Quetiapine cross-reactivity with plasma tricyclic antidepressant immunoassays
Quetiapine cross-reactivity with plasma tricyclic antidepressant immunoassays
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DOI：
10.1345/aph.1g107
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发表时间：
2005-09-01
影响因子：
2.9
通讯作者：
Anderson, KT
中科院分区：
文献类型：
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作者：
Caravati, EM;Juenke, JM;Anderson, KT
背景：对经常过量用药的患者进行毒理学筛查，包括三环抗抑郁药（TCAs）作为评估的一部分。喹硫平是一种抗精神病药物，其结构与TCAs相似。目的：利用常用的自体分析仪，确定喹硫平是否可能与体外血浆TCA免疫测定发生交叉反应。方法：将喹硫平原液加入9个单独的无药人血浆样品中，使其浓度在1 ~ 640 ng/mL之间，通过气相色谱法进行验证。未发现喹硫平代谢物。每个加标血浆样本在两个独立实验室的TDxFLx自动分析仪上使用雅培三环抗抑郁药TDx检测，在AU400自动分析仪上使用Syva Emit tox血清三环抗抑郁药检测，在ACA-Star 300自动分析仪上使用S TAD血清三环抗抑郁药筛选。TDx检测是定量的，而Emit和S TAD是定性筛选，TCA阳性的阈值为300 ng/mL。我们感兴趣的结果是TCA阳性结果。结果：定量分析显示，喹硫平浓度为5 ng/mL时，TCA开始出现浓度相关的交叉反应。在实验室1和实验室2中，添加了640 ng/mL的样品分别产生了379和385 ng/mL的TCA结果。在S TAD和Emit的喹硫平浓度分别为160和320 ng/mL时，定性分析结果显示TCA阳性。结论：喹硫平与定量和定性血浆TCA免疫分析呈浓度依赖性交叉反应。治疗性使用或过量使用喹硫平可能导致TCA免疫测定结果假阳性。
BACKGROUND: Toxicology screens obtained on patients who have overdosed on drugs frequently include tricyclic antidepressants (TCAs) as part of the evaluation. Quetiapine is an antipsychotic agent with structural similarity to the TCAs.OBJECTIVE: To determine whether quetiapine may cross-react with plasma TCA immunoassays in vitro using commonly available autoanalyzers.METHODS: Quetiapine stock solution was added to 9 separate samples of pooled drug-free human plasma to produce concentrations ranging from 1 to 640 ng/mL that were verified by gas chromatography. No quetiapine metabolites were present. Each spiked plasma sample was tested in a blinded fashion using the Abbott Tricyclic Antidepressant TDx Assay on the TDxFLx autoanalyzer in 2 separate laboratories, the Syva Emit tox Serum Tricyclic Antidepressant Assay on the AU400 autoanalyzer and the S TAD Serum Tricyclic Antidepressant Screen on the ACA-Star 300 autoanalyzer. The TDx assay is quantitative, while Emit and S TAD are qualitative screening assays with a threshold of 300 ng/mL for TCA positivity. The outcome of interest was a positive TCA result.RESULTS: The quantitative assay showed concentration-related TCA cross-reactivity beginning at quetiapine concentrations of 5 ng/mL. The 640-ng/mL spiked sample produced TCA results of 379 and 385 ng/mL in labs 1 and 2, respectively. The qualitative assays were screened as TCA positive at quetiapine concentrations of 160 and 320 ng/mL for the S TAD and Emit assays, respectively.CONCLUSIONS: Quetiapine cross-reacts with quantitative and qualitative plasma TCA immunoassays in a concentration-dependent fashion. Therapeutic use or overdose of quetiapine may result in a false-positive TCA immunoassay result.