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R Brent Dixon, Amitava Dasgupta
BACKGROUND: We evaluated the analytical performance of the DRI hydrocodone/hydromorphone assay by comparing semi-quantitative values obtained by this assay with values obtained by a liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) method. We also evaluated the possibility of lowering the cutoff of the DRI assay from 300 to 100 ng/mL. MATERIALS AND METHODS: We compared semi-quantitative values obtained by the DRI assay in 97 specimens with values obtained by using the LC-MS/MS method including 10 specimens containing hydrocodone and/ or hydromorphone concentrations between 105...
October 19, 2016: Therapeutic Drug Monitoring
Bruno H Pypendop, Yael Shilo-Benjamini, Jan E Ilkiw
OBJECTIVE: To determine the effects of morphine, methadone, hydromorphone or oxymorphone on the thermal threshold in cats, following buccal and intravenous (IV) administration. STUDY DESIGN: Randomized crossover study. ANIMALS: Six healthy adult female ovariohysterectomized cats weighing 4.5 ± 0.4 kg. METHODS: Morphine sulfate (0.2 mg kg(-1) IV or 0.5 mg kg(-1) buccal), methadone hydrochloride (0.3 mg kg(-1) IV or 0...
November 2016: Veterinary Anaesthesia and Analgesia
Pongkwan Sitasuwan, Cathleen Melendez, Margarita Marinova, Kaylee R Mastrianni, Alicia Darragh, Emily Ryan, L Andrew Lee
Drug monitoring laboratories utilize a hydrolysis process to liberate the opiates from their glucuronide conjugates to facilitate their detection by tandem mass spectrometry (MS). Both acid and enzyme hydrolysis have been reported as viable methods, with the former as a more effective process for recovering codeine-6-glucuronide and morphine-6-glucuronide. Here, we report concerns with acid-catalyzed hydrolysis of opioids, including a significant loss of analytes and conversions of oxycodone to oxymorphone, hydrocodone to hydromorphone and codeine to morphine...
October 2016: Journal of Analytical Toxicology
Stéphanie Romand, Dany Spaggiari, Niloufar Marsousi, Caroline Samer, Jules Desmeules, Youssef Daali, Serge Rudaz
The hepatic metabolism of oxycodone by cytochromes P450 (CYP) and the UDP-glucuronosyltransferases (UGT), the main metabolic enzymes of phase I and phase II, respectively, was assessed in vitro. The N-demethylation by CYP3A4/5 and the O-demethylation by CYP2D6 in human liver microsomes (HLM) followed Michaelis-Menten kinetics, with intrinsic clearances of 1.46μL/min/mg and 0.35μL/min/mg, respectively. Although noroxycodone and oxymorphone mainly contribute to the elimination of oxycodone, the simulated total in vivo clearance using in vitro phase I metabolism was underestimated...
September 26, 2016: Journal of Pharmaceutical and Biomedical Analysis
Boaz Gedaliahu Samolsky Dekel, Gabriele Donati, Alessio Vasarri, Anna Laura Croci Chiocchini, Alberto Gori, Giuseppe Cavallari, Gianfranco Di Nino, Laura Mercolini, Michele Protti, Roberto Mandrioli, Rita Maria Melotti, Gaetano La Manna
OBJECTIVES: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. METHODS: We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone...
September 2, 2016: Pain Practice: the Official Journal of World Institute of Pain
Pao-Pao Yang, Geng-Chang Yeh, Teng-Kuang Yeh, Jinghua Xi, Horace H Loh, Ping-Yee Law, Pao-Luh Tao
Oxycodone has been used clinically for over 90 years. While it is known that it exhibits low affinity for the multiple opioid receptors, whether its pharmacological activities are due to oxycodone activation of the opioid receptor type or due to its active metabolite (oxymorphone) that exhibits high affinity for the mu-opioid receptors remains unresolved. Ross and Smith (1997) reported the antinociceptive effects of oxycodone (171nmol, i.c.v.) are induced by putative kappa-opioid receptors in SD rat while others have reported oxycodone activities are due to activation of mu- and/or delta-opioid receptors...
September 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Melissa Nataatmadja, Dakshinamurthy Divi
Thrombotic microangiopathy (TMA) associated with injecting sustained-release oxymorphone, an opioid intended for oral use, has previously been reported. We report a case of TMA secondary to intravenous use of sustained-release oxycodone, and the first case to demonstrate relapsing disease due to persistent intravenous opioid use. In cases such as these, TMA is suspected to be due to a polyethylene oxide (PEO) coating found on these drugs, and the disease is likely due to a directly toxic effect of PEO to endothelial cells...
