Cyclodextrin Micellar LC for Direct Selective Analysis of Combined Dosage Drugs in Urine.

Two cyclodextrin micellar liquid chromatographic methods were developed and applied to the simultaneous determination of bisoprolol/hydrochlorothiazide and atenolol/chlorthalidone combinations in urine matrices without sample pretreatment. These combined ß-blockers and diuretics chemotherapies are commonly used in the treatment of hypertension and cardiovascular diseases. Hybrid isocratic mobile phases containing hydroxypropyl-ß-cyclodextrin, sodium dodecyl sulfate, phosphate buffer and methanol on a Luna C18 column with 0.5 mL min(-1) flow rate and 25.0°C column temperature were used. The methods were sensitive enough for the determination of analytes at the therapeutic urine levels with limits of detections down to 1.0 µg mL(-1); relative standard deviations and recoveries were ranged between 1.5-4.4% and 98.00-109.52%, respectively. Urinary excretion studies showed that the detection of drugs is possible up to 24 h after their ingestion. The selective proposed separations with less consumption of organic solvents over the hitherto ones could be attributed to the four point competitive interactions among analysts, pseudostationary phases and a real stationary phase.

Chromatographic separation of chlorthalidone enantiomers using beta-cyclodextrins as chiral additives.

Different beta-cyclodextrins have been tested as chiral additives in the mobile phase for the chromatographic analysis of chlorthalidone enantiomers in a C18 LiChrospher (125 x 4 mm I.D.) column. The effect on enantioresolution of different parameters was studied: composition of the mobile phase (percentage of organic solvent, type of buffer and pH), mobile phase flow-rate, and type and concentration of beta-cyclodextrin. A 25:75 mixture of methanol and 0.1 M phosphate buffer, pH 4, containing 2% triethylamine (v/v), and 12.5 mM beta-cyclodextrin, at a flow-rate of 0.8 ml/min, was found to be the best option for the resolution of chlorthalidone enantiomers. Under such conditions, linear calibration curves were obtained in the 0.5-20-microg/ml interval using UV detection at 230 nm. The limit of detection for both isomers was 50 ng/ml. The utility of the described assay has been tested by analyzing chlorthalidone in different pharmaceutical preparations. Examples of application to biological samples are also given.

On-line solid-phase extraction and high-performance liquid chromatographic determination of chlorthalidone in urine.

A simple and rapid on-line method for the determination of chlorthalidone in urine is proposed. The sample containing the internal standard is injected in a CN precolumn. After a 2-ml water rinsing, the precolumn is coupled for 30 s to the HPLC column via a switching, valve, allowing the on-line elution of the compounds of interest. Analysis is carried out by reversed-phase chromatography with an acetonitrile-0.01 M phosphate buffer pH 7 (20:80, v/v) eluent, using UV detection at 214 nm. While the LC separation is performed, the precolumn is regenerated and conditioned, and is ready to receive the next sample at the end of the run. Accurate (> 95%) and precise (< 10%) analyses, in the range of 0.1-20 micrograms/ml of chlorthalidone in urine, have been achieved using this method.

[Surreptitious intake of diuretics as the cause of pseudo-Bartter's syndrome: apropos of a case and differential diagnosis]. / Ingesta subrepticia de diuréticos como causa de "Pseudo-Síndrome Bartter", a propósito de un caso y diagnóstico diferencial.

We describe a 39 years old patient with a history of chronic symptomatic hypokalemia. She denied taking any drugs. She satisfied the clinical criteria for Bartter's syndrome and more precisely for Gitelman's syndrome: hypokalemia in the presence of inappropriately high potassium excretion, metabolic alkalosis, hyperreninemic hyperaldosteronism, hypomagnesemia with inappropriately high magnesium excretion, normocalcemia, hypocalciuria and normal blood pressure. A HPLC analysis detected the presence of furosemide in urine and chlorthalidone in urine and plasma samples. After the self administration of diuretics was stopped, the above alterations came back to normality. Prior to the verification of a self administration of diuretics, the patient showed clinical and biochemical parameters that oriented to surreptitious diuretic ingestion (Pseudo-Bartter's syndrome) not to Bartter's syndrome or Gitelman's syndrome, particularly the plasma potassium readily restored to normal by the administration of potassium chloride supplements, the increased plasma uric acid with low uric acid fractional clearance, the widely different urine and plasma electrolyte levels and the presence psychiatric disorders. The literature is reviewed and differential diagnosis, among this three syndromes, is made.

