demethylmirtazapine and 8-hydroxymirtazapine

Mirtazapine is an antidepressant that acts specifically on noradrenergic and sertonergic receptors. A LC-MS method was developed that allows the simultaneous analysis of the R-(-)- and S-(+)-enantiomers of mirtazapine (MIR), demethylmirtazapine (DMIR), and 8-hydroxymirtazapine (8-OH-MIR) in plasma of MIR-treated patients. The method involves a 3-step liquid-liquid extraction, an HPLC separation on a Chirobiotic V column, and MS detection in electrospray mode. The limit of quantification (LOQ) for all enantiomers was 0.5 ng/mL, and the intra- and interday CVs were within 3.3% to 11.7% (concentration ranges 5-50 ng/mL). A method is also presented for the quantitative analysis of glucuroconjugated MIR and 8-OH-MIR. S-(+)-8-OH-MIR is present in plasma mainly as its glucuronide. Preliminary data suggest that in all patients, except in those comedicated with CYP2D6 inhibitors such as fluoxetine and thioridazine, R-(-)-MIR concentrations were higher than those of S-(+)MIR. Moreover, fluvoxamine seems also to inhibit the metabolism of MIR. Therefore, this method seems to be suitable for the stereoselective assay of MIR and its metabolites in plasma of patients comedicated with MIR and other drugs for routine and research purposes.

Topics: Adult; Aged; Aged, 80 and over; Antidepressive Agents, Tricyclic; Chromatography, High Pressure Liquid; Chromatography, Liquid; Female; Humans; Male; Mass Spectrometry; Mianserin; Middle Aged; Mirtazapine; Reproducibility of Results; Sensitivity and Specificity; Stereoisomerism

 To investigate the metabolism of mirtazapine (MIR) in Japanese psychiatric patients, we determined the plasma levels of MIR,.  Seventy-nine Japanese psychiatric patients were treated with MIR for 1-8 weeks to achieve a steady-state concentration. Plasma levels of MIR, DMIR, and 8-OH-MIR were determined using high-performance liquid chromatography. Plasma concentrations of MIR-G and 8-OH-MIR-G were determined by total MIR and total 8-OH-MIR (i. e., concentrations after hydrolysis) minus unconjugated MIR and unconjugated 8-OH-MIR, respectively. Polymerase chain reaction was used to determine CYP2D6 genotypes..  Plasma levels of 8-OH-MIR were lower than those of MIR and DMIR (median 1.42 nmol/L vs. 92.71 nmol/L and 44.96 nmol/L, respectively). The plasma levels (median) of MIR-G and 8-OH-MIR-G were 75.00 nmol/L and 111.60 nmol/L, giving MIR-G/MIR and 8-OH-MIR-G/8-OH-MIR ratios of 0.92 and 59.50, respectively. Multiple regression analysis revealed that smoking was correlated with the plasma MIR concentration (dose- and body weight-corrected, p=0.040) and that age (years) was significantly correlated with the plasma DMIR concentration (dose- and body weight-corrected, p=0.018). The steady-state plasma concentrations of MIR and its metabolites were unaffected by the number of CYP2D6*5 and CYP2D6*10 alleles..  The plasma concentration of 8-OH-MIR was as low as 1.42 nmol/L, whereas 8-OH-MIR-G had an approximate 59.50 times higher concentration than 8-OH-MIR, suggesting a significant role for hydroxylation of MIR and its glucuronidation in the Japanese population.

Topics: Age Factors; Alleles; Anti-Anxiety Agents; Asian People; Cytochrome P-450 CYP2D6; Genotype; Glucuronides; Humans; Hydroxylation; Japan; Mental Disorders; Mianserin; Mirtazapine; Smoking

Ultrasonic-assisted magnetic dispersive solid-phase microextraction coupled with high performance liquid chromatography has been developed for extraction and determination of mirtazapine, N-desmethyl mirtazapine, and 8-hydroxy mirtazapine in human urine and water samples. Magnetic graphene oxide-polyaniline nanocomposite (MGOPA) as a novel SPME sorbent was synthesized and used for the microextraction process. The analytical performance of MGOPA was compared with magnetic graphene oxide nanocomposite and indicated that the new sorbent was quite effective for extraction of mirtazapine, N-desmethyl mirtazapine, and 8-hydroxy mirtazapine. A two-stage experimental design approach, Plackett-Burman screening design and Box-Behnken optimization design, was used for screening and optimizing of significant variables in the microextraction process. The practical applicability of the proposed method was assessed by studying the linearity, intra-day and inter-day accuracy, enrichment factor, and precision. This method can be satisfactorily applied to the determination of mirtazapine and its metabolites in human urine and environmental water samples. Graphical Abstract Magnetic graphene oxide-polyaniline nanocomposite.

