Study on the interaction between erythrosine B and the cardiac drug amiodarone using fluorescence, scattering, and absorbance spectra and their analytical application

In an acidic buffered solution, erythrosine B can react with amiodarone to form an association complex, which not only generates great enhancement in resonance Rayleigh scattering (RRS) spectrum of erythrosine B at 346.5 nm but also results in quenching of fluorescence spectra of erythrosine B at λemission = 550.4 nm/λexcitation = 528.5 nm. In addition, the formed erythrosine B-amiodarone complex produces a new absorbance peak at 555 nm. The spectral characteristics of the RRS, absorbance, and fluorescence spectra, as well as the optimum analytical conditions, were studied and investigated. As a result, new spectroscopic methods were developed to determine amiodarone by utilizing erythrosine B as a probe. Moreover, the ICH guidelines were used to validate the developed RRS, photometric, and fluorimetric methods. The enhancements in the absorbance and the RRS intensity and the decrease in the fluorescence intensity of the used probe were proportional to the concentration of amiodarone in ranges of 2.5-20.0, 0.2-2.5, and 0.25-1.75 μg/mL, respectively. Furthermore, limit of detection values were 0.52 ng/mL for the spectrophotometric method, 0.051 μg/mL for the RRS method, and 0.075 μg/mL for the fluorimetric method. Moreover, with good recoveries, the developed spectroscopic procedures were applied to analyze amiodarone in its commercial tablets.

Detection of glutathione conjugates of amiodarone and its reactive diquinone metabolites in rat bile using mass spectrometry tools

RATIONALE

Amiodarone is reported to cause hepato and pulmonary toxicity in humans, which has been envisaged to be due to formation of its reactive metabolites, essentially based on its structural similarity to benzbromarone, a drug withdrawn from the market due to reasons of similar hepatotoxicity. Therefore, the purpose of this study was to detect glutathione conjugates of amiodarone and its reactive diquinone metabolites in rat bile using mass spectrometry tools.

METHODS

Wistar rats were dosed orally with an amiodarone suspension and bile was collected via bile duct cannulation followed by solid-phase extraction, protein precipitation and centrifugation. Samples were analysed by liquid chromatography coupled with linear ion trap mass spectrometry using tandem mass and constant neutral loss scan in positive electrospray ionization mode.

RESULTS

Glutathione adducts of amiodarone and its reactive diquinone metabolites were identified and characterized with the characteristic neutral loss of 129 Da. Glucuronide conjugates of previously reported stable phase-1 metabolites were also observed.

CONCLUSIONS

This study confirmed generation of reactive metabolites of amiodarone for the first time, as was hypothesised earlier by various research groups. Also, the responsible toxicophore was identified to be a benzofuran moiety liable to form reactive diquinone species. However, the results need to be further confirmed in human subjects. Copyright © 2016 John Wiley & Sons, Ltd.

C60-SIMS imaging of nanoparticles within mammalian cells

To achieve successful drug delivery via nanoparticles the interactions between the nanoparticle and the chemistry of the surrounding biological environment is of central importance. A thorough understanding of these interactions is necessary in order to better elucidate information regarding drug pathways and mechanisms of action in treatment protocols. As such, it is important to identify the location of the nanoparticle, the state of its functionalization, as well as any changes in the cellular environment. The use of cluster secondary ion mass spectrometry (SIMS) using C60 (+) primary ions makes simultaneous acquisition of this information possible. Here, SIMS has been successfully used to chemically image gold nanoparticles (AuNPs) within a model, single cell system involving macrophage-like RAW 264.7 cells. The macrophage-like properties of this cell line make it extremely well-suited for cell-uptake studies. Both AuNPs and two pharmaceutical compounds, amiodarone and elacridar, were successfully imaged within a cellular system using cluster SIMS. To verify that SIMS can also be used to detect functionalization and nanoparticles simultaneously, fluorophore-functionalized AuNPs were studied as a model system. The fluorescent characteristics of these functionalized nanoparticles enabled the visual confirmation of the presence and location of the particles within the cell.

Metabolite identification studies on amiodarone in in vitro (rat liver microsomes, rat and human liver S9 fractions) and in vivo (rat feces, urine, plasma) matrices by using liquid chromatography with high-resolution mass spectrometry and multiple-stage mass spectrometry: characterization of the diquinone metabolite supposedly responsible for the drug's hepatotoxicity

RATIONALE

Several mechanisms have been anticipated for the toxicity of amiodarone, such as oxidative stress, lipid peroxidation, phospholipidosis, free radical generation, etc. Amiodarone is structurally similar to benzbromarone, an uricosuric agent, which was withdrawn from European markets due to its idiosyncratic hepatotoxicity. A proposed reason behind the toxicity of benzbromarone was the production of a reactive ortho-diquinone metabolite, which was found to form adducts with glutathione. Therefore, taking a clue that a similar diquinone metabolite of amiodarone may be the reason for its hepatotoxicity, metabolite identification studies were carried out on the drug using liquid chromatography/mass spectrometry (LC/MS) tools.

METHODS

The studies involved in vitro (rat liver microsomes, rat liver S9 fraction, human liver S9 fraction) and in vivo (rat feces, urine, plasma) models, wherein the samples were analyzed by employing LC/HRMS, LC/MS(n) and HDE-MS.

RESULTS AND CONCLUSIONS

A total of 26 metabolites of amiodarone were detected in the investigated in vitro and in vivo matrices. The suspected ortho-diquinone metabolite was one of them. The formation of the same might be an added reason for the hepatotoxicity shown by the drug.

Visible spectrophotometric method for amiodarone

Amiodarone is an antiarrhythmic agent used for various types of tachyarrhythmia, both ventricular and supraventricular (atrial) arrhythmia. A spectrophotometric method for the assay of amiodarone was established. Based on the reduction of potassium ferricyanide in hydrochloric acid medium to potassium ferrocyanide forming a blue colored complex ferric ferrocyanide with Fe (III) ions. The compound was most stable in a mixture of ethylic alcohol and water (2:1, v/v) and it had an absorption maximum at 725 nm. The data were according to the Lambert-Beer Law in the concentration range of 0.5-5.0 microg/sample: correlation and coefficient R = 0.99977, R2 = 0.999541, slope of the line 0.12775, intercept 0.042077. The detection limit (DL) was 0.1032 microg/sample and the quantification limit (QL) 0.344 microg/ sample.

