Monitoring of plasmatic concentrations of AEDs is important to improve patient s theraphy.

Transcription

1 ANTIEPILEPTICS in plasma by LC-MS Deuterated internal Std - Code LC05015 (Levetiracetam, Lamotrigine, Primidone, Oxcarbazepine, Carbamazepine Epoxide, 10,11-Dihydro- 10-Hydroxy-Carbamazepine, Carbamazepine, Phelbamate, Desmethylsuximide, Rufinamide, Phenytoin, Methsuximide, Topiramate, Phenobarbital, Valproic Acid, Ethosuximide, Lacosamide, Zonisamide) INTRODUCTION Treatment of the epileptic patients requires a multidisciplinary medical knowledge, regarding i.e. pharmacology, psychology and social science. In this contest the various antiepileptic drugs (AEDs) are used to decrease the frequency and/or severity of seizures in people with epilepsy. Monitoring of plasmatic concentrations of AEDs is important to improve patient s theraphy. Our method allows to determine in the same HPLC run the sieric and/or plasmatic concentration of the following drugs: Levetiracetam, Lamotrigine, Primidone, Oxcarbazepine, Carbamazepine Epoxide, 10,11-Dihydro-10-Hydroxy-Carbamazepine, Carbamazepine, Phelbamate, Desmethylsuximide, Rufinamide, Phenytoin, Methsuximide, Topiramate, Phenobarbital, Valproic Acid, Ethosuximide, Lacosamide, Zonisamide. EUREKA srl LAB DIVISION VAT N info@eurekaone.com Head Quarter: Via Enrico Fermi Chiaravalle (AN) ITALY Tel Fax This product fulfills all the requirements of Directive 98/79/EC on in vitro diagnostic medical devices (IVD). The declaration of conformity is available upon request. Release N 001 Antiepileptics in plasma by LC/MS March

2 TECHNICAL FEATURES Principle of the Method : Antiepileptics are separated treating the serum/plasma with a suitable precipitant. After addition of a stabilization Reagent the solution is directly injected into HPLC. Sensitivity: Levetiracetam 0,07 µg/ml Lamotrigine 0,03 µg/ml Primidone 0,07 µg/ml Oxcarbazepina 0,03 µg/ml Carbamazepine Epoxide 0,02 µg/ml 10,11-Dihydro-10-Hydroxy-Carbamazepine 0,07 µg/ml Carbamazepine 0,01 µg/ml Phelbamate 0,1 µg/ml Rufinamide 0,02 mg/l Desmethylsuximide 0,3 mg/l Phenytoin 0,3 mg/l Methsuximide 0,3 mg/l Topiramate 0,1 mg/l Phenobarbital 1,5 µg/ml Valproic Acid 2,5 mg/l Ethosuximide 5,0 µg/ml Lacosamide 0,03 mg/l Zonisamide 0,07µg/ml Dynamic Range : Levetiracetam 0,2 100 µg/ml Lamotrigine Primidone Oxcarbazepina Carbamazepine Epoxide 10,11-Dihydro-10-Hydroxy-Carbamazepine Carbamazepine Phelbamate Rufinamide Desmethylsuximide Phenytoin Methsuximide Topiramate Phenobarbital Valproic Acid Ethosuximide Lacosamide Zonisamide 0,1 30 µg/ml 0,2 30 µg/ml 0,1 100 µg/ml 0,5 100 µg/ml 0,1 100 µg/ml 0,02 30 µg/ml 0,3 150 µg/ml 0, mg/l mg/l 0,8 50 mg/l mg/l 0,3 100 mg/l µg/ml mg/l µg/ml 0,1 30 mg/l 0,2 100 µg/ml CV% : Levetiracetam 4,36% intra serie 7,60% inter serie Lamotrigine 5,40% intra serie 6,50% inter serie Primidone 5,65% intra serie 5,70% inter serie Oxcarbazepina 4,79% intra serie 6,50% inter serie Carbamazepine Epoxide 5,76% intra serie 6,90% inter serie 10,11-Dihydro-10-Hydroxy-Carbamazepine 5,87% intra serie 7,90% inter serie Carbamazepine 4,84% intra serie 7,40% inter serie Phelbamate 5,68% intra serie 6,30% inter serie Rufinamide 6,59% intra serie 7,90% inter serie Desmethylsuximide 5,52% intra serie 9,20% inter serie Phenytoin 5,84% intra serie 9,90% inter serie Methsuximide 5,56% intra serie 9,20% inter serie Topiramate 6,50% intra serie 7,80% inter serie Phenobarbital 6,17% intra serie 6,30% inter serie Valproic Acid 4,79% intra serie 5,40% inter serie Ethosuximide 4,43% intra serie 5,10% inter serie Lacosamide 4,59% intra serie 9,20% inter serie Zonisamide 4,09% intra serie 4,90% inter serie 2

