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Evaluating Updated Fentanyl Immunoassays for Loperamide Interference.

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Loperamide and its metabolites can cause false-positive fentanyl test results in some immunoassays. This highlights the need for careful interpretation of urine drug screening results to avoid misdiagnosis.

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Area of Science:

  • Clinical Chemistry
  • Toxicology
  • Pharmacology

Background:

  • Loperamide, an opioid receptor agonist, is used for diarrhea treatment.
  • Previous studies noted loperamide's cross-reactivity with fentanyl immunoassays.
  • Newer fentanyl immunoassay devices are now available for clinical use.

Purpose of the Study:

  • To evaluate cross-reactivity of loperamide and its metabolites with new fentanyl immunoassays.
  • To assess the clinical implications of loperamide's cross-reactivity in drug testing.

Main Methods:

  • Tested five enzyme immunoassays and one lateral flow assay for fentanyl cross-reactivity.
  • Analyzed loperamide, N-desmethyl loperamide (dLop), and N-didesmethyl loperamide (ddLop) in drug-free urine.
  • Determined minimum reactive concentrations for positive results.

Main Results:

  • Three fentanyl immunoassays showed cross-reactivity with loperamide and/or its metabolites.
  • Immunalysis SEFRIA and Thermo Fisher DRI assays reacted to loperamide and its metabolites at specific concentrations.
  • Abbott iCassette, ARK Fentanyl II, and Lin-Zhi LZI II assays did not show cross-reactivity.

Conclusions:

  • Cross-reactivity of loperamide and its metabolites in certain fentanyl immunoassays can lead to false-positive results.
  • Careful interpretation of urine drug screening is essential.
  • Potential for misdiagnosis exists if cross-reactivity is not considered.