Preparation and determination of desethylamiodarone in dog lung by HPLC-MS

A novel method was developed for the preparation and determination of desethylamiodarone in dog lung by high-performance liquid chromatography (HPLC) with amiodarone as a standard. The selected dog was orally given amiodarone, then executed and the active metabolite desethylamiodirone in lung tissue was isolated, concentrated and purified by Waters C18 column (25 mm x 250 mm, 10 microm) with mobile phase of acetonitrile-100 mmol/L acetic acid containing 15 mmol/L diethylamine (55:45 v/v) at a flow rate of 10.0 mL/min. Hypersil ODS2 column (4.6 mm x 250 mm 5 microm) was used to analyze amiodarone and desethylamiodarone, with the same mobile phase at a flow rate of 1.0 mL/min, the detection wavelength was 237.5 nm. Atmosperic pressure electronic spray ionization (AP-ESI) and ion mass spectral (m/z) of 618.1(M + H) were selected to validate desethylamiodarone. The f(i) of desethylamiodarone and amiodarone were 1.04 +/- 0.02 and 1.020 +/- 0.01, respectively. It indicated that desethylamiodarone can be separated and purified by preparational HPLC after Mass Spectrometry (MS) validation and quantified according to f(i) of amiodarone indirectly. The proposed method enables the preparation and determination of desethylamiodarone in dog lung successfully.

A liquid chromatography–mass spectrometry assay method for simultaneous determination of amiodarone and desethylamiodarone in rat specimens

A liquid chromatographic-mass spectrometry (LC/MS) assay method was developed for the determination of amiodarone and desethylamiodarone in rat specimens. Analytes were extracted using liquid-liquid extraction in hexane. The LC/MS system consisted of a Waters Micromass ZQtrade mark 4000 spectrometer with an autosampler and pump. A C(18) 3.5 microm (2.1 x 50 mm) column heated to 45 degrees C was used for separation. The mobile phase consisted of methanol and 0.2% aqueous formic acid pumped at 0.2 mL/min as a linear gradient. Components eluted within 12 min. The concentrations of ethopropazine (internal standard), desethylamiodarone and amiodarone were monitored for m/z of 313.10, combination of 546.9 and 617.73, and 645.83, respectively. In plasma (0.1 mL), linearity was achieved between the peak area ratios and concentrations over the range of 2.5-1000 ng/mL for both amiodarone and desethylamiodarone (r(2) > 0.999). The intraday and interday CV were equal or less than 18%, and mean error was <12%. Similarly, in homogenates containing 0.1 g of rat tissue, linearity was observed in standards ranging from 5 to 5000 ng/g. The method was successfully used to measure tissue and plasma concentrations of drug. The validated lower limit of quantitation was 2.5 ng/mL for drug and metabolite, based on 0.1 mL of plasma.

Flow injection chemiluminescent determination of amiodarone in pharmaceutical preparations using photogenerated tris(2,2′-bipyridyl)ruthenium(III)

A flow injection configuration was developed and evaluated for the chemiluminescent determination of amiodarone. The method is based on the reaction of the drug with tris(2,2'-bipyridyl)ruthenium(III), which was generated through the on-line photo-oxidation of tris(2,2'-bipyridyl)ruthenium(II) with peroxydisulfate. Under the optimum experimental conditions, a linear calibration graph was obtained over the range 3.0-60.0 microg ml(-1) with a detection limit of 0.28 microg ml(-1). The proposed method allows 120 injections h(-1) with excellent repeatability and precision (R.S.D. less than 0.5% and 2.8%, respectively) and a reagent consumption of only 0.37 micromol (0.27 mg) of Ru(bpy)(3)Cl(2) x 6H(2)O per determination. The method was successfully applied to the determination of amiodarone in commercial pharmaceutical formulations.

N-nitrosylation potential of mono-N-desethylamiodarone at physiological pH

Amiodarone (AMI) is frequently used for the treatment of supraventricular arrhythmias. The parent drug is rapidly dealkylated to mono-N-desethylamiodarone (MDEA) and the plasma concentrations of AMI and MDEA are comparable. MDEA is a secondary amine and may thus undergo formation to the corresponding N-nitrosamine in combination with coadministered nitrovasodilators. Previous studies have shown that nitrovasodilators release the vasoactive NO? which may nitrosylate thiol or secondary amine groups in aqueous solutions. Therefore, the nitrosylation potential of MDEA at physiological pH was investigated. N-Nitroso-monodesethylamiodarone (NO-MDEA) was synthesized, characterized and used as a reference product for the detection of the corresponding N-nitrosamine. HPLC and NMR results have shown that the NO-MDEA product is an equilibrium of two configurational isomers (syn and anti). NO-release was generated by sodium nitroprusside (SNP) which was exposed to light. The formation to NO-MDEA was assayed by HPLC-UV. It has been found that MDEA is nitrosylated in the higher nanomolar range and that varying oxygenation of the reaction mixture did not significantly affect the reaction yields. The addition of thiols such as serum albumin (0.6mM), l-cysteine (2.5mM) or N-acetylcysteine (2.5mM) inhibited the NO-MDEA formation indicating that they may prevent N-nitrosamine formation in vivo. However, as S-nitrosothiols may also release NO?, in long term exposure to elevated levels of nitric oxide the nitrosylation of secondary amines may be taken into account.

Validated Spectrophotometric Methods for the Determination of Amiodarone Hydrochloride in Commercial Dosage Forms Using p-Chloranilic Acid and 2,3-Dichloro-5,6-dicyano-1,4-benzoquinone

Two simple, sensitive and economical spectrophotometric methods have been developed for the determination of amiodarone hydrochloride in pure form and commercial dosage form. These methods (A and B) are based on the reaction of amiodarone base as n-electron donor with p-chloranilic acid and 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ) as pi-acceptors to give highly colored complex species which absorb maximally at 535 and 570 nm, respectively. Beer's law is obeyed in the concentration ranges 10.0 - 360.0 and 2.0 - 65.0 microg ml(-1) for methods A and B, respectively. Application of the proposed methods to commercial pharmaceutical tablets are presented.

