Flubromazolam: Detection in five post-mortem cases.

Flubromazolam is a potent triazole benzodiazepine with moderately long-lasting central nervous system-depressant effects relative to other benzodiazepines such as commonly prescribed diazepam. Flubromazolam has been studied in the living. However, there are no published reports including measured drug concentrations in post-mortem cases. We report five cases in which flubromazolam was detected in a systematic screen using high-resolution mass spectrometry and then quantified in femoral blood. In none of the five cases was the cause of death directly attributed to flubromazolam toxicity, as there was a variety of both sedative and stimulant drugs also present. However, it is important that the drug concentrations that were measured are made available for future post-mortem forensic interpretation.

A new restricted access molecularly imprinted fiber for direct solid phase microextraction of benzodiazepines from plasma samples.

Restricted access molecularly imprinted polymers (RAMIPs) are hybrid materials that present selective binding sites for a template (or similar molecules), and an external hydrophilic layer that avoids the binding of proteins to the material, making them appropriate for the sample preparation of protein fluids. RAMIPs have been used successfully in online and offline solid phase extractions, but there is no application as a fiber in solid phase microextraction (SPME), to the best of our knowledge. In this paper, molecularly imprinted fibers were synthesized inside glass capillary tubes (0.53 mm i.d.), using diazepam and methacrylic acid as template and functional monomer, respectively. The MIP fibers were coated with a cross-linked bovine serum albumin (BSA) layer, resulting in RAMIP fibers that were used in the SPME of benzodiazepines directly from biological fluids. The BSA layer acts as a protective barrier that avoids the binding of proteins from the sample by an electrostatic repulsion mechanism. The protein exclusion capacity of the RAMIP fiber was about 98%, which is selective to benzodiazepines in comparison with other drugs (citalopram and fluoxetine). The SPME was optimized and the extraction conditions were set as follows: 1000 µL of the sample diluted with water (1 : 0.5, v : v), no pH adjustment, an extraction time of 20 min at 500 rpm, and elution with 200 µL of acetonitrile for 5 min at 500 rpm. The fibers were used in the SPME of benzodiazepines directly from plasma samples, followed by HPLC-DAD analyses. The method was linear for bromazepam (50-750 µg L-1), clonazepam (15-250 µg L-1), alprazolam (15-350 µg L-1), nordiazepam (100-2100 µg L-1) and diazepam (100-2600 µg L-1), with correlation coefficients higher than 0.97. Relative standard deviations (precision) and relative errors (accuracy) ranged from 0.5 to 20.0%, and -15.6 to 21.6%, respectively.

A fast and simple approach for the quantification of 40 illicit drugs, medicines, and pesticides in blood and urine samples by UHPLC-MS/MS.

A fast and simple approach to overcome challenges in emergency toxicological analysis, using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) has been developed, for the detection of analytes in blood and urine samples from the following drug classes: analgesics, benzodiazepines, antidepressants, anticonvulsants, drugs of abuse, and pesticides. These substances are relevant in the context of emergency toxicology in Brazil. The sample preparation procedure was relatively easy and fast to perform. The method was fully validated giving limits of in the range of 0.5 and 20 ng mL-1 for blood and urine samples. The intraday and interday precision and accuracy were considered adequate for all analytes once the relative standard deviation (RSD) (%) was lower than 20% for quality control (QC) low and lower than 15% for CQ medium and high. The developed method was successfully applied to 320 real samples collected at the Poison Control Center of São Paulo, and 89.1% have shown to be positive for some of the analytes. This confirms its applicability and importance to emergency toxicological analysis, and it could be very useful in both fields of clinical and forensic toxicology.

The development and validation of a method for quantifying olanzapine in human plasma by liquid chromatography tandem mass spectrometry and its application in a pharmacokinetic study.

