There has been a significant increase in the number of new intoxicants on the illegal drugs marke... more There has been a significant increase in the number of new intoxicants on the illegal drugs market globally, also in Norway. The substances are given the name NPS: Novel Psychoactive Substances, and are mainly sold over the Internet. Uncertain dosage of potent substances entails a risk of accidental overdose, and therefore serious intoxication and death. In this article we provide an overview of current knowledge with regard to these substances.
The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are ... more The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are all metabolized by the cytochrome P-450 isoenzyme CYP2C19, which is inhibited by the proton pump inhibitors (PPIs) omeprazole, esomeprazole, lansoprazole, and pantoprazole. The aim of the present study was to evaluate the effect of these PPIs on the serum concentrations of citalopram, escitalopram, and sertraline. Serum concentrations from patients treated with citalopram, escitalopram, or sertraline were obtained from a routine therapeutic drug monitoring database, and samples from subjects concomitantly using PPIs were identified. Dose-adjusted SSRI serum concentrations were calculated to compare data from those treated and those not treated with PPIs. Citalopram concentrations were significantly higher in patients treated with omeprazole (+35.3%; P < 0.001), esomeprazole (+32.8%; P < 0.001), and lansoprazole (+14.7%; P = 0.043). Escitalopram concentrations were significantly higher in patients treated with omeprazole (+93.9%; P < 0.001), esomeprazole (+81.8%; P < 0.001), lansoprazole (+20.1%; P = 0.008), and pantoprazole (+21.6%; P = 0.002). Sertraline concentrations were significantly higher in patients treated with esomeprazole (+38.5%; P = 0.0014). The effect of comedication with PPIs on the serum concentration of SSRIs is more pronounced for omeprazole and esomeprazole than for lansoprazole and pantoprazole, and escitalopram is affected to a greater extent than are citalopram and sertraline. When omeprazole or esomeprazole are used in combination with escitalopram, a 50% dose reduction of the latter should be considered.
It is frequently questioned whether cannabinoids are detectable in urine from individuals having ... more It is frequently questioned whether cannabinoids are detectable in urine from individuals having been passively exposed to hashish or marihuana smoke. Literature was reviewed to shed light on an issue that is often debated in the health services, judicial system and in sports. A Medline search with the index terms "cannabis", "hashish", "marihuana" was conducted in September 2007. Summaries, abstracts and reference lists of selected articles were screened for relevancy. Seven experimental studies with humans were identified. Cannabinoids were detected in urine in two studies where the subjects had been exposed to high smoke levels. In studies conducted under less extreme conditions no urine samples were positive for more than a few hours after exposure and the measured cannabinoid levels were low. When cannabinoids are detected in urine with conventional methods and limits of quantification the results are commensurate with active smoking.
The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are ... more The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are all metabolized by the cytochrome P-450 isoenzyme CYP2C19, which is inhibited by the proton pump inhibitors (PPIs) omeprazole, esomeprazole, lansoprazole, and pantoprazole. The aim of the present study was to evaluate the effect of these PPIs on the serum concentrations of citalopram, escitalopram, and sertraline. Serum concentrations from patients treated with citalopram, escitalopram, or sertraline were obtained from a routine therapeutic drug monitoring database, and samples from subjects concomitantly using PPIs were identified. Dose-adjusted SSRI serum concentrations were calculated to compare data from those treated and those not treated with PPIs. Citalopram concentrations were significantly higher in patients treated with omeprazole (+35.3%; P < 0.001), esomeprazole (+32.8%; P < 0.001), and lansoprazole (+14.7%; P = 0.043). Escitalopram concentrations were significantly hig...
Pregabalin has an abuse potential and is occasionally used as a recreational drug. To draw the ri... more Pregabalin has an abuse potential and is occasionally used as a recreational drug. To draw the right conclusions regarding new intake of pregabalin in situations of repeated urinary drug testing, the knowledge of its disappearance rate in urine is essential. One healthy male volunteer took a single oral dose of pregabalin at 2 occasions, first 75 mg and thereafter 150 mg. All urine was collected in 8-hour portions for 5 days and analyzed for pregabalin. A systematic search for literature describing concentrations of pregabalin in urine was performed, and the results from these studies were interpreted on the basis of the findings from the healthy volunteer. In the healthy volunteer, specimens remained positive for 56 hours after intake of 75 mg and for 64 hours after intake of 150 mg. Urinary elimination half-lives based upon creatinine-normalized concentrations were 5.7-5.9 hours. The systematic literature search revealed only 1 article describing urinary concentrations of pregabal...
In many clinical situations it is useful to measure drug levels in patient samples. The purpose o... more In many clinical situations it is useful to measure drug levels in patient samples. The purpose of this survey is to obtain an overview of the therapeutic drug monitoring analyses offered by Norwegian laboratories. At the end of 2011, the authors of this article phoned all the public and private hospitals in Norway, and located their laboratories. All clinical chemical and pharmacological laboratories were contacted and asked to state which drug analyses (including drugs-of-abuse and toxic alcohols, but excluding metabolites) they performed in blood/serum at the time in question. The overview thus obtained was updated and quality assured by means of further telephone contact with the laboratories in August 2012. Around 80 laboratories were contacted. In August 2012, 49 of them performed analyses of drugs in blood/serum. Altogether, these laboratories offered 151 different analyses. This article provides an overview of the analyses that were carried out, and where. The overview of analyses provided here can be used as a tool in everyday practice. However, the user must be aware that the analytical repertoire of the laboratories is constantly changing. A web-based, dynamic version is currently being planned.