August 2016: Clinical Kidney Journal
Philip J Peters, Pamela Pontones, Karen W Hoover, Monita R Patel, Romeo R Galang, Jessica Shields, Sara J Blosser, Michael W Spiller, Brittany Combs, William M Switzer, Caitlin Conrad, Jessica Gentry, Yury Khudyakov, Dorothy Waterhouse, S Michele Owen, Erika Chapman, Jeremy C Roseberry, Veronica McCants, Paul J Weidle, Dita Broz, Taraz Samandari, Jonathan Mermin, Jennifer Walthall, John T Brooks, Joan M Duwve
BACKGROUND: In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. METHODS: We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner...
July 21, 2016: New England Journal of Medicine
Anne Z DePriest, Rebecca Heltsley, David L Black, John M Mitchell, Charles LoDico, Ronald Flegel, Edward J Cone
Oxymorphone (OM), a prescription opioid and metabolite of oxycodone, was included in the recently published proposed revisions to the Mandatory Guidelines for Federal Workplace Drug Testing Programs. To facilitate toxicological interpretation, this study characterized the time course of OM and its metabolite, noroxymorphone (NOM), in hydrolyzed and non-hydrolyzed urine specimens. Twelve healthy subjects were administered a single 10 mg controlled-release OM dose, followed by a periodic collection of pooled urine specimens for 54 h following administration...
July 11, 2016: Journal of Analytical Toxicology
Eric T Shimomura, Alice J Briones, Wendy S Warren, Joseph W Addison, Jessica L Knittel, Sarah A Shoemaker, Taj D King, Thomas Z Bosy
It is reasonable to expect the presence of multiple drugs to present a complicated picture of toxicity. We report a fatal case involving a young man who purchased illicit drugs and knowingly consumed them. After consuming these drugs and going to sleep in his friend's car, he was found unresponsive the next morning with no signs of physical violence. Drugs found in the peripheral blood at autopsy were oxymorphone, methylone and ethanol at concentrations of 0.106, 0.50 and 130 mg/dL, respectively. The levels of oxymorphone and methylone in peripheral blood were comparable to those observed in other reported fatalities...
September 2016: Journal of Analytical Toxicology
Sabrin Fuad Salmin, Marie-Chantal Giroux, Pascal Vachon, Francis Beaudry
Codeine and oxycodone are opioids used to alleviate pain. The outcome of the treatment is ultimately related to their metabolism by Cytochromes P450 (CYPs). Depending on the drugs used, alterations in the metabolism of drugs by CYPs can lead to severe consequences including alterations in their efficacy, safety and toxicity. The objectives of this study were to develop a novel HPLC-MS/MS method capable of quantifying codeine and oxycodone along with specific metabolites using an isotopic dilution strategy and study the rate of formation of morphine (CYP2D), norcodeine (CYP3A), oxymorphone (CYP2D) and noroxycodone (CYP3A)...
July 7, 2016: Biomedical Chromatography: BMC
Mark J Elzey, Sarah M Barden, Eric S Edwards
BACKGROUND: Opioid overdose continues to be a significant and growing cause of preventable mortality and morbidity. Studies suggest that unintentional, non-fatal overdose from prescription opioid analgesics constitutes a large portion of total overdose events. The societal burden associated with these events is a frequently overlooked public health concern. OBJECTIVES: To evaluate unintentional, non-fatal prescription opioid overdoses, including the identification of risk factors, societal burden, and knowledge gaps where further study is warranted...
May 2016: Pain Physician
Theodore J Cicero, Matthew S Ellis, Zachary A Kasper
The introduction of extended-release opioid analgesics helped initiate an epidemic of prescription opioid abuse in the United States. To make access to the drug by crushing or dissolution more difficult, abuse-deterrent formulations (ADFs) of OxyContin (Purdue Pharma, Stamford, CT) and Opana ER (Endo Pharmaceuticals Inc., Malvern, PA), which use the same foundation technology (Intac, Grunenthal, Aachen, Germany), were introduced in 2010 and 2012, respectively. To examine their relative effectiveness, we used a structured survey of 12,124 individuals entering treatment for opioid use disorder followed by a more focused online survey with a subset of these patients (N = 129) using both structured and open-ended questions...