1. A rapid method using liquid chromatography tandem mass spectrometry for the quantification of olanzapine (OLZ) in human plasma was developed and validated. Venlafaxine was used as the internal standard (IS), and the samples were extracted from 400-µL human plasma with methyl tert-butyl ether for liquid-liquid extraction. 2. Chromatography was performed using an ACE C18, 125 × 4.6-mm i.d., 5-µm column. The mobile phase consisted of water with 0.1% formic acid for solvent A and acetonitrile with 0.1% formic acid for solvent B (50 : 50 v/v) in isocratic mode. The flow rate was 1.2 mL/min. The retention times for OLZ and the IS were 0.78 and 1.04 min, respectively. Tandem mass spectrometry operating in positive electrospray ionization mode with multiple reaction monitoring was used to detect OLZ and the IS (m/z: 313.1 > 256.1 and 278.1 > 260.2, respectively). 3. No significant matrix effects were observed on OLZ and the IS retention times, and the mean recovery of OLZ was 90.08%. The assay was linear in the concentration range of 1-20 ng/mL (R(2) = 0.9976). The intra- and inter-day precision were < 11.60% and the accuracy was < 1.66%. 4. This validated method was successfully applied to a pharmacokinetic study in which 10-mg OLZ tablets were administered to healthy volunteers and their plasma OLZ levels were monitored over time. The tests showed that the OLZ test and reference drug (Zyprexa(®)) were bioequivalent, as 90% of the confidence intervals were within the 80-125% interval proposed by regulatory agencies.

Body mass index increase, serum leptin, adiponectin, neuropeptide Y and lipid levels during treatment with olanzapine and haloperidol.

INTRODUCTION: Body mass index (BMI) increase is an undesired effect associated with antipsychotics, and crucial for patients' global health and treatment compliance. We aimed to investigate the relation between BMI during olanzapine or haloperidol treatments and leptin, neuropeptide Y (NPY), adiponectin and lipid serum levels. METHODS: In this 9-month, randomized and naturalist study, 34 male patients, 18 on olanzapine and 16 on haloperidol group were enrolled, all were under monotherapy. Patient outcome was evaluated with positive and negative syndrome scale (PANSS) at every 3-month period. In each visit, BMI, leptin, NPY, lipid, olanzapine or haloperidol levels were also monitored. RESULTS AND DISCUSSION: Leptin levels positively correlated with BMI in olanzapine (r=0.64, p<0.001) and haloperidol (r=0.73, p<0.001) groups; only in olanzapine patients, the former also correlated with PANSS score (r=0.54, p<0.05). NPY levels negatively correlated with olanzapine levels (r=− 0.65, p<0.01). Adiponectin levels had not significantly varied. CONCLUSION: Antipsychotics probably interfere on leptin and NPY signalling ways and disturb these hormones in eating behaviour control.

Quantitation of drugs via molecularly imprinted polymer solid phase extraction and electrospray ionization mass spectrometry: benzodiazepines in human plasma.

The association of solid phase extraction with molecularly imprinted polymers (MIP) and electrospray ionization mass spectrometry (ESI-MS) is applied to the direct extraction and quantitation of benzodiazepines in human plasma. The target analytes are sequestered by MIP and directly analyzed by ESI-MS. Due to the MIP highly selective extraction, ionic suppression during ESI is minimized; hence no separation is necessary prior to ESI-MS, which greatly increases analytical speed. Benzodiazepines (medazepam, nitrazepam, diazepam, chlordiazepoxide, clonazepam and midazolam) in human plasma were chosen as a proof-of-principle case of drug analyses by MIP-ESI-MS in a complex matrix. MIP-ESI-MS displayed good figures of merits for medazepam, nitrazepam, diazepam, chlordiazepoxide and midazolam, with analytical calibration curves ranging from 10 to 250 µg L(-1) (r > 0.98) with limit of quantification <10 µg L(-1) and acceptable within-day and between-day precision and accuracy.

Quantification of chlordesmethyldiazepam by liquid chromatography-tandem mass spectrometry: application to a cloxazolam bioequivalence study.

