Long-term detection of clodronate in equine plasma by liquid chromatography-tandem mass spectrometry.

Clodronate is a non-nitrogen-containing bisphosphonate drug approved in equine veterinary medicine. Clodronate is prohibited for use in competition horses; therefore, to set up an appropriate control, detection times and screening limits are required. The quantitative method in plasma consisted of addition of chloromethylene diphosphonic acid as internal standard. Automated sample preparation comprised a solid phase extraction with weak anion exchange properties on microplate. After methylation of the residue with trimethyl orthoacetate, analysis was conducted by high-performance liquid chromatography-tandem mass spectrometry. Using a weighting factor of 1/(concentration)2 , good linearity was observed in the range of 1 to 500 ng/ml, with low limits of detection and quantification of 0.5 and 1 ng/ml, respectively. Precision and accuracy determined at four concentrations were satisfactory, with an error percentage less than 15%. Absence of carry-over and good stability of clodronic acid in plasma after a long-term storage at -20°C were verified. The method was successfully applied to the quantification of clodronic acid in plasma samples from horses administered with a single intramuscular administration of Osphos® at a mean dose of 1.43 ± 0.07 mg/kg. The observed detection time will be verified in a clinical population study conducted in diseased horses.

LC-MS/MS method for the determination of clodronate in human plasma.

Clodronate belongs to the class of bisphosphonates which are used for the treatment of bone disorders. Due to its high polarity it has a low and highly variable oral bioavailability which results in low plasma concentrations and requires sensitive bioanalytical methods to characterize its pharmacokinetics in human. Here, we describe for the first time the development and validation of a LC-MS/MS assay for the quantification of clodronate in human plasma. The bisphosphonate was isolated from the biological matrix by protein precipitation using perchloric acid (10%), and derivatized with trimethylorthoacetate prior sample clean-up with liquid-liquid extraction using methyl tert-butyl ether. The chromatography was performed using an isocratic elution with ammonium acetate 5mM (85% v/v, pH 3.8) and acetonitrile (15% v/v) as mobile phase with a flow rate of 300µl/min on a reversed-phase column (Supelco Ascentis(®), C18) temporized at 50°C. The mass spectrometric detection was done using the API4000 triple quadruple mass spectrometer monitoring the mass/charge transitions 301.0/145 for clodronate and 305.2/137.1 for the internal standard etidronate. The analytical range was set to 5-800ng/ml, allowing an evaluation of the plasma concentration-time profiles of clodronate for approximately 7-8 half-life (∼24h). The method was validated according to current FDA/EMA guidelines on bioanalytical method validation with respect to specificity, linearity, intra- and inter-day accuracy and precision, matrix effect, recovery as well as stability. The precision of the assay was 0.6-6.9% and 0.6-8.1% for the intra-day and inter-day variability, respectively. The intra-day and inter-day accuracy (error) was 0.6-8.8% and 2.2-4.5%. The recovery of the analyte was low (2-3%) but reproducible over the entire validation range and sufficient to monitor the target concentrations in human plasma. The drug was shown to be stable in plasma at room temperature for at least 3h (96.0±6%) and for at least 24h when stored in the cooled autosampler at 4°C (102.4±4.5%). Clodronate can also undergo up to three freeze-thaw cycles without impaired stability. Thus, the method was shown to possess sufficient specificity, sensitivity, accuracy, precision and stability to measure plasma concentrations of clodronate. Finally, the developed method was successfully applied to study the clodronate serum levels in a pharmacokinetic study in healthy volunteers.

Fluorimetric quantification of clodronate and alendronate in aqueous samples and in serum.

The bisphosphonates clodronate and alendronate are drugs in the therapy of osteoporosis or Paget's disease. They are highly hydrophilic and therefore of low oral bioavailability. Determination methods for bisphosphonates are often laborious and expensive equipment is needed. The presented quantification method based on kinetic measurement of the fluorescence decrease of an Al(3+)-morin complex can be used to determine the bisphosphonate content in aqueous and plasma samples. The intra- and inter-assay accuracies were found to be within 98.8% and 102.3% of the target samples for clodronate and within 97.2% and 105.0% of the target samples for alendronate. The LOQ was defined as 15.6 ng/ml for clodronate and 62.5 ng/ml for alendronate. In serum samples, intra- and inter-assay accuracy was found to be within 99.0% and 101.6% of the target samples for clodronate and within 97.8% and 102.6% of the target samples for alendronate. In serum samples, the LOQ was defined as 1.55 mg/ml for clodronate and 0.39 mg/ml for alendronate. Though less sensitive in serum, the presented method could support research on the development of drug delivery systems in vitro and in vivo for the investigated and other structurally related bisphosphonates.