3 Therapeutic range : Levetiracetam µg/ml Lamotrigine 3 14 µg/ml Primidone 5 12 mg/l Oxcarbazepine 0 4 mg/l Carbamazepine Epoxide 2 4 mg/l 10,11-Dihydro-10-Hydroxy-Carbamazepine 3 40 µg/ml Carbamazepine 6 12 mg/l Phelbamate mg/l Rufinamide 1 50 mg/l Desmethylsuximide mg/l Phenytoin mg/l Methsuximide mg/l Topiramate 2 25 mg/l Phenobarbital mg/l Valproic Acid mg/l Ethosuximide µg/ml Lacosamide 1 10 mg/l Zonisamide µg/ml Accuracy: Levetiracetam 96,4% Lamotrigine 100,7% Primidone 116,8% Oxcarbazepine 100,1% Carbamazepine Epoxide 89,3% 10,11-Dihydro-10-Hydroxy-Carbamazepine 101,8% Carbamazepine 91,3% Phelbamate 95,3% Rufinamide 105,5% Desmethylsuximide 110,7% Phenytoin 94,3% Methsuximide 105,9% Topiramate 100,1% Phenobarbital 91,3% Valproic Acid 103,1% Ethosuximide 97,1% Lacosamide 96,3% Zonisamide 116,6% Recovery: 100% Components of the kit (500 tests): All reagents are ready to use and stable 3 years at 2-8 C, except Reagent A. Reagent A Deproteinization Solution with Internal Standards, 1 x 250 ml Store at -20 C Reagent B Stabilization Solution, 1 x 250 ml Plasma Calibrator Level 1, 3 x 1 ml Plasma Calibrator Level 2, 3 x 1 ml Plasma Calibrator Level 3, 3 x 1 ml Plasma Calibrator Level 4, 3 x 1 ml Code LC04916 (packed separately see data sheet) Code LC04916 (packed separately see data sheet Code LC04916 (packed separately see data sheet Code LC04916 (packed separately see data sheet 3

4 Plasma Calibrator Level 5, 3 x 1 ml Plasma Calibrator Level 5, 3 x 1 ml Reagent M1 Mobile Phase A, 4 x 500 ml Code LC04916 (packed separately see data sheet Code LC04916 (packed separately see data sheet Reagent M2 Mobile Phase B, 4 x 500 ml Minimum Instrumental equipment required: Optional Equipment: LC/MS System with triple quadrupole MRM Work Mode, positive/ negative ESI Operational Computer Autosampler. Blood Collection Procedure: Take 3 ml of whole blood in a test tube without gel or with EDTA as anticoagulant. Centrifuge at 4000 rpm for 5 minutes. Separate the serum and store at 20 C. Stable 4 weeks. 4

5 ANALYTICAL PROCEDURE STEP 1 : Sample Preparation Dispense in an eppendorf: Calibrator Sample Control Calibrator 50 µl Sample 50 µl Control 50 µl Reagent A Deproteinization Sol. with Internal Standards 500 µl 500 µl 500 µl Warning: deproteinize directly on Vortex for at least 20 sec. STEP 2 : Incubate at 2-8 C for 15 minutes. STEP 3 : Centrifuge at rpm for 15 minutes STEP 4 : Put 50 µl of surnatant in a glass vial of 2 ml. Add 450 µl of Reagent B Stabilization Solution (or an appropriate volume for the instrument sensitivity) Vortex for 10 seconds N.B.: at this step, the sample is stable 2 days at 2-8 C INJECTION : Inject 1-10 µl of the eluate into the chromatographic system. Release N 001 Antiepileptics in plasma by LC/MS March

6 ANTIEPILEPTICS - Warnings COLUMN CONDITIONING Install a new analytical column HYPERSIL GOLD C18 50 x 2,1 mm 1,9 um. Termostatate at 40 C. Disconnect the detector and flux a solution of Acetonitrile : H 2O ( 95 : 5 v/v ) set flow at 400 ul / minute for 15 minutes. Don t recycle the washing solutions. Condition further on the column with a solution of Mobile Phase M1 : Mobile Phase M2 ( 98 : 2 v/v ) set flow at 400 ul / minute for 15 minutes. Making two injections of HPLC grade water before proceeding with the analytical series. It s NOT possible to make analysis at recycling phase. If room temperature is > 20 C store the Mobile Phase at 2-8 C between an analytical session and another. COLUMN CLEANING Wash with a solution containing Mobile Phase M2: M1 (95: 5 v / v) at a flow of 400 ul / minute for 15 minutes. It recommends flushing the Analytical Column at the end of each run. The column must be stored in a solution containing Mobile Phase M2: M1 (95: 5 v / v). WASH AUTOSAMPLER SYRINGE Wash the syringe, before every analytical session, with a solution of Ethanol, Acetontrile or Methanol. GRADIENT Time (min) % M1 (PUMP A) % M2 (PUMP B) Flow (µl/min) ESI+ PARAMETERS (optimized on triple quadrupole Sciex 4500) Curtain Gas (CUR): 40 Collision Gas (CAD): 8 Ion Spry Voltage: (IS): 5500 V Temperature (TEM): 600 C Ion Source Gas 1 (GS1): 40 Ion Source Gas 2 (GS2): 30 ESI- PARAMETERS (optimized on triple quadrupole Sciex 4500) Curtain Gas (CUR): 40 Collision Gas (CAD): 8 Ion Spry Voltage: (IS): V Temperature (TEM): 600 C Ion Source Gas 1 (GS1): 30 Ion Source Gas 2 (GS2): 30 6

