Analysis of antidepressant prescribing tendencies in Lithuania in 2003-2004.

Depression is one of the leading causes of disability worldwide, affecting 121 million people in whole world. In many developed countries, the number of prescriptions for antidepressants increased steeply during the 1990s. The objective of the present study was to evaluate the antidepressant prescribing patterns in all regions of Lithuania during 2003-2004, to analyze the use within different antidepressant groups, and to examine trends in age- and gender-specific antidepressant use. Antidepressants were classified into three groups according to Anatomic Therapeutic Chemical (ATC) Classification specifying the defined daily doses. The results of our study show an increase in the use of reimbursed antidepressants except tricyclic in 2004 when compared to 2003. Increase in the use of selective serotonin reuptake inhibitors and other nontricyclic antidepressants is probably related to their better tolerability, improved risk-benefit ratio, and less toxicity in overdose. There was no increase in the percentage of consumed selective serotonin reuptake inhibitors in elderly patients when compared with younger ones, despite elderly patients are most likely to benefit from reduced sedation, less antimuscarinic and less cardiac toxicity of selective serotonin reuptake inhibitors. The prevalence of the antidepressant use is the highest among middle-aged people (40-59 years), while the young (under 20) and elderly (older than 70) patients receive mostly selective serotonin reuptake inhibitors. Additional studies should be carried out in order to assess drug-prescribing patterns in accordance with the guidelines of depression treatment in Lithuania considering diagnosis, dosage, and duration of treatment.

Distribution of ibogaine and noribogaine in a man following a poisoning involving root bark of the Tabernanthe iboga shrub.

In the present paper, we report for the first time the tissue distribution of ibogaine and noribogaine, the main metabolite of ibogaine, in a 48-year-old Caucasian male, with a history of drug abuse, found dead at his home after a poisoning involving the ingestion of root bark from the shrub Tabernanthe iboga. Ibogaine and noribogaine were quantified in tissues and fluids using a fully validated liquid chromatography-electrospray mass spectrometry method. Apart from cardiac tissue, ibogaine and noribogaine were identified in all matrices investigated. The highest concentrations were found in spleen, liver, brain, and lung. The tissue/subclavian blood concentration ratios averaged 1.78, 3.75, 1.16, and 4.64 for ibogaine and 0.83, 2.43, 0.90, and 2.69 for noribogaine for spleen, liver, brain, and lung, respectively. Very low concentrations of the two drugs were found in the prostatic tissue. Both ibogaine and noribogaine are secreted in the bile and cross the blood-brain barrier. Four other compounds were detected in most of the studied matrices. One of them was identified as ibogamine. Unfortunately, we were not able to positively identify the other three compounds because of the unavailability of reference substances. Two of them could possibly be attributed to the following oxidation products: iboluteine and desmethoxyiboluteine. The third compound could be ibogaline.

[Identification of the drugs in the mixture using thin-layer chromatography in sudden poisoning cases]. / Vaistu misinio komponentu identifikavimas plonasluoksnes chromatografijos metodu uminiu apsinuodijimu atvejais.

The problem of acute intoxication has become very urgent now due to a great number of various chemical preparations accumulated during the last decades in the environment. Intoxications with psychotropic drugs and their mixtures form the significant part of the intoxications; there is an increasing tendency of intoxication with several preparations at a time. Amitriptyline and codeine are the preparations, which more frequently can cause intoxication. Fluoxetine is one of the newest and often used antidepressants. Under certain circumstances, like overdose, using all preparations together, long term using or using for suicide, these preparations can be even a cause of death. In such cases amitriptyline, fluoxetine and codeine become the objects of chemical-toxicological analysis. The possibility of the separation and identification of amitriptyline, fluoxetine and codeine in the mixture using thin-layer chromatography was established. Dragendorf reagent, modified by Munje, is most suitable for the spray-distinct of the chromatographic plates for all three substances. Amitriptyline research limit, using this developer, is 0.4 microg, fluoxetine--1.6 microg, codeine--0.8 microg. Most acceptable for separation the components of the mixture are 5 mobile phases: 1. Diethyl acetate-methanol-ammonium hydroxide (concentrated solution) (85:10:5). Amitriptyline, fluoxetine and codeine R(f) medium values respectively are 0.94; 0.63; 0.51. 2. Buthylacetate-methanol-ammonium hydroxide (concentrated solution) (85:10:5). Amitriptyline, fluoxetine and codeine R(f) medium values respectively are 0.65; 0.24; 0.15. 3. Cyclohexane-diethyl acetate-diethyl amine (70:15:15). Amitriptyline, fluoxetine and codeine R(f) medium values respectively are 0.93; 0.75; 0.37. 4. Cyclohexane-buthylacetate-diethyl amine (70:15:15). Amitriptyline, fluoxetine and codeine R(f) medium values respectively are 0.92; 0.51; 0.25. 5. Acetone-1,4-dioxane-ammonium hydroxide (concentrated solution) (30:68:2). Amitriptyline, fluoxetine and codeine R(f) medium values respectively are 0.82; 0.62; 0.42. Recommended methodology for the separation and identification of amitriptyline, fluoxetine and codeine in the mixture using thin-layer chromatography is statistically reliable: when confidence level is 0.95, relative error is less than 0.05; standard deviation is from 0.007 to 0.03. Recommended methodology suits for mixture, extracted from biological liquids, components separation and identification.

