Trimeprazine is enantioselectively degraded by an activated sludge in ready biodegradability test conditions.

A great number of available pharmaceuticals are chiral compounds. Although they are usually manufactured as racemic mixtures, they can be enantioselectively biodegraded as a result of microbial processes. In this paper, a biodegradability assay in similar conditions to those recommended in OECD tests of enantiomers of trimeprazine (a phenothiazine employed as a racemate) is carried out. Experiments were performed in batch mode using a minimal salts medium inoculated with an activated sludge (collected from a Valencian Waste Water Treatment Plant, WWTP) and supplemented with the racemate. The concentration of the enantiomers of trimeprazine were monitored by means of a chiral HPLC method using a cellulose-based chiral stationary phase and 0.5 M NaClO4/acetonitrile (60:40, v/v) mobile phases. Experiments were performed at three concentration levels of the racemate. In parallel, the optical density at 600 nm (OD600) was measured to control the biomass growth and to connect it with enantioselectivity. The calculated enantiomeric fractions (EF) offer the first evidence of enantioselective biodegradation of trimeprazine. A simplified Monod equation was used as a curve fitting approach for concentration (S), biodegradation (BD), and for the first time, EF experimental data in order to expand the usefulness of the results. Precision studies on S (repeatability conditions) and, for the first time, EF (intermediate precision conditions) were also performed.

Alimemazine poisoning as evidence of Munchausen syndrome by proxy: A pediatric case report.

Munchausen syndrome by proxy (MSBP), also known as fabricated or induced illness in a child by a caretaker, is a form of abuse where a caregiver deliberately produces or feigns illness in a person under his or her care, so that the proxy will receive medical care that gratifies the caregiver. The affected children are often hospitalized for long periods and endure repetitive, painful and expensive diagnostic attempts. We present an analytically confirmed case of MSBP by alimemazine. A 3-year-old boy was brought repetitively to a Pediatric Emergency Department by his mother because he presented limb tremors, dysarthria, obnubilation, and ataxia and generalized tonic-clonic seizures coinciding with intermittent fever. Neither the rest of the physical examination nor the complementary tests showed any significant alterations. MSBP was suspected and a routine systematic toxicological analysis in urine and blood was requested. Alimemazine was detected in all biological samples. The administration of this drug was never mentioned by the mother and the subsequent interview with her corroborated the suspicion of MSBP. Clinically, after separation from the mother, the child's neurological symptoms gradually improved until the complete disappearance of the cerebellar symptoms. Alimemazine was quantified in serum, urine, gastric content and cerebrospinal fluid samples by gas chromatography-mass spectrometry (maximum serum level was 0.42µg/ml). Hair quantification of alimemazine was performed by ultra-performance liquid chromatography-tandem mass spectrometry in different segments of hair. The results confirmed regular substance use during the at least eight last months (8.8, 14.7, 19.7 and 4.6ng/mg hair starting from most proximal segment). This patient represents the first case published with analytical data of alimemazine in blood, urine, gastric content, cerebrospinal fluid and hair, which allowed us to prove an acute and repetitive poisoning with alimemazine as evidence of MSBP.

Factors affecting efficacy of oral trimeprazine sedation for dental procedures in children: A retrospective study.

OBJECTIVE: To investigate the influence of factors such as age, gender and pre-operative behavior rating on the outcome of sedation using oral trimeprazine during dental treatment of children. METHOD: Records of children who received dental treatment under sedation with oral trimeprazine between 2000 and 2007 were reviewed and the following data were obtained: age and weight of patient at the time of treatment, gender, behavior classification prior to sedation, dose of medication used, efficacy of sedation and treatment accomplished. Descriptive statistics, cross-tabulations and χ (2) analysis were done. RESULT: Forty-eight sedation sessions met the inclusive criteria for children whose mean age was 4.92 (SD 1.65, range 3.0-8.0) years and mean weight was 18.23 (SD 4.82, range: 12.0-31.0) kg. Overall, 54.2% (26/48) of the sedations were rated successful, 20.8% (10/48) were partially successful and 25.0% (12/48) not successful. Younger children 3-5 years, and those with only negative pre-operative behavior rating had more successful sedation sessions than older, 6-8 years or children with definitely negative pre-operative behavior rating (X (2) = 8.165, p = .017) and (X (2) = 17.258, p = .001), respectively. CONCLUSION: Variables such as patient's age and pre-operative behavior but not gender and type of treatment could predict outcome of dental sedation using trimeprazine in children.