Topics: Adsorption; Aniline Compounds; Antidepressive Agents, Tricyclic; Chromatography, High Pressure Liquid; Factor Analysis, Statistical; Fresh Water; Graphite; Healthy Volunteers; Humans; Magnets; Mianserin; Mirtazapine; Nanocomposites; Oxides; Solid Phase Microextraction; Sonication; Water Pollutants, Chemical

A simple, rapid and sensitive chiral capillary zone electrophoresis coupled with acetonitrile-field-amplified sample stacking method was developed that allows the simultaneous enantioselective separation of the mirtazapine, N-demethylmirtazapine, 8-hydroxymirtazapine and mirtazapine-N-oxide. The separation was achieved on an uncoated 40.2 cm×75 μM fused silica capillary with an applied voltage of 16 kV. The electrophoretic analyses were carried out in 6.25 mM borate-25 mM phosphate solution at pH 2.8 containing 5.5 mg/mL carboxymethyl-β-cyclodextrin. The detection wavelength was 200 nm. Under these optimized conditions, satisfactory chiral separations of four pair enantiomers were achieved in less than 7 min in vitro. After one step clean-up liquid-liquid extraction using 96-well format, sample was introduced capillary zone electrophoresis with acetonitrile-field-amplified sample stacking to enhance the sensitivity of enantiomers. The method was validated with respect to specificity, linearity, lower limit of quantitation, accuracy, precision, extraction recovery and stability. The lower limit of quantification was 0.5 ng/mL with linear response over the 0.5-50 ng/mL concentration range for each mirtazapine, N-demethylmirtazapine and 8-hydroxymirtazapine enantiomer. The developed and validated method has been successfully applied to the enantioselective pharmacokinetic studies in 12 healthy volunteers after oral administration of rac- mirtazapine.

Topics: Acetonitriles; Administration, Oral; Antidepressive Agents, Tricyclic; beta-Cyclodextrins; Biotransformation; Buffers; Chemical Fractionation; Cyclic N-Oxides; Electrophoresis, Capillary; Humans; Limit of Detection; Male; Mianserin; Mirtazapine; Reproducibility of Results; Stereoisomerism

Mirtazapine (MRT) is a human antidepressant drug mainly metabolised by the cytochrome P450 enzyme system to 8-OH mirtazapine (8-OH) and dimetilmirtazapine (DMR). The drug is usually administered to dogs with anorexia according to doses extrapolated from humans, although it could also have applications as an antidepressant and analgesic in this species. The aim of this study was to assess the pharmacokinetics of MRT and its metabolites, DMT and 8-OH. Six healthy male Beagle dogs were administered MRT orally (20 mg/dog) and plasma MRT and metabolite concentrations were evaluated by high performance liquid chromatography with fluorescence detection. The pharmacokinetic profiles of MRT and DMR were similar (detected from 0.25 up to 10 h), while 8-OH (detected from 0.50 up to 10 h) attained the highest concentrations. The mean half-life of MRT was 6.17 h with a clearance of 1193 mL/h/kg. The study showed that MRT has a different pharmacokinetic profile in the dog compared to other species.

Topics: Administration, Oral; Animals; Antidepressive Agents, Tricyclic; Chromatography, High Pressure Liquid; Dogs; Half-Life; Male; Metabolic Clearance Rate; Mianserin; Mirtazapine; Pilot Projects

A selective and reproducible off-line solid-phase microextraction procedure was developed for the simultaneous enantioselective determination of mirtazapine (MRT), demethylmirtazapine and 8-hydroxymirtazapine in human urine. CE was used for optimization of the extraction procedure whereas LC-MS was used for method validation and application. The influence of important factors in the solid-phase microextraction efficiency is discussed, such as the fiber coatings, extraction time, pH, ionic strength, temperature and desorption time. Before extraction, human urine samples were submitted to enzymatic hydrolysis at 37 degrees C for 16 h. Then, the enzyme was precipitated with trichloroacetic acid and the pH was adjusted to 8 with 1 mol/L pH 11 phosphate buffer solution. In the extraction, the analytes were transferred from the aqueous solution to the polydimethylsiloxane-divinylbenzene fiber coating and then desorbed in methanol. The mean recoveries were 5.4, 1.7 and 1.0% for MRT, demethylmirtazapine and 8-hydroxymirtazapine enantiomers, respectively. The method was linear over the concentration range of 62-1250 ng/mL. The within-day and between-day assay precision and accuracy were lower than 15%. The method was successfully employed in a preliminary cumulative urinary excretion study after administration of racemic MRT to a healthy volunteer.