Development of an enzyme-linked immunosorbent assay for the quantification of amiodarone

A sensitive and specific enzyme-linked immunosorbent assay for an antiarrhythmic drug, amiodarone (AMI), was developed, which is capable of measuring levels as low as 16 ng/ml. Anti-AMI antibody was obtained by immunizing rabbits with an antigen conjugated with bovine serum albumin using diazotized 4-amino-1-(2-diethylaminoethoxy)-2,6-diiodobenzene. Enzyme labeling of AMI with beta-D-galactosidase was similarly performed using a diazotized 4-amino-1-(2-diethylaminoethoxy)-2,6-diiodobenzene. This enzyme-linked immunosorbent assay was specific for AMI and showed a very slight cross-reactivity (1.25%) with its major metabolite, mono-N-desethylamiodarone. The values of the AMI concentrations measured by this assay were in good correlation to those by HPLC. Its analytical applicability was demonstrated by a kinetic study with human liver microsomes. The enzyme-linked immunosorbent assay should be a valuable tool in therapeutic drug monitoring and pharmacokinetic studies of AMI.

Characterization of amiodarone metabolites and impurities using liquid chromatography/atmospheric pressure chemical ionization mass spectrometry

Using the high performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometry (HPLC/APCI-MS/MS) technique, together with established trends from the literature, the structures of metabolites and impurities of amiodarone, an anti-arrhythmic drug, have been assigned. By comparing analyses of products of incubation with rat liver microsomes with controls in which glucose 6-phosphate dehydrogenase was omitted, metabolites could be distinguished from impurities. Structures for the two proposed metabolites and four impurities are proposed.

Unusual interference from primary collection tube in a high-performance liquid chromatography assay of amiodarone

We describe an unusual interference in our routine high-performance liquid chromatography (HPLC) assay of amiodarone and its active metabolite, desethylamiodarone, used to quantify the parent drug and the active metabolite in serum from the primary sample collection tube. The interfering peak had a retention time very similar to that of the authentic desethylamiodarone. Substitution of Corvac tubes with Vacutainer tubes for the collection and transportation of serum samples eliminated the source of interference. We routinely suggest the use of Vacutainer collection tubes for obtaining blood samples of cardiac patients undergoing amiodarone therapy.

A systematic review and critical comparison of internal standards for the routine liquid chromatographic assay of amiodarone and desethylamiodarone

Despite potential adverse effects, clinical use of amiodarone is increasing because of its efficacy in treating arrhythmias. Thus there is a continued need for a rapid, practical amiodarone assay to better study the relationship between serum concentrations and clinical effects and to guide safer dosing. Because the most widely used internal standard, L8040, is no longer available, a systematic comparison of potential alternatives was undertaken based on physicochemical and chromatographic characteristics. All amiodarone assays indexed on Medline were reviewed to produce a list of alternatives and five other potential substances considered based on previous experiences. An isocratic high-performance liquid chromatographic method was modified to allow simultaneous resolution of multiple compounds. The internal standard was expected to perform well in the solid-phase extraction of small sample volumes. No commercially available substances were able to duplicate all the advantages of L8040. Tamoxifen, the most acceptable alternative, was used to develop an assay to measure amiodarone and desethylamiodarone at concentrations as low as 0.25 mg/L in 100 microliters of serum (5 ng detected in a 20 microliters injection). Standard curves were linear over the range of concentrations found in our patients (0.25 to 8 mg/L), within-run coefficients of variation (CVs) averaged 5.3% for amiodarone and 2.9% for desethylamiodarone, and between-run CVs were 4.5% for amiodarone and 1.6% for desethylamiodarone.

Subchronic pulmonary inflammation and fibrosis induced by silica in rats are attenuated by amiodarone

A previous study demonstrated that the acute phase of silica-induced lung injury in rats can be attenuated by concomitant administration of amiodarone, a cationic amphiphilic drug that inhibits phospholipase activity in the lungs. The purpose of the present study was to determine whether continued amiodarone administration could inhibit subchronic silica-induced lung injury and fibrosis. Male Fischer-344 rats were administered amiodarone (150 mg/kg, p.o., 5 days/week) for 14 days and were then instilled with silica (100 mg/kg) intratracheally. Amiodarone treatment then continued for 60 days. Injury was evaluated by parameters in bronchoalveolar lavage fluid and fibrosis was assessed by lung hydroxyproline content and trichrome staining of collagen. Within the bronchoalveolar lavage fluid, amiodarone treatment resulted in significant decreases in silica-induced elevations in albumin levels, lactate dehydrogenase activity, beta-glucuronidase activity, and neutrophil influx. Amiodarone treatment resulted in significant reductions in silica-induced increases in lung weight and hydroxyproline levels; the diminution of fibrosis due to amiodarone treatment was confirmed histologically. These results indicate that subchronic pulmonary inflammation and fibrosis induced by silica in the rat can be attenuated by the concomitant administration of amiodarone.

Sympatholytic action of intravenous amiodarone in the rat heart

BACKGROUND

Amiodarone is a commonly used antiarrhythmic agent with complex pharmacological effects. Although ventricular arrhythmias can be suppressed soon after intravenous amiodarone, the mechanisms responsible for this action are unclear. We studied the effects of acute treatment with amiodarone on the metabolism and release of norepinephrine (NE) in intact rats and in perfused rat hearts.

