein-free ultrafiltrate, and in brain, by using high-performance liquid chromatography.

RESULTS

Although the initial PHT-free fraction was significantly higher for FPHT-treated rats than it was for PHT-treated rats, brain PHT levels were significantly reduced after infusion of FPHT.

CONCLUSIONS

When FPHT is used for treatment of generalized status epilepticus, it should be anticipated that lower initial brain PHT levels will be achieved than are typically found with standard PHT.

Determination of phenytoin in sections of head hair: a preliminary study to evaluate the history of drug use

Phenytoin (PH) levels were determined in the head hair of twenty five patients (fourteen males and eleven females, aged from five to seventy seven years old) who were receiving this drug chronically. The assay method involved sectional hair analysis by dissolution and liquid phase extraction procedures, using both high pressure liquid chromatography (HPLC) and immunoassay (Abbott TDx) techniques. Five sections were studied, the first being the one closet to the root. The phenytoin levels of the hair sections ranged: a) 1st: 0.68 to 39.56 micrograms/g (mean 16.12 micrograms/g), b) 2nd: 0.85 to 34.15 micrograms/g (mean 9.45 micrograms/g), c) 3rd: 1.33 to 27.90 micrograms/g (mean 3.72 micrograms/g), d) 4th: 1.10 to 10.96 micrograms/g (mean 3.04 micrograms/g) and e) 5th: 1.05 to 7.00 micrograms/g (mean 2.84 micrograms/g) according to the HPLC analysis. The immunoassay technique gave similar results. The mean values of phenytoin in the hair sections according to the immunoassay technique were: 16.28; 9.47; 3.77; 3.22; 2.97 micrograms/g, respectively from the 1st to the 5th section. A reduction of drug concentrations in hair from the first to the consecutive segments was observed. Higher amounts of phenytoin were deposited in black, untreated hair in comparison to blond brown or grey hair. Phenytoin concentrations in hair sections correlated with the oral daily dosage of the drug. Our data indicate to the use of hair testing as a marker of the dosage history and evaluation of the compliance of patients under long treatment with phenytoin.

Carbamazepine-10,11-epoxide in therapeutic drug monitoring

Carbamazepine (CBZ) is widely used in the treatment of epilepsy, frequently in combination with other anticonvulsants. Its metabolite, carbamazepine-10,11-epoxide, is pharmacologically active and is increased with concurrent use of valproate and other anticonvulsants. This pharmacokinetic interaction may be particularly important because CBZ, its epoxide, phenytoin, and lamotrigine all act on fast voltage-dependent sodium channels. Over a 2-month period, routine serum requests for CBZ (n=47) (excluding known cases of overdose) were also analyzed for CBZ epoxide, phenytoin, and lamotrigine using a simultaneous high performance liquid chromatographic (HPLC) method. Valproate was measured using fluorescence polarization immunoassay (FPIA). With concurrent phenytoin and lamotrigine administration, there was a relative increase in CBZ epoxide and a significant decrease in the ratio of CBZ to epoxide (from more than 5 to 3). If valproate was also present, the concentration of parent and metabolite increased significantly, causing potential toxicity. Two patients in this latter group had significant clinical toxicity, with parent CBZ concentrations in the reference range; a third patient suffered from poor control of seizures. This study illustrates the importance of awareness of the contribution of active metabolites in therapeutic drug monitoring and raises questions about the role of the routine monitoring of such metabolites.

[Application of statistical simulation spectrophotometry to the determination of four medicaments in feibaosanxiao tablets]

The steps of statistical simulation spectrophotometry are to build a model based on a collection of limited but sufficient data from simulation samples to reveal the real absorbance-concentration relationship of the real sample and provide concentrated data of the individual components of the real sample measured by its absorbance data at several sensitive wavelengths. In this article, the method of stepwise regression has been used for building absorbance-concentration model of Feibaosanxiao tablets, a compound formulation of multimedicaments, and uniform design, for experimental design and recovery test. Recoveries of the four medicaments, acetaminophen, phenytoin sodium, theophylline and caffeine were 99.6%, 97.4%, 100.7% and 100.7% with RSD 0.3%, 1.9%, 1.3% and 1.3% respectively (n = 14).