Use of 18O3-clodronate as an internal standard for the quantitative analysis of clodronate in human plasma by gas chromatography/electron ionisation mass spectrometry.

A sensitive and specific method for the quantitative determination of clodronate in human plasma is presented. The drug was extracted from plasma by anion-exchange chromatography and derivatised to the tetra-tert-butyldimethylsilyl derivative. 18O3-Clodronate was prepared from unlabeled clodronate and used as an internal standard. Gas chromatography/mass spectrometry (GC/MS) under electron ionisation conditions was used for quantitative measurement of the drug, using m/z 643.16 and 651.17 for target and internal standard, respectively. Calibration graphs were linear within the range of 10-1280 ng/mL plasma. Intra-day precision was 1.8% (10 ng/mL), 0.5% (40 ng/mL), 1.0% (120 ng/mL), 0.5% (200 ng/mL), 0.5% (400 ng/mL) and 2.7% (800 ng/mL) and inter-day variability was found to be 0.7% (10 ng/mL), 1.6% (40 ng/mL), 1.3% (120 ng/mL), 2.3% (200 ng/mL), 2.5% (400 ng/mL) and 1.2% (800 ng/mL). Intra-day accuracy showed deviations of 0.8% (10 ng/mL), 0.8% (40 ng/mL), 0.9% (120 ng/mL), 0.9% (200 ng/mL), 1.9% (400 ng/mL) and 0.3% (800 ng/mL) and intra-day accuracy was of -1.4% (10 ng/mL), 0.0% (40 ng/mL), -0.7% (120 ng/mL), -0.4% (200 ng/mL), -1.2% (400 ng/mL) and -3.3% (800 ng/mL). The stable isotope labeled standard was found to be stable under analysis conditions.

Determination of disodium clodronate in human plasma and urine using gas-chromatography-nitrogen-phosphorous detections: validation and application in pharmacokinetic study.

We present a specific method for the determination of disodium clodronate in human plasma and urine using a gas-chromatographic system with nitrogen phosphorus detector (NPD). The compound was extracted from plasma and urine samples by an anion-exchange resin and derivatizated with bistrimethylsilyltrifluoroacetamide (BSTFA). Sodium bromobisphosphonate was used as internal standard. The calibration curves were linear in both plasma and urine, with a regression coefficient r > 0.9975 in plasma and r > 0.9977 in urine. The limit of quantitation was 0.3 microg/ml in plasma and 0.5 microg/ml in urine. The method was validated by intra-day assays at three concentration levels. During the study we carried out inter-day assays to confirm the feasibility of the method. The precision in plasma at 0.5, 15, and 45 microg/ml was 12.4, 0.2, and 6.5% (n = 40), respectively; in urine at 0.8, 8, and 40 microg/ml it was 8.6, 6.4, and 9.3% (n = 40), respectively. The method was accurate and reproducible, and was successfully applied to determine the pharmacokinetic parameters of clodronate in healthy volunteers after intravenous infusion and intramuscular injection of 200 mg of the compound. The Cmax after intravenous infusion and intramuscular injection was 16.1 and 12.8 microg/ml, respectively. AUC(0-48 h) after infusion administration and intramuscular injection was 44.2 +/- 18.0 and 47.5 +/- 12.4 h microg/ml, respectively. The elimination half-life in both administrations was 6.31 +/- 2.7 h.

Comparison of pharmacokinetics of clodronate after single and repeated doses.

OBJECTIVE: Pharmacokinetics of orally given clodronate disodium, a drug for the treatment of hypercalcemia and bone resorption, were studied after a single dose of 400, 800 and 1600 mg given randomly to 11 healthy volunteers in a crossover manner, in 7-14 hospitalized cancer patients given 400, 800 and 1600 mg twice daily, each dosage for one week, and during the customary therapy in 15 additional cancer patients treated in hospital with 400 mg thrice daily for > or = 2 weeks. METHODS: Clodronate concentrations in serum and urine were measured by capillary gaschromatography with mass-selective detection. Pharmacokinetic parameters were calculated with a three-compartmental model. RESULTS: After a single oral dose to healthy volunteers the absolute clodronate concentrations increased almost dose-dependently. The mean cumulative excretion in urine was 1.72-2.77% of the dose, an interindividual range being from 0.92% to 5.52%. With 800 and 1600 mg twice daily for one week to cancer patients the serum drug concentrations increased almost progressively with increasing the dose. In cancer patients serum drug concentrations were clearly higher and renal drug clearances (mean 25-62 ml/min) lower than in healthy volunteers (mean 123-149 ml/min). The mean urinary excretions were 2.24-3.14% of the dose and interindividual ranges from 0.18% to 19.0%. During the routine cancer therapy with 400 mg thrice daily, the clodronate excretions in urine on two successive days were on an average 3.26% (range 0.0-10.5%). CONCLUSIONS: Absolute concentrations in serum and excretions in urine of orally given clodronate increase dose-dependently, but during the maintenance therapy in hospitalized cancer patients the renal drug clearances seem to be lower than in healthy volunteers. This and the large interindividual variation in kinetics propose therapeutic monitoring of clodronate for optimizing the oral dose of the drug.