METHODS AND RESULTS

Experiments were performed in anesthetized rats and in perfused, innervated hearts with amiodarone administered intravascularly. NE release was induced by electrical stimulation of the sympathetic ganglion. Concentrations of NE and its intraneuronal metabolite dihydroxyphenylglycol (DHPG) in hearts, plasma, and coronary venous effluent were measured by high-performance liquid chromatography. Acute administration of amiodarone induced dose-dependent increases in DHPG concentrations in plasma (5 mg/kg, +48%; 15 mg/kg, +84%; and 50 mg/kg, +467%) and in coronary venous effluent (1 mumol/L, +37%; 3 mumol/L, +510%; and 10 mumol/L, +1100%) together with an unchanged basal overflow of NE. In perfused hearts, NE release evoked by nerve stimulation was inhibited by infusion of amiodarone (1 mumol/L, -16%; 3 mumol/L, -24%; and 10 mumol/L, -64%) or by intravenous amiodarone (50 mg/kg) given 1 hour before heart perfusion (-70%), and the extent of this suppression correlated well with levels of DHPG overflow present immediately before nerve stimulation. When given in vitro and in vivo, amiodarone also significantly reduced NE and increased DHPG content in the heart, leading to a raised DHPG/NE ratio. All these effects of amiodarone were similar to those found with reserpine but less potent. In contrast, oral amiodarone produced none of these effects.

CONCLUSIONS

Acute administration of amiodarone in perfused hearts or intact rats induces partial NE depletion in the heart by interfering with vesicular NE storage and enhancing intraneuronal NE metabolism, effects associated with an impaired NE release during sympathetic activation. Oral dosing with amiodarone has no such effect. Further study is required to test whether this novel sympatholytic effect of amiodarone contributes to its antiarrhythmic action after intravenous administration.

Measurement of tissue-bound amiodarone and its metabolites by computed tomography

Amiodarone is strongly tissue-bound and serum levels are a poor guide to therapeutic efficacy. The electrocardiographic measure of the QT interval corrected for heart rate (QTc) is a better guide but is unhelpful in patients with bundle branch block or U-waves on the electrocardiogram. Myocardial amiodarone levels are the most accurate guide but are not easy to obtain. There is, however, a relationship between myocardial concentration and hepatic concentration of amiodarone and its metabolites. Since amiodarone contains iodine, and there is hepatic uptake, the increased hepatic attenuation from single slice computed tomography was compared with serum levels and the electrocardiographic QTc in 12 patients before and during amiodarone therapy. Hepatic attenuation increased by a mean value of 18.25 HU over a 12 month study period. This increase correlated well with increased QTc (r = 0.83) and with serum amiodarone levels (r = 0.89), but less well with serum desethyl amiodarone levels (r = 0.43). An iodine-containing phantom was used to construct a curve of attenuation against iodine concentration in mol/l. Thus an indirect measurement of amiodarone concentration in g/l wet weight of liver could be determined.

X-ray microanalysis of cultured alveolar macrophages with phospholipidosis

When administered to humans and animals, the iodine-containing drug amiodarone can cause pulmonary toxicity. As part of the pulmonary response to amiodarone, the drug and its principal metabolite, desethylamiodarone, accumulate in alveolar macrophages. Little is known about the susceptibility of lungs with preexisting damage to amiodarone administration. A number of chemicals can cause pulmonary phospholipidosis in humans and animals. To study the effect of a preexisting phospholipidosis on the intracellular accumulation of amiodarone and desethylamiodarone, rats were treated with chlorphentermine to induce a phospholipidosis in alveolar macrophages. The cells were recovered from the lungs by pulmonary lavage and placed in cell culture. They were then exposed to the same concentration of either amiodarone or desethylamiodarone. The intracellular distribution of each drug was quantified by measuring the associated iodine signal using X-ray microanalysis of freeze-dried cryosections of cells. Both drugs accumulated in lipid-rich amorphous bodies which correspond to lysosomally derived lamellar structures observed in conventional plastic sections. The level of desethylamiodarone exceeded that of amiodarone in the amorphous bodies. With both drugs, a higher concentration of iodine was present at the outer edges of the amorphous bodies compared to that in the center core. This suggests that the drugs are unable to freely penetrate the performed structures. By monitoring the concentrations of sodium and potassium ions within the nucleus, it was determined that chlorphentermine treatment disrupted the ionic distribution in the cells. Exposure to amiodarone, but not desethylamiodarone, resulted in further changes in sodium and potassium levels.(ABSTRACT TRUNCATED AT 250 WORDS)

High-performance liquid chromatographic assay for amiodarone N-deethylation in microsomes of rat liver

A reversed-phase high-performance liquid chromatographic assay using ultraviolet detection is described for determining the production of the major N-dealkylated metabolite of amiodarone in rat liver microsomes. The principal advantages of this method are its simple sample preparation (protein precipitation by acetonitrile), low detection limit for N-desethylamiodarone (0.05 mumol/l) and relatively short analysis time (16 min). Its analytical applicability is demonstrated by the comparison of the kinetic parameters (maximum velocity and Michaelis-Menten constant) between Sprague-Dawley and Dark-Agouti rats.

Amiodarone-induced pulmonary inflammation. Correlation with drug dose and lung levels of drug, metabolite, and phospholipid

To investigate the hypotheses that amiodarone-induced pulmonary inflammation may be related to direct drug toxicity, groups of 10 or more Wistar rats were fed amiodarone by gavage at concentrations of 175, 300, 400, and 500 mg/kg/day, or vehicle alone. After 6 wk of drug feeding, the rats were examined for histologic and cellular evidence of pulmonary inflammation. In addition, the amounts of amiodarone, the major metabolite of amiodarone N-desethylamiodarone (N-des), and phospholipid in the lungs were determined. We found that rats fed 175 mg/kg of amiodarone were essentially no different from control animals. The 175 mg/kg group had normal lung histologies, no change in lavage cell counts or differential counts, and very little amiodarone, N-des, or phospholipid in the lungs. In contrast, the three high-dose groups had abnormal lung histologies along with increases in lavage cell counts and change in differential counts. There were also significant increases in the amounts of amiodarone, N-des, and phospholipid in the lung. We conclude that the development of amiodarone-induced pulmonary inflammation is dose dependent, and that there is a direct correlation between the amount of amiodarone, N-des, and phospholipid in the lung with the development of inflammation. It therefore appears that the drug is directly toxic to lung tissue.