Topics: Antidepressive Agents, Tricyclic; Buffers; Chromatography, Liquid; Humans; Hydrogen-Ion Concentration; Mianserin; Mirtazapine; Osmolar Concentration; Reproducibility of Results; Solid Phase Microextraction; Stereoisomerism; Tandem Mass Spectrometry

Mirtazapine is a tetracyclic antidepressant drug available as a racemic mixture of S(+)- and R(-)-mirtazapine. These enantiomers have different pharmacological properties, and both contribute to the clinical and adverse effects of the drug. Cytochrome P450 (CYP) 2D6 has been implicated in the metabolism of S(+)-mirtazapine. However, the effect of CYP2D6 on serum concentrations of the enantiomers of mirtazapine and its metabolites has not been assessed in patients on long-term treatment. The main objective of the study was to evaluate the effect of the CYP2D6 genotype on enantiomeric steady-state trough serum concentrations of mirtazapine and its metabolites N-desmethylmirtazapine and 8-hydroxymirtazapine. The effects of sex, age and smoking behaviour were also assessed.. The study included 95 patients who had depression according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition and were treated for 4 weeks with a daily dose of mirtazapine 30 mg. The serum concentrations of the enantiomers of mirtazapine and its metabolites were analysed by liquid chromatography-mass spectrometry, and the subjects were genotyped for CYP2D6 alleles *3, *4, *5 and *6 and gene duplication.. Three subjects (3%) were classified as ultrarapid metabolizers (UMs), 56 (59%) as homozygous extensive metabolizers (EMs), 30 (32%) as heterozygous EMs and 6 (6%) as poor metabolizers (PMs) of CYP2D6. The median trough serum concentrations of S(+)-mirtazapine were higher in PMs (59 nmol/L, p = 0.016) and in heterozygous EMs (39 nmol/L, p = 0.013) than in homozygous EMs (28 nmol/L). PMs and heterozygous EMs also had higher mirtazapine S(+)/R(-) ratios (0.4) than homozygous EMs (0.3, p = 0.015 and 0.004, respectively). The S(+)-N-desmethylmirtazapine concentration was higher in PMs (16 nmol/L) than in homozygous EMs (7 nmol/L, p = 0.043). There was an association between the CYP2D6 genotype and the ratio between S(+)-8-hydroxymirtazapine and S(+)-mirtazapine, with a significantly higher ratio in homozygous EMs than in heterozygous EMs (0.11 vs 0.05, p = 0.007). The influence of the CYP2D6 genotype on S(+)-mirtazapine, the mirtazapine S(+)/R(-) ratio and S(+)-N-desmethylmirtazapine remained significant after correction for the influence of sex, age and smoking. Smokers had significantly lower concentrations of S(+)-mirtazapine (23 vs 39 nmol/L, p = 0.026) and R(-)-N-desmethylmirtazapine (39 vs 51 nmol/L, p = 0.036) and a significantly lower mirtazapine S(+)/R(-) ratio (0.28 vs. 0.37, p = 0.014) than nonsmokers, and the effect of smoking remained significant after multivariate analysis.. This study is the first to show the impact of the CYP2D6 genotype on steady-state serum concentrations of the enantiomers of mirtazapine and its metabolites. Our results also support the role of CYP1A2 in the metabolism of mirtazapine, with lower serum concentrations in smokers than in nonsmokers.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP2D6; Female; Genotype; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Prospective Studies; Smoking; Stereoisomerism

Capillary electrophoresis and liquid-phase microextraction using porous polypropylene hollow fibers were employed for the enantioselective analyses of mirtazapine and its metabolites demethylmirtazapine and 8-hydroxymirtazapine in human urine. Before the extraction, urine samples (1.0 mL) were submitted to enzymatic hydrolysis at 37 degrees C for 16 h. Then, the enzyme was precipitated with trichloroacetic acid, the pH was adjusted to 8 with 0.5 mol/L phosphate buffer solution (pH 11) and 15% sodium chloride was further added. The analytes were transferred from the aqueous donor phase, through n-hexyl ether (organic solvent immobilized in the fiber), into 0.01 moL/L acetic acid solution (acceptor phase). The electrophoretic analyses were carried out in 50 mmol/L phosphate buffer solution (pH 2.5) containing 0.55% w/v carboxymethyl-beta-cyclodextrin. The method was linear over the concentration range of 62.5-2500 ng/mL for each mirtazapine and 8-hydroxymirtazapine enantiomer and 62.5-1250 ng/mL for each demethylmirtazapine enantiomer. The quantification limit was 62.5 ng/mL for all the enantiomers. Within-day and between-day assay precision and accuracy were lower than 15% for all the enantiomers. Finally, the method proved to be suitable for pharmacokinetic studies.