Improved detection limits for screening of diuretics by coupled liquid chromatography and ultraviolet-visible spectrophotometry.

Experimental conditions have been studied in order to improve the sensitivity for the analysis of diuretics and probenecid in urine samples by high-performance liquid chromatography with ultraviolet detection. Sample clean-up and chromatographic parameters have been optimized to obtain a suitable sensitivity for the detection or quantification of each diuretic using an HP-Hypersil ODS-C18 column (5 microns, 250 mm x 4 mm I.D.), taking into account the pharmacological properties of each compound. The reliability of this method was tested by analysing urine samples after a minimum single-dose administration of chlorthalidone and probenecid.

Compliance to treatment for hypertension in elderly patients: the SHEP pilot study. Systolic Hypertension in the Elderly Program.

Assessing the compliance of people over 60 years of age and older with an antihypertensive treatment regimen was a major objective of the Systolic Hypertension in the Elderly Program (SHEP) pilot study. The study randomized 551 men and women over the age of 60 (mean age = 72 years) to a stepped care treatment that included chlorthalidone or placebo in a double-blind trial. Three measures of compliance to treatment protocol--pill count, self-report, and a urine chlorthalidone assay--all indicated high levels of compliance in 80 to 90% of participants at 3 months and 1 year after randomization. Pill-taking compliance was similar in the active and placebo groups, although the rate of discontinuance from study medications at 1 year was higher in the placebo than in the active group. Compliance was high in all age categories, including those over age 80. These data suggest that elderly patients can achieve high levels of compliance with antihypertensive medications.

Analysis of chlorthalidone in biological fluids by high-performance liquid chromatography using a rapid column cleanup procedure.

A high-performance liquid chromatographic assay usable for clinical monitoring of chlorthalidone in biological fluids was developed. Extraction efficiency was greater than 80% for blood and urine using a rapid, disposable column cleanup procedure. Chlorthalidone could be reliably measured in the range of 100-4,000 ng/ml in biological fluids with excellent day-to-day reproducibility and within-day precision. Chlorthalidone was found to be stable at -20 degrees C in blood and urine for at least 1 year, permitting repeat assays and large clinical studies to be conducted. The pharmacokinetics of chlorthalidone was studied in 24 subjects over a 120-h time interval following a single dose. chlorthalidone has a long terminal half-life in whole blood of 49 h, with peak concentrations occurring 8-10 h after oral dosing. During the first 12 h after dosing, chlorthalidone was rapidly excreted into urine followed by a slower phase with a half-life of 49 h.

Can simple clinical measurements detect patient noncompliance?

Measurement of patient compliance is essential if management of low compliance is to be performed efficiently. We assessed the value of several easily obtained clinical assessments compared to quantitative pill counts among 134 newly treated hypertensive male steelworkers during the first 6 months of their treatment with antihypertensive medication. Patient's self-reports obtained on structured interview correlated best with pill count compliance (r = 0.74, p less than 0.0001). Patients overestimated their compliance by an average of 17% but 90% of those who admitted to being noncompliant were found so. Qualitative urinary chlorthalidone and hydrochlorothiazide levels and changes in serum potassium, uric acid, and blood pressure also correlated with pill count compliance but were less accurate than interviews. Assessment of the patient's "health beliefs" and a variety of sociodemographic and health traits and perceptions did not provide useful information on compliance. Interviewing the patient is a simple and useful approach in assessing compliance with antihypertensive therapy.

Biliary excretion of chlorthalidone in humans.