Myocardial amiodarone and desethylamiodarone concentrations in patients undergoing cardiac transplantation

Myocardial amiodarone and desethylamiodarone concentrations were measured at multiple sites in the explanted heart in four patients who underwent cardiac transplantation. Patients were taking amiodarone, 200 to 400 mg/day (mean 300 +/- 115), for 88 to 428 days (mean 229 +/- 148). The mean cumulative dose was 58 +/- 21.3 g. Plasma amiodarone concentration in three subjects was 204, 312 and 419 ng/ml and desethylamiodarone concentration was 268, 513 and 880 ng/ml, respectively. Significant interindividual variability in myocardial concentrations of amiodarone and desethylamiodarone was observed (p less than 0.05). Mean myocardial amiodarone concentration ranged from 4 +/- 1.0 to 29 +/- 17.2 micrograms/g (p less than 0.05); mean desethylamiodarone concentration ranged from 22 +/- 8.8 to 141 +/- 102.5 micrograms/g (p less than 0.05). At each site, save for fat, myocardial desethylamiodarone concentration was higher than amiodarone concentration. Greater intraindividual variability was observed in myocardial desethylamiodarone compared with amiodarone concentration particularly in septal and scar tissue (p = NS). No significant relation was found between myocardial concentration and duration of treatment. In patients with significant ventricular disease, usefulness of plasma amiodarone and desethylamiodarone concentration to estimate myocardial concentration is limited by intra- and interindividual variability.

Application of X-ray microanalysis to the study of drug uptake in cell culture

X-ray microanalysis has been used previously to study the accumulation of iodine in alveolar macrophages of rats treated with the iodinated drug, amiodarone. Due to metabolism of the drug in vivo, primarily to desethylamiodarone, it was not possible to identify the source of the iodine signal. In the present study we have utilized primary cell cultures of alveolar macrophages to study the intracellular accumulation of each of these drug species in vitro. Neither drug is metabolized by these cells in culture, permitting characterization of the accumulation of each independent of the other. Cells were incubated with equimolar concentrations of either amiodarone or desethylamiodarone for 42 hr, and X-ray microanalysis of freeze-dried cryosections of cells was used to quantify accumulation by monitoring the iodine signal associated with each drug. For both drug exposures, the highest iodine content was present in amorphous bodies and dense granules, consistent with the pattern following in vivo exposure. Higher levels of desethylamiodarone, compared to amiodarone, were measured in all compartments of the cells. The results of the in vitro investigation further demonstrate the utility of X-ray microanalysis in the study of the cellular response to amiodarone and desethylamiodarone.

A comparative analysis of the loss of amiodarone from small and large volume PVC and non-PVC infusion systems

The time-course of the adsorption of amiodarone hydrochloride onto flexible polyvinyl chloride (PVC) infusion bags and administration sets has been studied under ambient conditions similar to the intensive and coronary care units at the Repatriation General Hospital--Daw Park. When admixtures containing 900-1000 mg amiodarone hydrochloride in 500 ml PVC infusion bags containing glucose 5% were assayed, a minimal (2.7%) loss of amiodarone was detected at 24 hours compared with glass infusion bottles. There was no loss apparent when 100 ml PVC infusion bags were used compared with 100 ml glass bottles. When PVC administration sets were attached to 500 ml glass infusion bottles, maximal adsorption losses of up to 4.9% were observed in the effluent within one hour of the commencement of the simulated infusion. In Australia, the current recommendations by the distributor of amiodarone, Reckitt & Colman Pharmaceuticals, advise that the administration of amiodarone should be via glass infusion bottles or rigid PVC plastic containers without plasticisers together with non-PVC administration lines. These results do not support this recommendation.

Amiodarone and desethylamiodarone concentrations in plasma and tissues of surgically treated patients on long-term oral amiodarone treatment

The tissue disposition of amiodarone and its metabolite desethylamiodarone was studied in 12 surgical patients with various types of arrhythmias after chronic oral treatment with amiodarone. Amiodarone and desethylamiodarone concentrations in plasma and tissues were determined using a simple and sensitive high performance liquid chromatographic method. The mean plasma level of amiodarone and desethylamiodarone was found to increase from 0.55 microgram/ml to 1.40 microgram/ml and 0.68 microgram/ml to 1.80 microgram/ml for the respective components following the increase of the daily oral dose from 200 mg to 600 mg of amiodarone and indicates a linear relationship between plasma concentrations and dose. The mean levels of both drugs in different parts of the heart varied for amiodarone from 15 to 48 micrograms/g and for desethylamiodarone from 48 to 71 micrograms/g, with the highest values present in the epicardially resected ventricular myocardium. The mean cardiac tissue/plasma ratios ranged for amiodarone from 12 to 35 and for desethylamiodarone from 35 to 61 and show an extensive tissue uptake in the different parts of the heart for both drugs, with the metabolite accumulation 2 to 5 times higher than the parent compound. Relatively low levels, ranging for amiodarone from 2 to 15 micrograms/g and for desethylamiodarone from 5 to 25 micrograms/g, were observed in skeletal muscle, epidermis, skin and femoral artery. By far the largest content of the drugs was found in adipose tissue with mean concentrations of 207 +/- 98 micrograms/g and 82 +/- 43 g/g respectively for the parent compound and its metabolite, which suggests that fat constitutes the main depot of the drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Amiodarone-induced hepatitis: biological, histological diagnosis, development and role of associated factors. Review of the literature. Report of 2 cases]

Two cases of pseudo-alcoholic amiodarone-induced hepatitis are reported. The authors mention the different clinical forms of the disease and describe its clinical, biochemical and histological features. They stress the unpredictable and discordant character of its course and the influence of associated pathological factors. The role played by Ito's cells in the genesis of the liver fibrosis observed in amiodarone toxicity is discussed.

Determination of amiodarone hydrochloride in pharmaceutical formulations by derivative UV spectrophotometry and high-performance liquid chromatography (HPLC)

Assay procedures based on derivative ultraviolet spectrophotometry and high-performance liquid chromatography (HPLC) have been developed for the specific determination of amiodarone hydrochloride in pharmaceutical dosage forms. The use of first- and second-order derivative spectrophotometry was found to have suppressed the background absorption from the excipients with comparable accuracy and precision to the reversed-phased HPLC reference method. A conventional UV absorption method (lambda = 242 nm) is subject to possible interference by formulation excipients.