7 ANALYTE PARENT ION Levetiracetam Lamotrigine Primidone Oxcarbazepine Carbamazepine Epoxide ,11-dihydro-10-hydroxy-carbamazepine Carbamazepine Phelbamate Rufinamide Desmethylsuximide Ritonavir Phenytoin Methsuximide Topiramate Pravastatin Phenobarbital Valproic Acid Ethosuximide Lacosamide Zonisamide DEPROTEINIZATION SOLUTION WITH INTERNAL STANDARD: Solution with: Levetiracetam-d6, Zonisamide-d4, Lacosamide-d3, Phelbamate-d4, Ethosuximide-d3, Desmethylsuximide-d5. Store at 20 C. Ionization Analyte Standard Interno consigliato per la calibrazione Levetiracetam Levetiracetam-d6 Lamotrigine Lacosamide-d3 Primidone Lacosamide-d3 Oxcarbazepine Lacosamide-d3 Carbamazepine epoxide Lacosamide-d3 OH-carbamazepine Lacosamide-d3 Positive Carbamazepine Lacosamide-d3 Phelbamate Phelbamate-d4 Rufinamide Lacosamide-d3 Desmethylsuximide Desmethylsuximide-d5 Phenitoin Lacosamide-d3 Methsuximide Desmethylsuximide-d5 Topiramate Lacosamide-d3 Lacosamide Lacosamide-d3 Phenobarbital Zonisamide-d4 Negative Valproic Acid Zonisamide-d4 Ethosuximide Ethosuximide-d3 Zonisamide Zonisamide-d4 7

8 FRAGMENTATIONS (optimized on TRIPLE QUADRUPOLE Sciex 4500) ANALYTE Q1 Q3 COLLISION ENERGY Levetiracetam Lamotrigine Primidone Oxcarbazepine Carbamazepine Epoxide ,11-Dihydro-10-Hydroxy- Carbamazepine Carbamazepine Phelbamate Rufinamide Desmethylsuximide Phenitoin Methsuximide Topiramate Lacosamide Phenobarbital Valproic Acid Ethosuximide Zonisamide Levetiracetam-d Phelbamate-d Desmethylsuximide-d Lacosamide-d Ethosuximide-d Zonisamide- d CODE DESCRIPTION PACKAGING LC04916 Calibrator for Antiepileptics in plasma 5 x 2 x 1 ml LC04917 Control per Antiepileptics in plasma Level 1 5 x 1 ml LC04918 Control per Antiepileptics in plasma Level 2 5 x 1 ml LC04919 Control per Antiepileptics in plasma Levels 1 and 2 2 x 5 x 1 ml Z Hypersil GoldC18 (50 x 2,1 mm 1,9 um) Analytical Column 1 Pk S Clear glass vials with reduced volume 1 x 100 Pk S Caps for clear glass vials with reduced volume 1 x 100 Pk SK05010 Starter kit for Antiepileptics 1 Pk 8

9 Fig. 1 : Plasma Calibrator Fig. 2 : Plasma Calibrator R.T Levetiracetam-D6 R.T Desmethylsuximide-D5 9

10 Fig. 3 : Plasma Calibrator Fig. 4 : Plasma Calibrator R.T Phelbamate-D3 R.T Lacosamide-D4 10

11 Fig. 5 : Plasma Calibrator Fig. 6 : Plasma Calibrator R.T Ethosuximide-D3 R.T Zonisamide-D4 11

12 Fig. 7 : Plasma Calibrator Fig. 8 : Plasma Calibrator R.T Lamotrigine R.T Primidone 12

13 Fig. 9 : Plasma Calibrator Fig. 10 : Plasma Calibrator R.T Topiramate R.T Rufinamide 13

14 Fig. 11 : Plasma Calibrator Fig. 12 : Plasma Calibrator R.T Lacosamide R.T Phenitoin 14

15 Fig. 13 : Plasma Calibrator Fig. 14 : Plasma Calibrator R.T Methsuximide R.T Phelbamate 15

16 Fig. 15 : Plasma Calibrator Fig. 16 : Plasma Calibrator R.T Ethosuximide R.T Desmethylsuximide 16

17 Fig. 17 : Plasma Calibrator Fig. 18 : Plasma Calibrator R.T Zonisamide R.T Phenobarbital 17

18 Fig. 19 : Plasma Calibrator Fig. 20 : Plasma Calibrator R.T Valproic Acid R.T Oxcarbazepine 18

19 Fig. 21 : Plasma Calibrator Fig. 22 : Plasma Calibrator R.T Carbamazepine Epoxide R.T ,11-Dihydro-10-Hydroxy-Carbamazepine 19

20 Fig. 23 : Plasma Calibrator Fig. 24 : Plasma Calibrator R.T Carbamazepine R.T Levetiracetam 20