Transformation of bisphosphonates into insoluble material in human blood in vitro.

The aim of the study was to find out whether bisphosphonates transform into insoluble material in human blood and serum in vitro. Samples of fresh blood and serum were incubated with various concentrations of 14C-labelled clodronate, etidronate, pamidronate and tiludronate for 2 h and 8 h at 37 degrees C. The presence of unfiltrable material in the plasma separated from the blood, and in the serum were studied with 1) 100, 300 and 1,000 kd (kilo Daltons) filter tubes centrifuged at 3,000 g for 60 min, and 2) high-speed centrifugation at 13,000 g for 30 min. The radioactivities in the ultrafiltrates and supernatants were compared to those in the native plasma or serum. All bisphosphonates transformed into unfiltrable material, which was separated from the samples with the 100 and 300 kd filters but not with the 1,000 kd filter. The material was not sedimented with the high-speed centrifugation. The lengthening of the incubation time from 2 h to 8 h increased the unfiltrable fraction, which generally was dependent on the drug concentration in the blood, too. However, the fraction of the unfiltrable material did not seem to increase with time when the drug was incubated with serum instead of blood. Since drug binding to plasma proteins is generally a very rapid process, some factors other than proteins only, e.g. cations or cation residues, present in the blood but not in the serum, should be involved in transforming of bisphosphonates into insoluble material in the blood.

Simultaneous determination of clodronate and its partial ester derivatives by ion-pair reversed-phase high-performance liquid chromatography coupled with evaporative light-scattering detection.

A new ion-pair HPLC method coupled with evaporative light-scattering detection (ELSD) for the simultaneous determination of clodronate and its partial esters has been developed. The simultaneous chromatographic separation was achieved on a reversed-phase C8 column with a gradient system and butylamine as an ion-pair reagent. This method provides good enough reproducibility and sensitivity for in vitro determinations of clodronate and its ester derivatives. The method is applied for hydrolysis studies of clodronate monoesters which have been described as possible prodrugs of clodronate.

Biodistribution of clodronate and liposomes used in the liposome mediated macrophage 'suicide' approach.

Clodronate (Cl2MBP; dichloromethylene-bisphosphonate)-containing liposomes are used to investigate the role of macrophages in immune and non-immune defense mechanisms by elimination of these macrophages followed by functional studies. The present studies characterize such liposomes in terms of the leakage of clodronate and the biodistribution of both the encapsulated drug and the liposomal carrier. The distribution of liposomes was studied using a radioactively labelled lipid phase marker (111In-DTPA-SA) and the distribution of the encapsulated drug was examined following injection of radioactively labelled clodronate (99mTc-Cl2MBP). Furthermore, the biodistribution of variously composed multilamellar liposomes (EPC/Chol molar ratio 7:1.3 or 7:7; EPC/Chol/PS 7:1.3:1 or 7:7:1; EPC/Chol/M 7:2:1; EPC/Chol/M-PE 7:2:1) after intravenous injection was investigated. The findings suggest that only one third of the originally entrapped clodronate was still encapsulated in the liposomes at the time of ingestion by the macrophages in the liver and spleen after intravenous injection of the clodronate containing liposomes. 3 h after injection no clodronate could be detected in the circulation.

Accumulation of bisphosphonates in the aorta and some other tissues of healthy and atherosclerotic rabbits.