A rapid, sensitive and specific LC-MS/MS method was developed and validated for quantifying chlordesmethyldiazepam (CDDZ or delorazepam), the active metabolite of cloxazolam, in human plasma. In the analytical assay, bromazepam (internal standard) and CDDZ were extracted using a liquid-liquid extraction (diethyl-ether/hexane, 80/20, v/v) procedure. The LC-MS/MS method on a RP-C18 column had an overall run time of 5.0 min and was linear (1/x weighted) over the range 0.5-50 ng/mL (R > 0.999). The between-run precision was 8.0% (1.5 ng/mL), 7.6% (9 ng/mL), 7.4% (40 ng/mL), and 10.9% at the low limit of quantification-LLOQ (0.500 ng/mL). The between-run accuracies were 0.1, -1.5, -2.7 and 8.7% for the above mentioned concentrations, respectively. All current bioanalytical method validation requirements (FDA and ANVISA) were achieved and it was applied to the bioequivalence study (Cloxazolam -- test, Eurofarma Lab. Ltda and Olcadil -- reference, Novartis Biociências S/A). The relative bioavailability between both formulations was assessed by calculating individual test/reference ratios for Cmax, AUClast and AUC0-inf. The pharmacokinetic profiles indicated bioequivalence since all ratios were as proposed by FDA and ANVISA.

Simultaneous determination of multibenzodiazepines by HPLC/UV: investigation of liquid-liquid and solid-phase extractions in human plasma.

A method for simultaneous determination of seven benzodiazepines (BZPs) (flunitrazepam, clonazepam, oxazepam, lorazepam, chlordiazepoxide, nordiazepam and diazepam using N-desalkylflurazepam as internal standard) in human plasma using liquid-liquid and solid-phase extractions followed by high-performance liquid chromatography (HPLC) is described. The analytes were separated employing a LC-18 DB column (250 mm x 4.6 mm, 5 microm) at 35 degrees C under isocratic conditions using 5mM KH(2)PO(4) buffer solution pH 6.0:methanol:diethyl ether (55:40:5, v/v/v) as mobile phase at a flow rate of 0.8 mL min(-1). UV detection was carried out at 245 nm. Employing LLE, the best conditions were achieved with double extraction of 0.5 mL plasma using ethyl acetate and Na(2)HPO(4) pH 9.5 for pH adjusting. Employing SPE, the best conditions were achieved with 0.5 mL plasma plus 3 mL 0.1M borate buffer pH 9.5, which were then passed through a C18 cartridge previously conditioned, washed for 3 times with these solvents: 3 mL 0.1M borate buffer pH 9.5, 4 mL Milli-Q water and 1 mL acetonitrile 5%, finally the BZPs elution was carried with diethyl ether:n-hexane:methanol (50:30:20). In both methods the solvent was evaporated at 40 degrees C under nitrogen flow. The validation parameters obtained in LLE were linearity range of 50-1200 ng mL(-1) plasma (r>or=0.9927), limits of quantification of 50 ng mL(-1) plasma, within-day and between-day CV% and E% for precision and accuracy lower than 15%, and recovery above 65% for all BZPs. In SPE, the parameter obtained were linearity range of 30-1200 ng mL(-1) plasma (r>or=0.9900), limits of quantification of 30 ng mL(-1) plasma, within-day and between-day CV% and E% for precision and accuracy lower than 15% and recovery above 55% for all BZPs. These extracting procedures followed by HPLC analysis showed their suitable applicability in order to examine one or more BZPs in human plasma. Moreover, it could be suggested that these procedures might be employed in various analytical applications, in special for toxicological/forensic analysis.

Naturally occurring benzodiazepines in human milk.

The presence of benzodiazepine-like molecules was detected radioimmunologically in the plasma and milk of 12 women and in the plasma of 9 men. All subjects were non-users of benzodiazepines. The concentration of these biological materials expressed as diazepam equivalents per mL amounted to 2.54 +/- 0.74 ng in male plasma; to 2.20 +/- 0.35 ng in female plasma and to 1.91 +/- 0.54 ng in milk. Further investigation of the active compounds in milk permitted the unequivocal identification of diazepam, both free and bound to a presumably protein carrier and, at least, three more benzodiazepine-like molecules. Their origin either from dietary sources or as a result of endogenous biosynthesis is still unclear.