Monitoring of phenytoin in human breast milk, maternal plasma and cord blood plasma by solid-phase extraction and liquid chromatography

A rapid liquid chromatographic method for the quantitation of phenytoin in human breast milk, maternal plasma and cord blood plasma was developed using a Develosil C85 micron reverse phase column and a potassium dihydrogen phosphate buffer/acetonitrile mobile phase. Phenytoin and mephenytoin as an internal standard were detected by ultraviolet absorbance at 240 nm. The sample preparation method involves a rapid and simple procedure based on solid-phase extraction using a C18-bonded phase. Phenytoin could be determined in the concentration range of 0.05-3 micrograms ml-1. The recovery of phenytoin added to human breast milk and plasma were 91.6-94.7 and 91.6-96.0%, respectively, with coefficient of variation less than 4.2 and 8.7%. The method has been used for drug level monitoring in the human breast milk, maternal plasma and cord blood plasma samples that were taken from patients treated with phenytoin. The average ratio between the breast milk concentrations versus the plasma concentration was 0.28 +/- 0.1, with a rather poor correlation (r = 0.3033).

Prevention of precipitation of phenytoin in an infusion fluid by hydroxypropyl beta-cyclodextrin

Injection of phenytoin is often diluted with infusion fluids before administration, which may lead to precipitation of the drug due to changes in pH and/or vehicle. It is not possible to add cyclodextrins to the original injections to prevent precipitation of the drug, because the quantities required would be impractical (>100% w/v). However, from a knowledge of the solubility of phenytoin in cyclodextrin solutions, it is possible to add sufficient amounts of a soluble cyclodextrin to infusion fluids to maintain the solubility of phenytoin after the original injection is diluted to clinical concentrations in the fluid. From solubility measurements, theoretical amounts of hydroxypropyl beta-cyclodextrin (HPCD), sufficient to prevent precipitation of phenytoin, were added to 0.9% w/v sodium chloride solution, adjusted to pH 7.0. Phenytoin injection was diluted to clinical concentrations in the cyclodextrin/NaCl solutions. The mixtures, together with analogous mixtures containing phenytoin, but no HPCD, were stored at 25 degrees C for 3 days. In the presence of the cyclodextrin no precipitates of phenytoin were observed, but in its absence an immediate massive precipitation of phenytoin occurred. This is a flexible method for using soluble cyclodextrins to prevent precipitates of drugs in infusion fluids, provided the cyclodextrin used is not toxic.

Stability of fosphenytoin sodium with intravenous solutions in glass bottles, polyvinyl chloride bags, and polypropylene syringes

OBJECTIVE

To determine the stability of fosphenytoin sodium admixtures with NaCl 0.9% injection and dextrose 5% (D5W) injection when stored in glass or polyvinyl chloride (PVC) containers, to evaluate the compatibility of fosphenytoin with 11 other intravenous solutions, and to determine the stability of fosphenytoin repackaged in polypropylene syringes.

METHODS

Dilutions of fosphenytoin sodium 1, 8, and 20 mg phenytoin sodium equivalents (PE)/mL were prepared in NaCl 0.9%, D5W, and 11 other intravenous fluids. Aliquots of each solution in NaCL 0.9% or D5W were transferred to three glass bottles for storage at 25 degrees C and 21 PVC bags for storage at 25, 4, or -20 degrees C. Aliquots of each admixture with the other intravenous fluids were transferred to three PVC bags and stored at 25 degrees C for 7 days. In addition, 63 syringes were filled with fosphenytoin sodium 50 mg PE/mL (undiluted) and stored at 25, 4, or -20 degrees C. Samples of each solution from the three containers were analyzed for visual compatibility, pH, and fosphenytoin concentration initially and at 0.5, 1, 2, 3, 7, 14, and 30 days during storage at 25 and 4 degrees C and at 1, 7, 14, and 30 days during storage at -20 degrees C. Following removal of containers from the freezer, additional samples were obtained after 7 days at 4 or 25 degrees C, and 7 days at 25 degrees C, and then 7 days at -20 degrees C.

RESULTS

No visible precipitation or change in color or clarity was observed in any of the fosphenytoin solutions during the study. The concentration of fosphenytoin at each sampling time remained within 97-104% of initial concentration, regardless of container, concentration, intravenous admixture, or storage temperature.