Clodronate, etidronate, and pamidronate are highly hydrophilic bisphosphonates used for the treatment of bone resorption and hypercalcemia. They also inhibit the development of experimental atherosclerosis without influencing serum cholesterol level. We studied the distribution and the accumulation of the carbon 14-labeled bisphosphonates in the aorta and some other tissues of healthy rabbits and in rabbits with diet-induced atherosclerosis. After intravenous injection, clodronate and pamidronate disappeared from circulation more slowly in atherosclerotic than in healthy rabbits, and the drug concentrations in the peripheral tissues were generally lower in atherosclerotic than in healthy animals. At 24 hours after dosing in healthy rabbits, the mean aorta to plasma ratios of clodronate, etidronate, and pamidronate were, respectively, 2.4 to 2.8, 2.4 to 4.0, and 8.6 to 10. The corresponding ratios in atherosclerotic rabbits were, respectively, 13 to 22, 1.5 to 2.2, and 13 to 24. Seven days after the injection the mean clodronate concentration in the aortas of healthy rabbits was 0.5% to 0.9% of the dose given per tissue weight, and the concentration in those of atherosclerotic animals was 3.8% to 5.2% of the dose given per tissue weight. The results indicate that hydrophilic bisphosphonates, known to inhibit the atherogenesis, concentrate markedly in the aortas of healthy and atherosclerotic rabbits.

Short term clodronate treatment does not increase trabecular bone in posttraumatic osteopenia.

The paper describes the results of two experiments on clodronate treatment on bone metabolism in growing rabbits: 1. the serum and bone concentrations of the drug, and 2. the effects of 18 week clodronate treatment on quantitative histomorphometry of trabecular bone. The results indicated a rapid and high affinity of clodronate to bone after subcutaneous administration. Plate fixation of the tibia without a fracture or any operation on the femur induced a 25% decrease in bone volume per total volume in the femoral condyles. The osteopenic response resulted probably from operative trauma. Clodronate treatment for three months could not inhibit this decrease. The increase in calcium content in bone by the drug treatment (observed in diaphyseal bones in earlier studies) could not be verified on histology of trabecular bone.

Pharmacokinetics of clodronate in renal failure.

The pharmacokinetic parameters describing the fate of one intravenous clodronate (disodium dichloromethane diphosphonate) dose was studied in 24 normal subjects and in 24 patients with different degrees of renal insufficiency. The aim of the study was to derive data for adjustment of dosage in relation to renal function. Disodium clodronate in serum and urine samples was analyzed by capillary gas chromatography with mass-selective detection. The renal clearance (CLR) of clodronate was highly dependent on renal function and declined successively with declining glomerular filtration rate (GFR). Plasma clearance (CLP) declined, too, but to a lesser degree than CLR. The impairment of renal function resulted in decreased cumulative urinary elimination of clodronate and increased total areas under the serum concentration-time curve (AUC0-infinity). Hence, as the renal elimination of clodronate diminishes with decreasing GFR, there is a related retention of the substance. As a result of the present study, the following dosages are recommended: creatinine clearance (CLCr) from 50 to 80 ml/minute, 75-100% of normal dose; CLCr 12-50 ml/minute, 50-75% of normal dose; and ClCr < 12 ml/minute, 50% of normal dose. The results must be interpreted with caution in patients with malignancy and severe skeletal disease, in whom the nonrenal clearance may vary markedly.

Clodronate. A review of its pharmacological properties and therapeutic efficacy in resorptive bone disease.

Clodronate (clodronic acid, dichloromethylene bisphosphonate) is a bisphosphonate which has demonstrated efficacy in patients with a variety of diseases of enhanced bone resorption including Paget's disease, hypercalcaemia of malignancy and osteolytic bone metastases. In addition, early reports demonstrating potential efficacy of clodronate in the treatment of osteoporosis suggest a possible role in this debilitating disease. Short term intravenous administration (usually 300 mg/day for 5 days) or longer courses of oral clodronate (usually 1600 mg/day for 6 months) effectively reduced bone pain and/or improved mobility in most patients with Paget's disease, and these effects persisted for up to 12 months after discontinuing clodronate. When administered intravenously (300 mg/day for up to 12 days) to patients with malignant hypercalcaemia, serum calcium levels declined significantly within 2 days of starting treatment and approximately 70 to 95% of patients became normocalcaemic. While there is less experience with oral administration, clodronate (800 to 3200 mg/day) achieved normocalcaemia in the majority of patients, usually within 1 week, and serum calcium levels remained significantly reduced from baseline for up to 6 months with continued treatment. Clodronate is clearly superior to placebo and, based on a retrospective analysis, appears to produce greater and more sustained reductions in serum calcium levels than calcitonin in patients with malignant hypercalcaemia. The few available prospective comparative trials showed that clodronate is at least as effective as etidronate, but comparisons with alendronate and pamidronate produced results of questionable clinical relevance because of low bisphosphonate dosages used in these trials. Nevertheless, single intravenous doses of clodronate 600 mg or alendronate 7.5 mg (both agents repeated on day 3 if necessary) were comparable in efficacy, whereas a single intravenous dose of pamidronate 30 mg was more effective than a single intravenous dose of clodronate 600 mg. Normocalcaemic patients with osteolytic bone metastases due to advanced breast cancer experienced significant reductions in the number of episodes of hypercalcaemia and terminal hypercalcaemia, incidence of vertebral fractures and overall rate of morbid events, including the need for radiotherapy to treat bone-related pain, following treatment with clodronate 1600 mg/day for 3 years in a large placebo-controlled study. A similar large placebo-controlled trial in patients with multiple myeloma demonstrated that clodronate 2400 mg/day orally for 2 years significantly reduced progression of osteolytic bone lesions. Follow-up data from clinical trials revealed that the effects on development of fractures and hypercalcaemia persisted for at least 12 months after the drug was discontinued.(ABSTRACT TRUNCATED AT 400 WORDS)

