Evaluating the reliability of hair analysis in monitoring the compliance of ADHD patients under treatment with Lisdexamphetamine

Considering the high clinical and forensic relevance of pharmaco-adherence during lisdexamphetamine (LDX) treatment for attention-deficit/hyperactivity disorder (ADHD), the aim here was to evaluate hair analysis as a tool for monitoring compliance in patients currently undergoing long term treatment with LDX, by detecting possible interruptions of medication intake or changes in dosage. For this purpose, a total of 24 patients from an outpatient clinic for ADHD were recruited. Hair and urine samples were taken after three consecutive therapy sessions over a 7-month period and analyzed for amphetamine (AMP) enantiomers and other drugs, using chiral and achiral liquid chromatography-tandem mass spectrometry (LC-MS/MS). Participants also provided information on the condition of their hair, the consumption of illegal psychotropic substances and the regularity of taking LDX. Two participants withdrew from the study early. Urine analyses were positive for D-AMP in all urine samples and therapy sessions, except in two patients who did not take LDX on a daily basis. D-AMP was detected in all hair samples; however, no correlation was found between prescribed dose/day and D-AMP concentrations in proximal hair segments. Qualitative interpretation of hair analysis showed that 18 of the 22 study completers were compliant concerning the intake of LDX without additional consumption of illegal D,L-AMP. Analysis of urine taken during the therapy sessions showed no correlation between D-AMP concentrations and prescribed dosage, with or without normalization for creatinine. In conclusion, chiral LC-MS/MS hair analysis might represent a non-invasive way to confirm LDX use within the approximate period covered by the hair segment tested, but it does not allow for quantitative therapeutic drug monitoring because of interindividual variability of concentrations in hair. Drug concentrations in hair at different stages of long-term treatment should thus be interpreted with caution by clinicians and forensic experts alike when making assessments of treatment adherence.

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Successful and safe long‐term treatment of cerebral aspergillosis with high‐dose voriconazole guided by therapeutic drug monitoring

British Journal of Clinical Pharmacology ◽

10.1111/bcp.13789 ◽

2018 ◽

Vol 85 (1) ◽

pp. 266-269 ◽

Cited By ~ 2

Author(s):

Pier Giorgio Cojutti ◽

Maria Merelli ◽

Lorenzo Allegri ◽

Giuseppe Damante ◽

Matteo Bassetti ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Term Treatment ◽

Therapeutic Drug ◽

High Dose ◽

Long Term Treatment

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Analysis of Aflatoxin Biomarkers in the Hair of Experimental Animals

Toxins ◽

10.3390/toxins13080570 ◽

2021 ◽

Vol 13 (8) ◽

pp. 570

Author(s):

Innocent Mupunga ◽

Ilse Janse van Rensburg ◽

Nokuthula Luthuli ◽

Ovokeroye A. Abafe ◽

Leshweni J. Shai ◽

...

Keyword(s):

Guinea Pigs ◽

Hair Analysis ◽

Historical Record ◽

Body Fluids ◽

Urine Samples ◽

Long Term Effects ◽

Experimental Animals ◽

Explorative Study ◽

Hair Samples

Analysis of body fluids and tissues of aflatoxin exposed individuals for the presence of aflatoxins and aflatoxin metabolites has emerged as a reliable indicator of exposure and metabolism of aflatoxins. However, current aflatoxin biomarkers are not appropriate for investigating the long-term effects of aflatoxin exposure. In this explorative study, we investigated the analysis of hair as a complementary or alternative matrix for the assessment of biomarkers of long-term aflatoxin exposure. Three groups of guinea pigs were orally dosed with 5 ugkg−1bw−1, 50 ugkg−1bw−1, and 100 ugkg−1bw−1 of AFB1. Urine and hair samples were collected on days 0, 1, 2, 3, 7, 30, 60, and 90 and analysed for AFB1 and AFM1 using UHPLC-MS/MS. AFB1 and AFM1 were detected in 75% and 13.6%, respectively, of the day 1 to day 7 urine samples. AFB1 was detected in hair samples collected from day 3 up to day 60. This is the first report to confirm the deposition of AFB1 in the hair of experimental animals. These findings indicate that hair analysis has the potential to provide an accurate long-term historical record of aflatoxin exposure with potentially important implications for the field of aflatoxin biomarkers.

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Proactive therapeutic drug monitoring (TDM) may be helpful in managing long-term treatment with linezolid safely: findings from a monocentric, prospective, open-label, interventional study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz374 ◽

2019 ◽

Vol 74 (12) ◽

pp. 3588-3595 ◽

Cited By ~ 2

Author(s):

Pier Giorgio Cojutti ◽

Maria Merelli ◽

Matteo Bassetti ◽

Federico Pea

Keyword(s):