Structure and location of amiodarone in a membrane bilayer as determined by molecular mechanics and quantitative x-ray diffraction

Amiodarone is a drug used in the treatment of cardiac arrhythmias and is believed to have a persistent interaction with cellular membranes. This study sought to examine the structure and location of amiodarone in a membrane bilayer. Amiodarone has a high membrane partition coefficient on the order of 10(6). Small angle x-ray diffraction was used to determine the position of the iodine atoms of amiodarone in dipalmitoylphosphatidylcholine (DPPC) lipid bilayers under conditions of low temperature and hydration where the DPPC bilayer is in the gel state. The time-averaged position of the iodine atoms was determined to be approximately 6 A from the center (terminal methyl region) of the lipid bilayer. A dielectric constant of kappa = 2, which approximates that of the bilayer hydrocarbon core region, was used in calculating a minimum energy structure for membrane-bound amiodarone. This calculated structure when compared with the crystal structure of amiodarone demonstrated that amiodarone could assume a conformation in the bilayer significantly different from that in the crystal. The results reported here are an attempt to correlate the position of a membrane-active drug in a lipid bilayer with its time-averaged conformation. This type of analysis promises to be of great use in the design of drugs with greater potency and higher specificity.

Amiodarone-induced hepatic phospholipidosis: a morphological alteration independent of pseudoalcoholic liver disease

In order to study the relationship between amiodarone-induced hepatic phospholipidosis and liver disease, liver biopsies obtained from 13 patients treated with amiodarone for 4 months to 15 years were investigated by light and electron microscopy. Light microscopy showed pseudoalcoholic liver lesions that were probably related to amiodarone in four cases, various alterations (i.e. cirrhosis, three cases; steatosis and fibrosis, two cases; chronic venous congestion, one case; acute hepatitis, one case) that could be explained by another cause than amiodarone in seven cases and normal liver in two cases. In all cases, electron microscopy showed intralysosomal myelin figures suggestive of phospholipidosis. These myelin figures were associated with intralysosomal electron-dense deposits. In the four cases in which analysis by electron microprobe was performed, it demonstrated large amounts of iodine in the electron-dense deposit-containing lysosomes, indicating the accumulation of amiodarone. These results show that hepatic phospholipidosis is constantly observed in amiodarone-treated patients, whether or not pseudoalcoholic liver lesions are present. This phospholipidosis, which could be only a morphological marker of intrahepatic accumulation of the drug, should not therefore be considered grounds for attributing liver disease to the drug.

Amiodarone-induced hepatic phospholipidosis: correlation of morphological and biochemical findings in an animal model

Morphological and biochemical investigations were performed in guinea pigs after 1, 3, 5 and 16 weeks of amiodarone feeding. The most prominent morphological finding was an increase in dense bodies in hepatocytes, Kupffer cells and in bile duct epithelia, reaching a maximum after 5 weeks of treatment according to morphometric analysis. Similar time courses were observed for the serum and liver tissue concentrations of amiodarone and desethylamiodarone and the--albeit minimal--extent of hepatocellular necrosis. Phospholipids in the liver homogenate were unchanged after 1 week, but significantly increased after prolonged amiodarone treatment. There was no significant alteration in the pattern of individual phospholipids. Serum and tissue concentrations as well as the extent of phospholipidosis do not appear to be a function of the duration of drug application. A very close correlation, however, was observed between the liver tissue concentration of amiodarone and the amount of dense bodies as a morphological expression of phospholipidosis.

Amiodarone pulmonary toxicity: biochemical evidence for a cellular phospholipidosis in the bronchoalveolar lavage of human subjects

Amiodarone pulmonary toxicity represents an example of a life-threatening adverse drug reaction. Our study examined 10 subjects with amiodarone pulmonary toxicity by bronchoalveolar lavage (BAL) and determined that cells obtained by BAL demonstrated marked increases in various phospholipids compared to control subjects (n = 7). Bis monoacylglycerol phosphate and phosphatidylglycerol were significantly increased in both relative and absolute amounts (P less than .01). Several other phospholipids also were significantly increased in absolute amounts within the cell fraction. In contrast, the cell-free BAL fluid revealed only minor differences in phospholipid content. There was a strong direct correlation between concentration of amiodarone and its primary metabolite, desethylamiodarone in BAL cells (r = 0.98), and also a direct correlation between either the concentration of amiodarone or desethylamiodarone and the accumulation of phospholipids in the cells (r = 0.97, both determinations). This study indicates that findings from BAL in human subjects may provide specific and quantifiable evidence of pulmonary phospholipidosis, and suggests the concentration of the drug or its primary metabolite in BAL cells is a major determinant for the degree of phospholipid accumulation in the lung.

Association of seminal desethylamiodarone concentration and epididymitis with amiodarone treatment

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Sensitive method for the measurement of amiodarone and desethylamiodarone in serum and tissue and its application to disposition studies

A high-performance liquid chromatographic (HPLC) method for the measurement of amiodarone (AM) and its metabolite(s) in serum and tissues was developed. The method uses a 5-micron silica column, methanol containing 0.02% perchloric acid at pH 4 as the mobile phase, and ultraviolet detection at 240 nm. The standard curves for AM and desethylamiodarone (DAM) were linear for serum (range 0.025-6.0 microgram/ml) and tissues (range 0.1-0.5 micrograms for 10-25 mg wet weight). There was a significant decrease as a function of time in AM and DAM concentrations in patients' sera left at ambient temperature in the presence of light. This HPLC method was applied to studies on serum AM elimination kinetics in patients and on tissue uptake during chronic AM administration to rabbits. The elimination half-life (5.8 h) of AM after a 5 mg/kg intravenous dose to a patient was similar to that after acute oral doses. AM, being lipophilic, accumulated maximally in the fat tissue (56 micrograms/g wet weight), followed by lung and liver in rabbits injected with AM for six weeks. The latter two tissues also contained nearly equal quantities of DAM. The high concentrations of AM and DAM in the liver and lungs may be related to the hepatic toxicity and pulmonary fibrosis associated with chronic AM therapy. Two new metabolites were found in the lung and bile of AM-treated rabbits, but these have not yet been identified.