The tissue distribution of clodronate (dichloromethylene bisphosphonate) in mice. The effects of vehicle and the route of administration.

Clodronate (dichloromethylene bisphosphonate) accumulates extensively in bone by binding to hydroxyapatite crystals. In an hypo-osmotic vehicle, it accumulates also in the spleen and, to a lesser extent, in the liver of mice and rats. In the present study, the effects of parenteral routes of administration (intravenous, intraperitoneal, and subcutaneous), drug dose, and injection vehicle on the distribution of [14C]-clodronate were studied in mice. The route of drug injection had no effect on the deposition of clodronate in bone. Either deionized water or iso-osmotic saline used as vehicles for intravenous administration of the drug caused equal and dose-dependent accumulation in bone. In iso-osmotic glucose, however, the osseous deposition of the drug was 2.2-2.5 times lower than in the other vehicles (water, saline, choline chloride). Clodronate accumulated in spleen and liver only after intravenous injection when the drug was in hypo-osmotic vehicle, and the process was saturable at high doses. The hypotonic vehicle probably causes a local hemolysis, and clodronate forms complexes with erythrocyte iron, which is a prerequisite for ingestion of the drug by splenic and hepatic macrophages.

Pharmacokinetics of disodium clodronate after daily intravenous infusions during five consecutive days.

The pharmacokinetics of disodium clodronate was studied in six patients, three females and two males with Paget's disease and one male patient with prostatic cancer. The drug was given at a dose of 300 mg/day as a 3-hour infusion for 5 consecutive days. The concentration of the drug in serum and urine was measured by a gas chromatographic method. The peak concentration of disodium clodronate in serum was 5.7 +/- 1.0 micrograms/ml (means +/- SD) for the males and 10.1 +/- 2.8 micrograms/ml for the females. The elimination half-lives of the drug were 0.76 +/- 0.47 h and 1.79 +/- 0.26 h and the total clearances 18.2 +/- 3.3 l/h and 11.5 +/- 1.9 l/h, respectively. During the fifth day both sexes showed similar mean clearances of 11.9 +/- 1.3 l/h and 11.1 +/- 2.5 l/h and half-lives of about 2 h. The renal clearances was 7.3 +/- 0.5 l/h and 5.9 +/- 0.4 l/h for males and females, respectively. The mean urinary excretion of disodium clodronate during the 5-day period was 59.5% in the male patients and 56.0% in the female patients. We concluded that the slow infusion may increase the accumulation of clodronate in the body causing a higher clearance and a lower urine excretion of the drug than seen in earlier studies with faster infusions.

Determination of (dichloromethylene) diphosphonate in physiological fluids by ion-exchange chromatography with phosphorus-selective detection.

An analytical method is presented for the determination of (dichloromethylene) disphosphonate (Cl2MDP) in serum and urine. Cl2MDP is isolated from biological samples by adsorption onto precipitated calcium phosphate. Orthophosphate is separated from Cl2MDP by anion-exchange chromatography using AG 1-X8 resin. Detection is accomplished on-line using a flame photometric detector. Potentially interfering condensed phosphates are removed by acid hydrolysis. Sample handling losses are corrected by monitoring the recovery of a [14C] Cl2MDP spike added to the samples. Determinations of Cl2MDP to concentrations as low as 2 mumol/l are possible. Extension of the method to determine other diphosphonates is discussed.