There has been a significant increase in the number of new intoxicants on the illegal drugs marke... more There has been a significant increase in the number of new intoxicants on the illegal drugs market globally, also in Norway. The substances are given the name NPS: Novel Psychoactive Substances, and are mainly sold over the Internet. Uncertain dosage of potent substances entails a risk of accidental overdose, and therefore serious intoxication and death. In this article we provide an overview of current knowledge with regard to these substances.
The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are ... more The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are all metabolized by the cytochrome P-450 isoenzyme CYP2C19, which is inhibited by the proton pump inhibitors (PPIs) omeprazole, esomeprazole, lansoprazole, and pantoprazole. The aim of the present study was to evaluate the effect of these PPIs on the serum concentrations of citalopram, escitalopram, and sertraline. Serum concentrations from patients treated with citalopram, escitalopram, or sertraline were obtained from a routine therapeutic drug monitoring database, and samples from subjects concomitantly using PPIs were identified. Dose-adjusted SSRI serum concentrations were calculated to compare data from those treated and those not treated with PPIs. Citalopram concentrations were significantly higher in patients treated with omeprazole (+35.3%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), esomeprazole (+32.8%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and lansoprazole (+14.7%; P = 0.043). Escitalopram concentrations were significantly higher in patients treated with omeprazole (+93.9%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), esomeprazole (+81.8%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), lansoprazole (+20.1%; P = 0.008), and pantoprazole (+21.6%; P = 0.002). Sertraline concentrations were significantly higher in patients treated with esomeprazole (+38.5%; P = 0.0014). The effect of comedication with PPIs on the serum concentration of SSRIs is more pronounced for omeprazole and esomeprazole than for lansoprazole and pantoprazole, and escitalopram is affected to a greater extent than are citalopram and sertraline. When omeprazole or esomeprazole are used in combination with escitalopram, a 50% dose reduction of the latter should be considered.
It is frequently questioned whether cannabinoids are detectable in urine from individuals having ... more It is frequently questioned whether cannabinoids are detectable in urine from individuals having been passively exposed to hashish or marihuana smoke. Literature was reviewed to shed light on an issue that is often debated in the health services, judicial system and in sports. A Medline search with the index terms &amp;amp;quot;cannabis&amp;amp;quot;, &amp;amp;quot;hashish&amp;amp;quot;, &amp;amp;quot;marihuana&amp;amp;quot; was conducted in September 2007. Summaries, abstracts and reference lists of selected articles were screened for relevancy. Seven experimental studies with humans were identified. Cannabinoids were detected in urine in two studies where the subjects had been exposed to high smoke levels. In studies conducted under less extreme conditions no urine samples were positive for more than a few hours after exposure and the measured cannabinoid levels were low. When cannabinoids are detected in urine with conventional methods and limits of quantification the results are commensurate with active smoking.
The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are ... more The selective serotonin reuptake inhibitors (SSRIs) citalopram, escitalopram, and sertraline are all metabolized by the cytochrome P-450 isoenzyme CYP2C19, which is inhibited by the proton pump inhibitors (PPIs) omeprazole, esomeprazole, lansoprazole, and pantoprazole. The aim of the present study was to evaluate the effect of these PPIs on the serum concentrations of citalopram, escitalopram, and sertraline. Serum concentrations from patients treated with citalopram, escitalopram, or sertraline were obtained from a routine therapeutic drug monitoring database, and samples from subjects concomitantly using PPIs were identified. Dose-adjusted SSRI serum concentrations were calculated to compare data from those treated and those not treated with PPIs. Citalopram concentrations were significantly higher in patients treated with omeprazole (+35.3%; P < 0.001), esomeprazole (+32.8%; P < 0.001), and lansoprazole (+14.7%; P = 0.043). Escitalopram concentrations were significantly hig...
Pregabalin has an abuse potential and is occasionally used as a recreational drug. To draw the ri... more Pregabalin has an abuse potential and is occasionally used as a recreational drug. To draw the right conclusions regarding new intake of pregabalin in situations of repeated urinary drug testing, the knowledge of its disappearance rate in urine is essential. One healthy male volunteer took a single oral dose of pregabalin at 2 occasions, first 75 mg and thereafter 150 mg. All urine was collected in 8-hour portions for 5 days and analyzed for pregabalin. A systematic search for literature describing concentrations of pregabalin in urine was performed, and the results from these studies were interpreted on the basis of the findings from the healthy volunteer. In the healthy volunteer, specimens remained positive for 56 hours after intake of 75 mg and for 64 hours after intake of 150 mg. Urinary elimination half-lives based upon creatinine-normalized concentrations were 5.7-5.9 hours. The systematic literature search revealed only 1 article describing urinary concentrations of pregabal...
In many clinical situations it is useful to measure drug levels in patient samples. The purpose o... more In many clinical situations it is useful to measure drug levels in patient samples. The purpose of this survey is to obtain an overview of the therapeutic drug monitoring analyses offered by Norwegian laboratories. At the end of 2011, the authors of this article phoned all the public and private hospitals in Norway, and located their laboratories. All clinical chemical and pharmacological laboratories were contacted and asked to state which drug analyses (including drugs-of-abuse and toxic alcohols, but excluding metabolites) they performed in blood/serum at the time in question. The overview thus obtained was updated and quality assured by means of further telephone contact with the laboratories in August 2012. Around 80 laboratories were contacted. In August 2012, 49 of them performed analyses of drugs in blood/serum. Altogether, these laboratories offered 151 different analyses. This article provides an overview of the analyses that were carried out, and where. The overview of analyses provided here can be used as a tool in everyday practice. However, the user must be aware that the analytical repertoire of the laboratories is constantly changing. A web-based, dynamic version is currently being planned.
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