CONCLUSIONS

Fosphenytoin sodium, either undiluted in polypropylene syringes or diluted with NaCl 0.9% or D5W in PVC bags, remains stable for at least 30 days at room temperature, under refrigeration, or frozen. After removal from the freezer, fosphenytoin can be thawed, kept at 4 or 25 degrees C for 7 days, and then returned to the freezer for another 7 days. Admixtures of fosphenytoin sodium in various other intravenous fluids are stable for at least 7 days at room temperature.

Simultaneous determination of phenytoin and carbamazepine in human hair by high-performance liquid chromatography

Drug detection in human hair has been regarded as a potentially useful technique for therapeutic drug monitoring and for the assessment of therapeutic compliance. An isocratic high-performance liquid chromatography (HPLC) assay for the simultaneous measurement of phenytoin and carbamazepine in human hair was used to assess therapeutic compliance in a population of patients with epilepsy. After alkaline digestion, phenytoin and carbamazepine were separated on a reverse-phase column by using a mobile phase of acetonitrile/methanol/water (9:37:54) and monitored at a wavelength of 214 nm with methylphenyl-5-phenylhydantoin as internal standard. The assay was linear in the range from 0 to 66.66 ng/mg hair, and recoveries of both drugs at concentrations of 8.33, 33.3, and 66.66 ng/mg hair from the hair matrix ranged from 91.2 to 104.0%. Inter- and intraassay coefficients of variation for both drugs (assessed at three concentrations in the calibration range) were < 10%. The limits of detection for phenytoin and carbamazepine were 2.0 and 1.33 ng/mg hair, respectively.

Examination of stability of anticonvulsants in a protease solution and assay of anticonvulsants in hairs

For analyzing the concentrations of drugs in hairs, a new method of digestion of hairs with Biopurase, a protease obtained from Bacillus subtilis, was examined. The concentrations of drugs in hairs were then determined in order to examine the usefulness of the protease for the digestion of hairs. The stability of five anticonvulsants in the protease solution was maintained over a 12-h period. In the clinical tests, the concentrations of the drugs in hairs obtained from patients who were taking anticonvulsants for a long time were determined. The concentration of phenobarbital in hairs in 10 patients taking phenobarbital ranged from 194 to 5020 ng/10 mg with a mean of 578 ng/10 mg, and the concentration of phenytoin in hairs in 6 patients taking phenytoin ranged from 44 to 299 ng/10 mg with a mean of 115 ng/10 mg. From these results, the transfer of phenobarbital and phenytoin from circulating blood into hairs was confirmed, and the usefulness of Biopurase for the digestion of hairs was proved.

Quantitative analysis of mixtures of metal-carbonyl complexes by Fourier-transform infrared spectroscopy: application to the simultaneous double immunoassay of antiepileptic drugs by the nonisotopic carbonyl metalloimmunoassay method

The feasibility of a double immunoassay of haptens by the nonisotopic carbonyl metalloimmunoassay (CMIA) method is demonstrated. Three different pairings of antiepileptic medications from the groups carbamazepine, diphenylhydantoin, and phenobarbital (for each of which a mono-CMIA is already available) were assayed by double CMIA. The assay method employs as tracers metal-carbonyl complexes that give very strong signals in the range of 1850-2200 cm-1 in the infrared spectrum, permitting quantitative analysis by Fourier-transform infrared spectroscopy. The fact that the signals are individually assignable and of comparable intensity permits quantitative analysis of mixtures of two tracers. The analysis may proceed in one of two ways: in the simpler case, there is no peak overlap with the two tracers and the quantitative analysis can be performed by simply measuring the absorbance of characteristic peaks of the two tracers. In the second case, in which there is partial or total overlap of peaks, a stepwise calculation provides rapid quantification of the two tracers. These findings allowed us to perform the double CMIA of two antiepileptics in which experimental conditions and time of analysis were strictly identical to those for mono-CMIA. We show here that there is a very good correlation between the results obtained in mono- and double-immunoassay by the CMIA method (correlation coefficient > 0.990).

Relationship between ischemic damage and concentrations of phenytoin and phenobarbital in the brain cortex of epileptic patients in vegetative state at death

Post-mortem concentrations of phenytoin (PHT) and phenobarbital (PB) were determined by high-performance liquid chromatography in the cortical matter of specified brain regions and in the serum (total and free) from 3 epileptic males in vegetative state and compared to the data of 45 deceased epileptic control patients. The duration of the vegetative state was 12 days, 15 days or about 4 months until death and was associated with corresponding stages of generalized ischemic brain damage. The histological examination was completed by immunohistochemical and morphometric methods. According to other investigators nerve cells are the major binding sites for PHT and PB in the cerebral cortex of rodents. But, in the 3 comatose patients the PHT and PB concentrations of the isocortex and neocerebellum were not significantly decreased in comparison with the control patients despite necrosis and loss of neurons as well as other distinct tissue alterations. The results strongly favor the non-specific binding of PHT and PB to cells and subcellular structures of the brain-mainly based on simple physico-chemical principles.