A single oral dose of the diuretic chlorthalidone (100 or 200 mg) was given to six cholecystectomized patients with T-tube drainage of the common bile duct, and the 24 h bile and urine were collected during 3--7 days. Urinary recovery of chlorthalidone was 23--27 per cent of the dose, which is in the range of that in healthy volunteers. Chlorthalidone concentration in bile was 11--44 times lower than urine concentration in corresponding periods, and biliary recovery was only 0.6--1.4 per cent of the dose. When compared from equal periods of sampling of bile and urine, the same relative amount of drug was found in bile, whether the 100 or 200 mg dose had been given (viz., a fraction of 2.5--4.7 per cent and 2.5--5.7 per cent of corresponding urinary amounts respectively). It was concluded that excretion into bile constitutes only a minor route of elimination for unchanged chlorthalidone. Bile samples treated with glucuronidase and sulphatase showed no increase of chlorthalidone concentration. The open acid analogue of chlorthalidone, 3-(4-chloro-3-sulphamoylbenzoyl)-benzoic acid, was apparently not formed as a human metabolite, as evidenced by gas chromatographic analysis of both urine and bile.

Automated analysis of chlorthalidone.

Chlorthalidone inhibition of the enzymatic hydrolysis rate of p-nitrophenyl acetate by bovine erythrocyte carbonic anhydrase was used as a basis for chlorthalidone determination in plasma and urine. For urinary samples, a completely automated, continuous flow system was developed to extract the samples and perform the enzymatic reaction. Over 100 samples per day could be assayed by one person. The assay had a sensitivity of 0.5 micrograms/ml and thus could determine urinary concentrations after a therapeutic chlorthalidone dose. To determine plasma concentrations after a therapeutic dose, a manual extraction procedure was used in combination with a second continuous flow system for the enzymatic reaction. This system was optimized to detect the lowest chlorthalidone concentration allowed by the enzymatic inhibition constant and could detect 25 ng/ml.

Determination of chlorthalidone in plasma, urine and red blood cells by gas chromatography with nitrogen detection.

A sensitive and selective gas chromatographic method is described for determining the diuretic and antihypertensive drug chlorthalidone in plasma, urine and erythrocytes. Use is made of an alkali flame ionization detector (nitrogen detector), and the chlorthalidone and internal standard are chromatographed as methyl derivatives. Down to 10 ng of drugs in the biological sample can be measured accurately, with a standard deviation of 5%. Because the concentration of chlorthalidone found in erythrocytes is 50-100 times higher than that in plasma, the influence of haemolysis on the plasma concentration has been investigated. In addition, a pharmacokinetic study with human volunteers revealed that the apparent concentration of the drug found in plasma can be much too low (by more than 50%), if the plasma is not separated from the erythrocytes immediately after venipuncture. Precautions to be observed to ensure correct handling of blood samples (so that results for plasma concentrations will be reliable) are stressed. The findings have application in kinetic studies on chlorthalidone.

Chlorthalidone analysis using carbonic anhydrase inhibition.

Chlorthalidone was analyzed in the concentration range of 0.1-3.0 microgram/ml with a precision of +/- 0.05 microgram/ml. Chlorthalidone inhibition of the enzymatic hydrolysis rate of p-nitrophenyl acetate by bovine erythrocyte carbonic anhydrase was used as a basis for the determination. The amount of p-nitrophenol formed was measured by monitoring the absorbance at 400 nm, and its formation rate was proportional to the chlorthalidone concentration. The mixing of the enzyme, substrate, and sample, the incubation of the reaction mixture, and the recording of the absorbance were automated. A survey of urine samples from 26 normal human subjects did not reveal any endogenous substances that interfered with the assay. Analyses of urine samples from six subjects after oral administration of 100 mg of chlorthalidone indicated rapid absorption and a biphasic elimination. The alpha-phase half-life was 1.5 hr, and the beta-phase half-life was 35 hr.

GLC determination of urinary chlorthalidone levels.

A sensitive and specific GLC method for the determination of urinary chlorthalidone levels was developed using on-column methylation. Chlorthalidone is converted to a tetramethylated derivative with trimethylanilinium hydroxide in methanol. This method which permits the determination of as little as 0.1 microgram of chlorthalidone/ml of dog urine, should be adequate for use with human subjects receiving a clinical dose.