Topics: Electrophoresis, Capillary; Humans; Hydrolysis; Mianserin; Mirtazapine; Temperature

In this work, the simultaneous enantioseparation of the second-generation antidepressant drug mirtazapine and its main metabolites 8-hydroxymirtazapine and N-desmethylmirtazapine by chiral CEC is reported. The separation of all enantiomers under study was achieved employing a capillary column packed with a vancomycin-modified diol stationary phase. With the aim to optimize the separation of the three pairs of enantiomers in the same run, different experimental parameters were studied including the mobile phase composition (buffer concentration and pH, organic modifier type and ratio, and water content), stationary phase composition, and capillary temperature. A capillary column packed with vancomycin mixed with silica particles in the ratio (3:1) and a mobile phase composed of 100 mM ammonium acetate buffer (pH 6)/H(2)O/MeOH/ACN (5:15:30:50, by vol.) allowed the complete enantioresolution of each pair of enantiomers but not the simultaneous separation of all the studied compounds. For this purpose, a packing bed composed of vancomycin-CSP only was tested and the baseline resolution of the three couples of enantiomers was achieved in a single run in less than 30 min, setting the applied voltage and temperature at 25 kV and 20 degrees C, respectively. In order to show the potential applicability of the developed CEC method to biomedical analysis, a study concerning precision, sensitivity, and linearity was performed. The method was then applied to the separation of the enantiomers in a human urine sample spiked with the studied compounds after suitable SPE procedure with strong cation-exchange (SCX) cartridges.

Topics: Antidepressive Agents; Capillary Electrochromatography; Humans; Mianserin; Mirtazapine; Stereoisomerism; Vancomycin

The tetracyclic antidepressant mirtazapine has been in clinical use for several years as a racemic drug. Because of a relatively narrow therapeutic index, therapeutic drug monitoring may be helpful to individually optimize therapy with mirtazapine. An enantioselective high-performance liquid chromatography (HPLC) method with fluorescence detection has been developed for the quantification of mirtazapine, desmethyl mirtazapine, 8-hydroxy mirtazapine, and mirtazapine N-oxide. The method is suitable for the analysis of plasma and urine samples in the range from 1 to 100 ng/mL with precision (coefficient of variation, or CV) between 12% and 19%. The sample preparation step comprises a liquid-solid extraction procedure with good recoveries, between 85% and 99%. Patient samples for therapeutic drug monitoring as well as concentration-time series were assayed and the resulting enantiomer ratios analyzed. Typical trough levels were between 1 and 100 ng/mL, with enantiomer ratios of approximately 0.42 (S/R). In concentration-time series, enantiomer ratios distinctively greater than 1 were observed at early time points. Because the enantiomers of mirtazapine and desmethyl mirtazapine have different pharmacological properties, the method is believed to be helpful in understanding the concentration-effect relationships in the former.

Topics: Antidepressive Agents, Tricyclic; Chromatography, High Pressure Liquid; Cyclic N-Oxides; Drug Monitoring; Fluorescence; Humans; Male; Mianserin; Mirtazapine; Quality Control; Stereoisomerism

Little information exists on the concentrations of recent antidepressants and their metabolites in cerebrospinal fluid (CSF). Using a stereoselective method, we measured plasma and CSF levels of mirtazapine (MIR), N-demethylmirtazapine and 8-OH-MIR in 3 depressed patients treated with racemic MIR (45 mg/day) for 4 weeks. S-(+)-MIR is considered to be the antidepressant enantiomer, but only R-(-)-MIR reached measurable concentrations in CSF. For R-(-)-MIR, the CSF/plasma ratio varied between 0.08 and 0.31. Further studies are needed to test the hypothesis that there are possible differences in the transport mechanisms of the enantiomers of MIR at the blood-CSF barrier.

Topics: Adult; Antidepressive Agents, Tricyclic; Depressive Disorder; Drug Administration Schedule; Humans; Male; Mianserin; Mirtazapine; Severity of Illness Index; Stereoisomerism