Stability of amiodarone hydrochloride in admixtures with other injectable drugs

The stability of amiodarone hydrochloride in intravenous admixtures was studied. Amiodarone hydrochloride 900 mg was mixed with 500 mL of either 5% dextrose injection or 0.9% sodium chloride injection in polyvinyl chloride or polyolefin containers; identical solutions were also mixed with either potassium chloride 20 meq, lidocaine hydrochloride 2000 mg, quinidine gluconate 500 mg, procainamide hydrochloride 2000 mg, verapamil hydrochloride 25 mg, or furosemide 100 mg. All admixtures were prepared in triplicate and stored for 24 hours at 24 degrees C. Amiodarone concentrations were determined using a stability-indicating high-performance liquid chromatographic assay immediately after admixture and at intervals during storage. Each solution was visually inspected and tested for pH. Amiodarone concentrations decreased less than 10% in all admixtures except those containing quinidine gluconate in polyvinyl chloride containers. The only visual incompatibility observed was in admixtures containing quinidine gluconate and 5% dextrose injection. In most solutions pH either decreased slightly or remained unchanged. Amiodarone hydrochloride is stable when mixed with either 5% dextrose injection or 0.9% sodium chloride injection in polyvinyl chloride or polyolefin containers alone or with potassium chloride, lidocaine, procainamide, verapamil, or furosemide and stored for 24 hours at 24 degrees C. Amiodarone should not be mixed with quinidine gluconate in polyvinyl chloride containers.

Sorption of amiodarone to polyvinyl chloride infusion bags and administration sets

The loss of amiodarone from i.v. admixtures to flexible polyvinyl chloride (PVC) infusion bags and i.v. administration sets was studied. Admixtures containing amiodarone hydrochloride 600 micrograms/mL and either 5% dextrose injection or 0.9% sodium chloride injection were stored at room temperature in glass bottles (both with and without contact of the drug solution with the rubber bottle closure), in flexible PVC bags, or in rigid PVC bottles. After 120 hours, the contents of each flexible PVC bag were emptied and replaced by methanol, which was allowed to remain in the bag for an additional 120 hours and was then analyzed for amiodarone content. To determine availability of amiodarone after infusion through a 1.8-m PVC i.v. administration set, solutions stored in glass containers were run through the set at 0.5 mL/min for 90 minutes. Samples of drug solutions were collected at appropriate intervals and analyzed by a stability-indicating high-performance liquid chromatography (HPLC) assay. Admixtures containing 0.9% sodium chloride injection were not stable; visual incompatibility was evident after 24 hours of storage in glass bottles, and no further testing was performed. In admixtures containing 5% dextrose injection that were stored in 50-mL flexible PVC bags, 60% of the initial amiodarone concentration remained after 120 hours; approximately half of the lost drug was recovered with the methanol. In effluent collected from the PVC administration set, 82% of the initial amiodarone concentration remained. Amiodarone concentrations did not decrease appreciably, after storage in glass or rigid PVC bottles, indicating that drug loss was probably affected by the plasticizer, di-2-ethylhexyl phthalate.(ABSTRACT TRUNCATED AT 250 WORDS)

Amiodarone and its desethyl metabolite: tissue distribution and morphologic changes during long-term therapy

The pharmacokinetic characteristics of amiodarone suggest extensive tissue deposition. We confirmed this by measuring tissue concentrations of the drug and of its major metabolite, desethylamiodarone, in human tissues. These were obtained at autopsy (n = 9), surgery (n = 7), or biopsy (n = 2) from 18 patients who had been treated with amiodarone for varying periods of time. High concentrations of amiodarone were found in fat (316 mg/kg wet weight in autopsy specimens, 344 mg/kg wet weight in biopsy specimens). Amiodarone and desethylamiodarone concentrations (mg/kg wet weight, autopsy samples) were also high in liver (391 and 2354), lung (198 and 952), adrenal gland (137 and 437), testis (89 and 470), and lymph node (83 and 316). We also found high concentrations of amiodarone (306 mg/kg wet weight) and desethylamiodarone (943 mg/kg wet weight) in abnormally pigmented ("blue") skin from patients with amiodarone-induced skin pigmentation. These values were 10-fold higher than those in unpigmented skin from the same patients. These high concentrations were associated with lysosomal inclusion bodies in dermal macrophages in the pigmented skin. The inclusion bodies were intrinsically electron dense and were shown to contain iodine by energy dispersive x-ray microanalysis. Lysosomal inclusion bodies shown by electron microscopy to be multilamellar were seen in other tissues. These tissues included terminal nerve fibers in pigmented skin, pulmonary macrophages, blood neutrophils, and hepatocytes and Kupffer cells. These characteristic ultrastructural findings occur in both genetic lipidoses and lipidoses induced by other drugs, e.g., perhexiline. We conclude that during therapy with amiodarone, widespread deposition of amiodarone and desethylamiodarone occurs. This leads to ultrastructural changes typical of a lipidosis. These changes are seen clearly in tissues associated with the unwanted effects of amiodarone, e.g., skin, liver and lung.

Amiodarone partitioning with phospholipid bilayers and erythrocyte membranes

The apparent partition coefficient (P) of amiodarone between aqueous buffer and lipid vesicles or erythrocyte ghosts was determined by equilibrium distribution using [125I]amiodarone as a tracer. The lipid vesicles consisted of total lipids extracted from erythrocyte or of egg phosphatidylcholine alone or mixed with a varying amount of stearic acid, phosphatidylethanolamine, sphingomyelin, phosphatidylserine, or cholesterol. All the conditions yielded a similar value of P (P approximately equal to 17,000). The log value of the partition coefficient of the neutral form of the drug is log PN = 5.95. The value of the extrapolated 1-octanol-buffer partition coefficient is log PN,oct = 6.66. Partition coefficient measurements on erythrocyte ghosts suggested that amiodarone partitioned to a similar extent in the protein and lipid content of the membrane.

