Development and validation of a liquid chromatography-mass spectrometry method for the simultaneous quantification of artesunate and dihydroartemisinin in human plasma.

The present study describes the development and validation of a simple, sensitive, and specific liquid chromatography-mass spectrometry (LC-MS) analytical method used for the co-quantification of artesunate (ARS) and its active metabolite, dihydroartemisinin (DHA), in human plasma, using artemisinin (ARN) as an internal standard. The liquid-liquid extraction of samples was carried out using dichloromethane and tert.-methyl butyl ether (at a ratio of 8:2 v/v) and then evaporated to dryness by a stream of nitrogen gas at room temperature. Chromatographic separation and mass analysis were performed on the Agilent 1100 Series Liquid Chromatography/Mass Spectrometer Detector Trap system, using electrospray ionization as an interface. The stationary phase was an Elipse XDB-C18 column. The mobile phase contained acetonitrile and 0.003 M glacial acetic acid at a ratio of 62:38 (v/v) delivered at a flow rate of 0.5 ml per minute. Positive ion mode was selected to detect extracted ions at m/z 407 and 261 for ARS, at m/z 307 and 261 for DHA, and at m/z 305 for ARN. The retention times for alpha-DHA, ARS, beta-DHA, and ARN were 6.6, 8.0, 9.2, and 10.8 minutes, respectively, and the total chromatography run time was 12 minutes. The limit of detection (LOD) was 2 ng/ml while the limit of quantification (LOQ) was 10 ng/ml for both ARS and DHA. In order to address any complications caused by the spontaneous non-catalytic breakdown of ARS to DHA, two calibration curves were prepared separately for both analytes. These graphs were found to be linear over the range of 10 to 3,200 ng/ml (r2 > 0.99). The recoveries at concentrations of 100, 200, 400, and 800 ng/ml were 108, 106, 91, and 89%, respectively, for ARS and were 112, 95, 80, and 86%, respectively, for DHA. For ARN, the recoveries were 119, 119, and 90% for concentrations of 200, 400, and 800 ng/ml, respectively. ARS working solutions were not stable after two months of storage at 4 degrees C or after 21 days at room temperature. This newly developed LC-MS method was then applied for measuring of ARS and DHA concentrations in a healthy volunteer having received oral ARS at 200 mg once daily for 5 consecutive days. There was no decline in ARS concentration after repeated doses and the C(ss-max-average) for DHA was found to be 703 +/- 94 ng/ml at t(ss-max) of 2 h.

Pharmacokinetics of mefloquine with dihydroartemisinin as 2-day regimens in patients with uncomplicated falciparum malaria.

The objective of this study was to investigate the pharmacokinetics of mefloquine (MQ) when given as 750 mg at two different times in combination regimens with dihydroartemisinin (DHA) in patients with acute uncomplicated falciparum malaria. A total of 12 Vietnamese patients (6 in each group) were randomized to receive two MQ-DHA regimens as follows: regimen-A: an initial oral dose of 300 mg DHA, followed by 750 mg MQ and 300 DHA 6 and 24 hours later; regimen-B: an initial dose of 300 mg DHA, followed by 300 mg DHA and 750 mg MQ at 24 hours. Both combination regimens were well tolerated. All patients responded well to treatment with no recrudescence during a 42 day follow-up period. The pharmacokinetics of MQ following both regimens were similar but pooled data from both groups suggest that the kinetics of MQ was different from that observed in Vietnamese healthy subjects reported in a previous study. The median (95% CI) time period for maintenance of whole blood MQ concentrations above 500 ng/ml was 16 (0-24) days. It was concluded that since no pharmacokinetic drug interaction was observed, MQ dose given 24 hours after an initial dose of DHA is a preferable combination treatment regimen with regard to patient compliance.