Un nuevo método radiorreceptor para la cuantificación de benzodiazepinas en fluidos biológicos / A new radioreceptor method for the quantification of benzodiazepines in biological fluids

Se desarrolló un método radiorreceptor, relativamente rápido y de bajo costo, para determinar concentraciones de benzodiazepinas en fluidos biológicos. El método se basa en el hecho que la cantidad de [3H]-flunitrazepam incorporada específicamente, por fotomarcado, en receptores de membranas sinaptosomales, está relacionada cuantitativamente con la cantidad de benzodiazepina no radiactiva presente en el medio de incubación. Después del fotomarcado, las membranas fueron tratadas con ácido tricloroacético, y el sedimento obtenido fue lavado con acetona para eliminar el [3H]-flunitrazepam remanente, no unido. La preparación de receptor, constituida por membranas liofilizadas obtenidas a partir de corteza de cerebro bovino, fue estable durante seis meses por lo menos. El análisis estadístico de los gráficos logit-log de las curvas de desplazamiento con varias benzodiazepinas, mostró los siguientes valores de IC50: clonazepam, 1,6 nM; flunitrazepam, 3,8 nM; nitrazepam, 15,3 nM; diazepam, 43,2 nM; y clorodiazepóxido, 7,4 micronM, valores que se correlacionaron significativamente con los correspondientes valores determinados por otro método. Los valores de concentración correspondientes a benzodiazepinas no identificadas, extraídas de sangre, fueron expresados en equivalentes de diazepam. La sensibilidad para diazepam fue 3,3 nM, y los niveles de dosis entre 15 y 138 nM, mostraron valores de coeficiente de variación intra e inter ensayo, variando desde 3,4 a 12,2%, y desde 13 a 30,7%, respectivamente

Un nuevo método radiorreceptor para la cuantificación de benzodiazepinas en fluidos biológicos / A new radioreceptor method for the quantification of benzodiazepines in biological fluids

Se desarrolló un método radiorreceptor, relativamente rápido y de bajo costo, para determinar concentraciones de benzodiazepinas en fluidos biológicos. El método se basa en el hecho que la cantidad de [3H]-flunitrazepam incorporada específicamente, por fotomarcado, en receptores de membranas sinaptosomales, está relacionada cuantitativamente con la cantidad de benzodiazepina no radiactiva presente en el medio de incubación. Después del fotomarcado, las membranas fueron tratadas con ácido tricloroacético, y el sedimento obtenido fue lavado con acetona para eliminar el [3H]-flunitrazepam remanente, no unido. La preparación de receptor, constituida por membranas liofilizadas obtenidas a partir de corteza de cerebro bovino, fue estable durante seis meses por lo menos. El análisis estadístico de los gráficos logit-log de las curvas de desplazamiento con varias benzodiazepinas, mostró los siguientes valores de IC50: clonazepam, 1,6 nM; flunitrazepam, 3,8 nM; nitrazepam, 15,3 nM; diazepam, 43,2 nM; y clorodiazepóxido, 7,4 micronM, valores que se correlacionaron significativamente con los correspondientes valores determinados por otro método. Los valores de concentración correspondientes a benzodiazepinas no identificadas, extraídas de sangre, fueron expresados en equivalentes de diazepam. La sensibilidad para diazepam fue 3,3 nM, y los niveles de dosis entre 15 y 138 nM, mostraron valores de coeficiente de variación intra e inter ensayo, variando desde 3,4 a 12,2%, y desde 13 a 30,7%, respectivamente (AU)

Benzodiazepinas: efeito clínico, correlacionado ao nível plasmatico (Cp) / Benzodiazepines: clinical effect, related to plasma level

A correlaçäo entre os níveis plasmáticos de BZ e seus diversos efeitos é elucidada com ênfase no metabolismo, farmacocinética, fenômeno dos receptores, validade dos métodos de análise utilizados e parâmetros para eficácia. Acredita-se que: 1) a farmacocinética da BZ e seus metabólitos ativos; 2) as características do receptor de BZ1 e BZ2; 3) a integraçäo entre as vias neuronais GABA-érgica, alfa - e ß - adrenérgica e 5-HT-érgica; 4) a regulaçäo superior ou inferior dos receptores de BZ; e 5) o tempo de ocupaçäo do receptor, todos contribuem para um modelo täo complexo que a previsäo absoluta dos efeitos de relaxamento muscular, anticonvulsivo, hipnótico, sedativo e ansiolítico ou da funçäo psicomotora comprometida dos níveis plasmáticos de BZ se torna muito difícil