Plasma and saliva concentrations of phenytoin and 5-(4-hydroxyphenyl)-5-phenylhydantoin in relation to the incidence and severity of phenytoin-induced gingival overgrowth in epileptic patients

This study examined the relationships between plasma and saliva concentrations of phenytoin and 5-(4-hydroxyphenyl)-5-phenylhydantoin (HPPH), the major metabolite of phenytoin in man, and the prevalence and severity of gingival overgrowth. Thirty-six adult epileptic patients who had been receiving phenytoin for greater than 6 months without a recent change in dosage were assessed for signs of periodontal disease and gingival overgrowth. Plasma and saliva samples were analyzed by high performance liquid chromatography for the determination of phenytoin and HPPH concentrations. Seventeen patients demonstrated clinically significant gingival over-growth (responders; overgrowth index > or = 30%). There were significant correlations between the gingival overgrowth index and both the papillary bleeding index (r = 0.495; P < 0.005) and probing depth (r = 0.632; P < 0.005). The plaque index correlated with the papillary bleeding index (r = 0.420; P < 0.05) and the probing depth (r = 0.301; P < 0.005), but not with the gingival overgrowth index. The extent of gingival overgrowth did not correlate significantly with either plasma or saliva concentrations of phenytoin or HPPH. Mean plasma and saliva concentrations of phenytoin and HPPH did not differ significantly between non-responders and responders, nor did the mean plaque index. The mean papillary bleeding index (32.5 +/- 21.2 vs. 63.8 +/- 37.7; P < 0.01) and mean probing depth (12.4 +/- 14.4% vs. 35.9 +/- 25.3%; P < 0.02) were significantly greater in the responders. This study found no evidence of a relationship between phenytoin or HPPH concentrations in plasma or saliva and the extent, or prevalence of phenytoin-induced gingival overgrowth. Further studies with larger populations may be necessary to establish the relationship, if any, between phenytoin or HPPH levels and gingival overgrowth.

The pharmacokinetics of phenytoin in gingival crevicular fluid and plasma in relation to gingival overgrowth

The aim of this study was to determine whether phenytoin (PHT) could be detected in gingival crevicular fluid (GCF), and to relate its concentration to both plasma level and degree of gingival overgrowth. 23 patients medicated with phenytoin for at least 6 months were clinically examined for signs of periodontal disease and gingival overgrowth. 12 patients out of these demonstrated clinically significant overgrowth and their plaque scores and gingival inflammation were greater than for the non-overgrowth group (p < 0.001). Phenytoin concentrations were determined by high performance liquid chromatography, and was detected in GCF. There was a significant correlation between the GCF and plasma phenytoin concentrations (p < 0.05), but it was not related to the extent of gingival overgrowth. Inflammation increased the GCF volume, but was not a determinant of GCF phenytoin concentration. It is concluded that effusion of phenytoin into GCF is regulated by the plasma levels of the drug, but its concentration in GCF is not related to the incidence of gingival overgrowth.

A comparison of the OPUS and TDx analysers for antiepileptic drug monitoring

Therapeutic drug monitoring of a variety of antiepileptic drugs is used routinely as a guide to individualising the drug treatment of patients with epilepsy. Thin dry film multilayer immunoassays (OPUS) for carbamazepine, phenytoin, phenobarbitone, and valproic acid were evaluated and compared with fluorescence polarisation immunoassay (TDx), using commercially available control material and patient sera. For the OPUS, the within-batch coefficient of variation (CV) for the different drugs in the control material varied between 3.9% (phenobarbitone) and 8.1% (valproic acid). The between-batch CVs varied between 5.3% (valproic acid) and 18.3% (carbamazepine). The comparative between-batch CVs for the TDx varied between 2.0% (phenytoin) and 7.0% (valproic acid). Analysis of 209 patient samples containing carbamazepine, phenytoin, phenobarbitone, or valproic acid demonstrated significant correlation between the two analytical methods, with correlation coefficients of 0.9336, 0.9560, 0.9448, and 0.9618, with slopes of the regression lines of 0.9042, 0.8663, 1.1368, and 1.1244, respectively. It is concluded that both the TDx and OPUS instruments exhibit comparable performance for the analysis of carbamazepine, phenobarbitone, phenytoin, and valproic acid in patient samples. Moreover, the OPUS instrument, with its facilities of random assay access and statim analysis, may be useful in an outpatient setting in which a major consideration would be a rapid turnaround of patient assay results.