Rapid liquid chromatographic assay for the determination of amiodarone and its N-deethyl metabolite in plasma, urine, and bile

A rapid high-performance liquid chromatographic assay was developed for the determination of amiodarone (1) and its N-deethyl metabolite (desethylamiodarone, 2) in plasma, urine, and bile. Analysis was performed on a C18 reversed-phase column and precolumn using a mobile phase consisting of methanol:water:58% ammonium hydroxide (94:4:2) delivered at a flow rate of 1.5 mL/min. The eluant was monitored at 244 nm. Under these conditions, 1, 2, and the internal standard eluted with retention times of 5.5, 4.6, and 6.8 min, respectively. Samples (100 microL) of plasma were prepared by precipitating the plasma proteins with acetonitrile containing the internal standard and injecting an aliquot of the supernatant directly onto the column. Samples (100 microL) of urine and bile were prepared for injection by acidifying the sample with concentrated HCl and then extracting the mixture with six volumes of 2,2-dimethoxyproprane. The recovery of 1 and 2 from plasma was virtually complete. The recovery from urine and bile was 80-90% for 1 and 60-65% for 2. The limit of sensitivity of both compounds in plasma was 100 ng/mL. For urine and bile, the detection limits were 1 and 5 micrograms/mL, respectively. Over the plasma concentration range of 0.1-10.0 micrograms/mL, the within-day CV ranged from 1 to 10% for 1 and from 1 to 8% for 2. The between-day CV ranged from 2 to 12% and from 1 to 17% for 1 and 2, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of amiodarone during pregnancy

Two cases are reported in which amiodarone was administered during pregnancy for longer periods than has been reported previously. Limited placental transfer of amiodarone and its desethyl metabolite was observed in both cases. A normal child resulted from each pregnancy despite, in one case, amiodarone therapy throughout the entire pregnancy. However, caution is urged in the use of amiodarone during pregnancy in view of the limited data available.

Thyrotoxicosis induced by amiodarone, a new efficient antiarrhythmic drug with high iodine content

Amiodarone is an antiarrhythmic agent with high iodine content. Ten patients treated with amiodarone developed thyrotoxicosis. I131 uptakes were negligible, and TT3 levels low in relation to TT4 levels, and sometimes even normal. Cessation of amiodarone caused thyroid functions to return to normal in one to five months, unrelated to propylthiouracil treatment. Eight of the patients had normal thyroid glands on radioscan or palpation. All patients tested had normal TRH tests. Thyrotoxicosis is a relatively common complication of amiodarone treatment, probably caused by its high iodine content. It is possible in apparently normal thyroid glands, suggesting failure of the homeostatic mechanisms controlling thyroid synthesis and release in these patients. Amiodarone is very efficient in controlling tachyarrhythmias and angina pectoris, situations in which thyrotoxicosis is dangerous. Thyroid function tests should therefore be drawn periodically, and the complication considered whenever tachyarrhythmias worsen on treatment with amiodarone.

Physicochemical and analytical characteristics of amiodarone

Data are reported on the analytical and physicochemical characteristics of amiodarone, for use in identifying and/or assaying this antiarrhythmic agent. The drug is highly soluble in chloroform and poorly soluble in water. Its acid-base constant (pKa) is 6.56, and its maximal lipid solubility range is from pH 3.5 to 5.5.

Screening for impurities in butoprozine

The purity analysis of butoprozine is described. Both gas chromatography-mass spectrometry (GC-MS) and high pressure liquid chromatography (HPLC) with UV-vis detection (conventional and multichannel) were used. In the butoprozine example disadvantages for both techniques became apparent: incorrect conclusions with regard to the purity of the drug would have been drawn if only one of these chromatographic techniques had been used. GC-MS allowed the identification of an impurity not found by HPLC.

High-performance liquid chromatographic measurement of amiodarone and desethylamiodarone in small tissue samples after enzymatic digestion

A method is described for the measurement of amiodarone and desethylamiodarone in small tissue samples. With the exception of fat, for which lipase is used, the tissues are digested with a proteolytic enzyme. After the addition of an internal standard the analytes are extracted from the homogeneous digest into an organic solvent and measured by high-performance liquid chromatography (HPLC) with UV detection at 240 nm. The method shows good reproducibility using tissue samples as small as 20 mg and suggests extensive accumulation of both compounds in some tissues, with particularly high concentrations in tissues associated with adverse effects of the drug.

Simultaneous determination of amiodarone and its major metabolite desethylamiodarone in plasma, urine and tissues by high-performance liquid chromatography

A simple and sensitive high-performance liquid chromatographic method for the simultaneous assay of amiodarone and desethylamiodarone in plasma, urine and tissues has been developed. The method for plasma samples and tissue samples after homogenizing with 50% ethanol, involves deproteinization with acetonitrile containing the internal standard followed by centrifugation and direct injection of the supernatant into the liquid chromatograph. The method for urine specimens includes extraction with a diisopropyl ether-acetonitrile (95:5, v/v) mixture at pH 7.0 using disposable Clin-Elut 1003 columns, followed by evaporation of the eluate, reconstitution of the residue in methanol-acetonitrile (1:2, v/v) mixture and injection into the chromatograph. Separation was obtained using a Radial-Pak C18 column operating in combination with a radial compression separation unit and a methanol-25% ammonia (99.3:0.7, v/v) mobile phase. A wavelength of 242 nm was used to monitor amiodarone, desethylamiodarone and the internal standard. The influence of the ammonia concentration in the mobile phase on the capacity factors of amiodarone, desethylamiodarone and two other potential metabolites, monoiodoamiodarone (L6355) and desiodoamiodarone (L3937) were investigated. Endogenous substances or a variety of drugs concomitantly used in amiodarone therapy did not interfere with the assay. The limit of sensitivity of the assay was 0.025 micrograms/ml with a precision of +/- 17%. The inter- and intra-day coefficient of variation for replicate analyses of spiked plasma samples was less than 6%. This method has been demonstrated to be suitable for pharmacokinetic and metabolism studies of amiodarone in man.