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- Title
Determining Zolpidem Compliance: Urinary Metabolite Detection and Prevalence in Chronic Pain Patients.
- Authors
Schwope, David M.; DePriest, Anne; Black, David L.; Caplan, Yale H.; Cone, Edward J.; Heltsley, Rebecca
- Abstract
Zolpidem (Ambien®) is the most prescribed insomnia treatment in the USA; however, little is known about zolpidem metabolite excretion in chronic pain patients. As zolpidem is extensively metabolized in vivo to zolpidem 4-phenyl carboxylic acid (ZCA), metabolite detection may provide improved accuracy for compliance determinations, thereby improving clinical decisions. Zolpidem and ZCA were extracted from 1 mL human urine by mixed-mode solid-phase extraction. Samples were analyzed by LC–MS-MS using positive electrospray ionization with multiple reaction monitoring mode employed for detection and quantification. Gradient chromatographic separation was achieved with a reversed-phase column in a rapid 1.8 min analysis. The assay was linear from 4 to 1,000 µg/L for zolpidem and 4 to 10,000 µg/L for ZCA. Interday recovery (bias) and imprecision (n = 20) were 100–107% of target and 2.4–3.7% relative standard deviation, respectively. Extraction efficiencies were 78–90%. Pain compliance samples (n = 3,142) were de-identified and analyzed for zolpidem and ZCA. Zolpidem was detected greater than limit of quantification in 720 specimens (22.9%), while ZCA was detected in 1,579 specimens (50.3%). Only five specimens contained zolpidem alone. ZCA was observed without parent zolpidem in 864 specimens, thereby increasing population detection rates by 27.5%. Addition of a zolpidem metabolite to compliance determinations substantially improved detection for zolpidem intake and also should prove useful in clinical and forensic settings.
- Subjects
UNITED States; ZOLPIDEM; METABOLITES; CHRONIC pain; INSOMNIA treatment; PATIENTS
- Publication
Journal of Analytical Toxicology, 2014, Vol 38, Issue 8, p513
- ISSN
0146-4760
- Publication type
Article
- DOI
10.1093/jat/bku068