An audit of therapeutic drug monitoring of anticonvulsants

An audit of therapeutic drug monitoring (TDM) of anticonvulsants was performed to assess both its use and misuse in the management of patients with epilepsy. Over a four week period all samples received for phenytoin, carbamazepine, sodium valproate and phenobarbitone assays were included in the audit. The aims were to establish the source of the specimens, the reasons for the requests and to ascertain what action, if any, would be taken when the result of the assay was provided. A total of 163 separate assays were performed over the four week period (43 phenytoin, 74 carbamazepine, 41 valproate, 5 phenobarbitone). Only 18.7% of all requests originated from the adult neurology department. The vast majority of tests had been ordered by junior medical staff (only 10% by consultants) and approximately 50% were 'routine' with no satisfactory clinical reason for the request offered. There was a tendency to manipulate prescribed doses on the basis of drug levels alone without taking the clinical picture into consideration. These results demonstrate a general ignorance, especially amongst junior medical staff, of the value of TDM of anticonvulsants, and reinforce the need for both an educative and interpretive service to be provided by the Chemical Pathology Department.

MDR1 gene expression in brain of patients with medically intractable epilepsy

Why some patients with seizures are successfully treated with antiepileptic drugs (AEDs) and others prove medically intractable is not known. Inadequate intraparenchymal drug concentration is a possible mechanism of resistance to AEDs. The multiple drug resistance gene (MDR1) encodes P-glycoprotein, an energy-dependent efflux pump that exports planar hydrophobic molecules from the cell. If P-glycoprotein is expressed in brain of some patients with intractable epilepsy and AEDs are exported by P-glycoprotein, lower intraparenchymal drug concentrations could contribute to lack of drug response in such patients. Eleven of 19 brain specimens removed from patients during operation for intractable epilepsy had MDR1 mRNA levels > 10 times greater than those in normal brain, as determined by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) method. Immunohistochemistry for P-glycoprotein from 14 of the patients showed increased staining in capillary endothelium in samples from epileptic patients as compared with staining in normal brain samples. In epileptic brain specimens with high MDR1 mRNA levels, expression of P-glycoprotein in astrocytes also was identified. Last, steady-state intracellular phenytoin (PHT) concentrations in MDR1 expressing neuroectodermal cells was one fourth that in MDR1-negative cells. MDR1 expression is increased in brain of some patients with medically intractable epilepsy, suggesting that the patients' lack of response to medication may be caused by inadequate accumulation of AED in brain.

Application of the non-radioisotopic carbonyl metalloimmunoassay (CMIA) to diphenylhydantoin

As part of our ongoing work to develop the new non-isotopic assay method carbonyl metalloimmunoassay (CMIA), whose efficacy has already been proven in the laboratory for phenobarbital and cortisol, we here present the steps involved in establishing CMIA of 5,5 diphenylhydantoin (DPH), one of the most commonly used antiepileptic medications. First, anti-DPH antibodies were obtained by injection of the immunogen DPH-3-valerate-BSA into rabbits. The titer value and specificity of these antibodies were examined by RIA using [14C]-DPH as tracer, and an antibody batch selected for its high titer value and good specificity for metabolites of DPH and other antiepileptic drugs. Next the organometallic complex Cr(CO)3-DPH, chosen as the CMIA tracer, was synthesized and shown to conserve a high recognition value for anti-DPH antibodies (CR = 200%). Isopropyl ether was selected as the best organic solvent for use in separating the free and bound fractions of the tracer. Employing the Cr(CO)3-DPH complex as tracer and FT-IR spectroscopy as the detection method, we were able to obtain a titration curve by CMIA using an amount of tracer identical to that used in RIA. The titer value obtained in CMIA is approximately twice that obtained by RIA. These results demonstrate the feasibility of DPH assay by the CMIA method.