June 2016: Pain
Waseem Gul, Brandon Stamper, Murrell Godfrey, Shahbaz W Gul, Mahmoud A ElSohly
Continuing our previous studies analyzing drugs of abuse in municipal wastewater, a method was developed for the analysis of opiates in wastewater samples using liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS). Eight opiate drugs and metabolites were analyzed including codeine, hydrocodone, hydromorphone, 6-monoacetylmorphine (6-MAM, the primary urinary metabolite of heroin), morphine, norhydrocodone (the primary urinary metabolite of hydrocodone), oxycodone and oxymorphone. These drugs were chosen because of their widespread abuse...
June 2016: Journal of Analytical Toxicology
Johan Viaene, Katrien Lanckmans, Bieke Dejaegher, Debby Mangelings, Yvan Vander Heyden
The aim of this work is to study whether a quadrupole time-of-flight (QToF) mass analyzer, coupled to an ultra high performance liquid chromatography (UHPLC) system, can be a valuable alternative for a triple-quadrupole (QqQ) mass analyzer, for quantitative toxicological purposes. The case study considered was the quantification of 16 opioids (6-monoacetylmorphine, buprenorphine, codeine, dihydrocodeine, ethylmorphine, fentanyl, hydrocodone, hydromorphone, morphine, norbuprenorphine, norcodeine, norfentanyl, oxycodone, oxymorphone, pholcodine and tilidine) in human plasma...
August 5, 2016: Journal of Pharmaceutical and Biomedical Analysis
Fleur Gaudette, Andréa Sirhan-Daneau, Maude St-Onge, Jacques Turgeon, Veronique Michaud
Oxycodone is an opioid agonist largely prescribed for the treatment of moderate to severe pain. Variability in analgesic efficacy could be explained by inter-subject variations in plasma levels of parent drug and its active metabolite, oxymorphone. For this purpose it is necessary to develop and validate a sensitive and selective analytical method for the quantification of oxycodone and its major metabolites, noroxycodone and oxymorphone, in human plasma. The analytical method consisted of a liquid-liquid extraction procedure followed by a high performance liquid chromatography with heated assisted electrospray ionization mass spectrometry (HPLC-HESI-MS/MS)...
January 1, 2016: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Frank Kunkel, Elizabeth Fey, Damon Borg, Richard Stripp, Christine Getto
Drug testing is an important clinical tool that is available to physicians who are assessing the effectiveness of drug treatment as well as patient compliance to the administered program. While urine has traditionally been the matrix of choice for drug monitoring, oral fluid, a filtrate of the blood, has shown great promise as an alternative matrix for such applications. Oral fluid collection can be accomplished without the need for highly trained medical staff through the use of a simple, noninvasive oral fluid collection device, which obtains an adequate sample in only a few minutes...
September 2015: Journal of Opioid Management
Cynthia M Magro, Aixa Toledo-Garcia, Ozlem Pala, Shabnam Momtahen, Lee Shapiro
BACKGROUND: In 2012, a nephrologist reported the development of a multiorgan thrombotic syndromic complex resembling thrombotic thrombocytopenic purpura (TTP) in patients who were abusing long acting oxymorphone hydrochloride; all patients had hemolytic anemia and thrombocytopenia. OBJECTIVE: Herein, we report another case involving a 31-year-old woman who self intravenously administered dissolved oral oxymorphone resulting in thrombotic sequelae resembling Degos disease...
September 2015: Dermatology Online Journal
Jeffrey R Enders, Gregory L McIntire
Opioid testing represents a dominant share of the market in pain management clinical testing facilities. Testing of this drug class in oral fluid (OF) has begun to rise in popularity. OF analysis has traditionally required extensive clean-up protocols and sample concentration, which can be avoided. This work highlights the use of a fast, 'dilute-and-shoot' method that performs no considerable sample manipulation. A quantitative method for the determination of eight common opioids and associated metabolites (codeine, morphine, hydrocodone, hydromorphone, norhydrocodone, oxycodone, noroxycodone and oxymorphone) in OF is described herein...
October 2015: Journal of Analytical Toxicology
Irene Shu, Joseph Jones, Mary Jones, Douglas Lewis, Adam Negrusz
Nails (fingernails and toenails) are made of keratin. As the nail grows, substances incorporate into the keratin fibers where they can be detected 3-6 months after use. Samples are collected by clipping of 2-3 mm of nail from all fingers (100 mg). We present drug testing results from 10,349 nail samples collected from high-risk cases during a 3-year period of time. Samples were analyzed by validated analytical methods. The initial testing was performed mostly using enzyme-linked immunosorbent assay, but by liquid chromatography-tandem mass spectrometry (LC-MS-MS) as well...
October 2015: Journal of Analytical Toxicology
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