[UV spectrophotometric research of drug mixture in sudden poisoning cases]. / Vaistu misinio UV-spektrofotometrinis tyrimas uminiu apsinuodijimu atvejais.

UNLABELLED: The objective of this research--to develop the methodics for analysis of amitriptyline, fluoxetine and codeine in the mixture. RESULTS: The analytical method of amitriptyline, codeine and fluoxetine in the mixture identification and quantitative determination using ultraviolet spectrophotometry was established. Preparations in the mixture can't be separated, because material ultraviolet light peaks are in insufficient distance and therefore cover one another. The maximum of ultraviolet light absorption for amitriptyline is at 217-220 and 238-240 nm; fluoxetine--at 226-228 nm; codeine--at 224-248 and 284-286 nm. Using ultraviolet spectroscopy it's possible to identify amitriptyline, fluoxetine and codeine only after separating mixture components by thin-layer chromatography, the same time executing cleaning of extracts from blood and urine. Using ultraviolet spectroscopy can be identificated at least 0.5 micro g/ml amitriptyline, 1.5 micro g/ml fluoxetine and 1.0 microg/ml codeine. The intervals of the quantitative determination: 5-25 microg/ml amitriptyline; 5-30 microg/ml fluoxetine; 100-300 microg/ml codeine; relative error of the measurement, when confidence level is 95%, is from 0.66 to 1.2% for amitriptyline; from 0.66 to 1.45% for fluoxetine; from 0.33 to 0.88% for codeine. Standard deviation is from 1.15 to 2.08% for amitriptyline; from 1.15 to 2.52% for fluoxetine; from 0.57 to 1.53% for codeine. Molar absorption coefficients for all three preparations in distillated water were determinated. CONCLUSIONS: recommended methodology suits for mixture, extracted from biological liquids, components separation, identification and quantitative determination.

[Poisonings with psychotropic drug mixtures: analysis using the thin-layer chromatography method]. / Apsinuodijimu psichotropiniu vaistu misiniu tyrimas plonasluoksnes chromatografijos metodu.

It is observed increase in number of remedy intoxications in Lithuania, especially important is intoxication with psychotropic drugs and their mixtures. The thin-layer chromatography (TLC) method was proposed for separation and identification of drugs in mixture aminazine: nitrazepam: barbamylum. The mixture of these drugs excreted from body fluids (blood and urine) was investigated by TLC. Most acceptable these mobile phases: 1. Diethyl ether: dioxane--40:60. Rf values for drugs: aminazine 0.23-0.25; barbamylum 0.85-0.9; nitrazepam 0.75-0.8. 2. Diethyl ether: NH3 (25%): benzenum--80:10:10. Rf values for drugs: aminazine 0.55-0.58; barbamylum 0.32-0.35; nitrazepam 0.17-0.2.

[Ultraviolet spectrophotometric determination of psychotropic drug mixtures]. / Psichotropiniu vaistu misinio tyrimas ultravioletines spektrofotometrijos metodu.

The mixture of psychotropic drugs aminazine, barbamylum and nitrazepam using ultraviolet (UV) spectrophotometric method was researched. As the solvent, most acceptable for identification and differentiation of these preparation was found 0.1N solution of sulphuric acid. By measuring the optical density of the solutions in different concentration the calibration diagrams for all preparations were made. The standard deviation, by determining the quantity of aminazine is 2.8; 4.0; 4.3; barbamylum--1.0; 2.5; 1.15; nitrazepam--2.64; 1.0; 1.35.

[Analysis of psychotropic drug mixtures using high-pressure liquid chromatography in acute poisoning cases]. / Psichotropiniu vaistu misinio tyrimas auksto slegio skysciu chromatografijos metodu uminiu apsinuodijimu atvejais.

The qualitative and quantitative method of determination of amitryptilin, codeine and fluoxetine in the mixture using high-pressure liquid chromatography is described in this paper. Chromatogram is presented which shows, that preparations are fully separated and do not interfere each others analysis. Tables with chromatographical separation characteristics are also presented. Proposed calibration curves of quantitative analysis and calculated medium relative error of quantitative ascertainment for every preparation of the mixture are shown. Final conclusion: method is applicable for qualitative and quantitative analysis of amitryptiline, fluoxetine and codeine in the mixture in hasty poisoning cases.