A Dilute and Shoot LC-MS/MS Method for Antipsychotics in Urine.

Area of Science:

• Pharmacology and Toxicology
• Analytical Chemistry
• Clinical Chemistry

Background:

• Poor adherence to antipsychotic medications is a significant clinical challenge.
• Current methods for assessing adherence, such as patient interviews and pill counts, have limitations.
• Existing analytical methods for antipsychotics often focus on blood analysis for therapeutic drug monitoring or toxicity.

Purpose of the Study:

• To develop and validate a novel, sensitive, and selective analytical method for quantifying antipsychotics and their metabolites in urine.
• To improve the assessment of antipsychotic adherence through a user-friendly urine-based assay.

Main Methods:

• A dilute and shoot liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the analysis of 19 antipsychotics and their metabolites.
• The method leverages unique and prevalent urine metabolites of specific antipsychotics (aripiprazole, brexpiprazole, haloperidol, lurasidone) to enhance sensitivity.
• Minimal sample preparation and fast analysis times were prioritized for clinical applicability.

Main Results:

• The developed method demonstrated selectivity and sensitivity for a broad range of antipsychotics and their metabolites in urine samples.
• The assay successfully quantified 19 different antipsychotics and metabolites, with enhanced sensitivity for key compounds.
• The method has been utilized for sample testing over a year, indicating its robustness and reliability.

Conclusions:

• This dilute and shoot urine analysis method provides a practical and effective tool for monitoring antipsychotic drug levels and adherence.
• The enhanced sensitivity for specific metabolites improves the detection capabilities for critical antipsychotic compounds.
• This analytical approach offers a valuable alternative or supplement to traditional adherence assessment methods in psychiatric care.