Trough Level ◽

Term Treatment ◽

Therapeutic Drug ◽

Interventional Study ◽

Open Label ◽

Long Term Treatment ◽

Group A ◽

Linezolid Therapy ◽

Dose Dependent

Abstract Background Thrombocytopenia may be a dose-dependent adverse effect of linezolid therapy. Objectives To assess whether proactive therapeutic drug monitoring (TDM) could be helpful in preventing and/or in recovering from the occurrence of linezolid-induced thrombocytopenia during long-term treatment. Methods This was a monocentric, prospective, open-label, interventional study conducted between June 2015 and December 2017 among adult patients receiving >10 days of linezolid therapy and undergoing proactive TDM (desired trough level 2–8 mg/L) and platelet count assessment at day 3–5 and then once weekly up to the end of treatment. Results Sixty-one patients were included. Twenty-eight (45.9%) always had desired trough level (group A) and 33 (54.1%) experienced linezolid overexposure (group B) [29/33 transiently (subgroup B1) and 4/33 persistently (subgroup B2)]. No patient experienced linezolid underexposure. Median duration of treatment for the different groups ranged between 19 and 54 days. Thrombocytopenia occurred overall in 14.8% of cases (9/61). The incidence rate of thrombocytopenia was significantly lower (P=0.012) in both group A (10.7%; 3/28) and subgroup B1 (10.3%; 3/29) than in subgroup B2 (75.0%; 3/4). Thrombocytopenic patients belonging to both group A and group B1 recovered from thrombocytopenia without the need for discontinuing therapy. Multivariate linear regression analysis revealed that thrombocytopenia was independently associated with baseline platelet count and with median linezolid trough concentrations. Conclusions Proactive TDM of linezolid may be beneficial either in preventing or in recovering from dose-dependent thrombocytopenia, even when treatment lasts for more than 28 days. Larger prospective studies are warranted to confirm our findings.

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Long-term Treatment of Teicoplanin for Methicillin-resistant Staphylococcus aureus Sternal Osteomyelitis with Renal Impairment: A Case of High Teicoplanin Trough Levels Maintained by Therapeutic Drug Monitoring

YAKUGAKU ZASSHI ◽

10.1248/yakushi.15-00296 ◽

2016 ◽

Vol 136 (9) ◽

pp. 1313-1317 ◽

Cited By ~ 1

Author(s):

Hideo Shiohira ◽

Masashi Nakamatsu ◽

Yuya Kise ◽

Futoshi Higa ◽

Masao Tateyama ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Therapeutic Drug Monitoring ◽

Renal Impairment ◽

Drug Monitoring ◽

Term Treatment ◽

Therapeutic Drug ◽

Sternal Osteomyelitis ◽

Long Term Treatment ◽

Trough Levels

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Therapeutic Drug Monitoring and its implications on acute and long-term treatment with neuroleptics

European Psychiatry ◽

10.1016/j.eurpsy.2007.01.276 ◽

2007 ◽

Vol 22 ◽

pp. S72

Author(s):

F. Bengtsson

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Term Treatment ◽

Therapeutic Drug ◽

Long Term Treatment

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Successful Long-Term Treatment of Cerebral Nocardiosis with Unexpectedly Low Doses of Linezolid in an Immunocompromised Patient Receiving Complex Polytherapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00135-12 ◽

2012 ◽

Vol 56 (6) ◽

pp. 3438-3440 ◽

Cited By ~ 14

Author(s):

Federico Pea ◽

Piergiorgio Cojutti ◽

Alberto Pagotto ◽

Francesco Cristini ◽

Mario Furlanut ◽

...

Keyword(s):

Mortality Rate ◽

Therapeutic Drug Monitoring ◽

Immunocompromised Patient ◽

Severe Infection ◽

Term Treatment ◽

Therapeutic Drug ◽

Low Doses ◽

Long Term Treatment ◽

Cerebral Nocardiosis

ABSTRACTCerebral nocardiosis is a severe infection that carries the highest mortality rate among all bacterial cerebral abscesses. We report on a case in an immunocompromised patient which was successfully treated with unexpectedly low doses of linezolid. Therapeutic drug monitoring was very helpful in highlighting issues of poor compliance and of drug-drug interactions.

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Drug-Drug Interactions with Antipsychotics

CNS Spectrums ◽

10.1017/s1092852900015947 ◽

2007 ◽

Vol 12 (S21) ◽

pp. 6-9 ◽

Cited By ~ 14

Author(s):

Jonathan Meyer

Keyword(s):

Drug Interactions ◽

The United States ◽

Term Treatment ◽

Therapeutic Monitoring ◽

Successful Outcome ◽

Therapeutic Drug ◽

Emergency Rooms ◽

Long Term Treatment ◽

Substantial Morbidity

Recognizing drug-drug interactions (DDIs) has become increasingly important as the country's demographics have aged, resulting in more complex medication regimens. Budnitz and colleagues highlighted the frequency of adverse drug reactions (ADRs) and the substantial morbidity that results. Their study estimated >700,000 cases of ADRs in emergency rooms (ER) in the United States between 2004 and 2005, and that ADRs accounted for 6.7% of ER visits for unintentional injuries that led to hospitalization. Moreover, medications that require monitoring accounted for 41.5% of all the ADR-related hospitalizations.These data have tremendous implications for the field of psychiatry because many psychiatric drugs require therapeutic monitoring. The importance of DDIs is particularly relevant for the psychiatric population, where adverse effects not only cause short-term morbidity, but may lead to long-term treatment noncompliance. For many patients taking antipsychotics, adherence is the key to a successful outcome. Minimizing DDIs maximizes the chance that people will avoid unnecessary ADRs while achieving therapeutic drug levels.

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