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Mefenamic acid prevents assessment of drug abuse with EMIT assays

Article  in  Clinical Chemistry · April 1993

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 False-PositIve Results from the Reference at 340 nm, the wavelength used in the
Syva EMIT’TMd.a.u. Monocional 1. Olsen KM, Gulliksen M, Christo- EMiT assays, were 0.97 A (urine 1
Amphetamine Assay as a Result of phersen AS. Metabolites of chlorpromazine diluted 50-fold) and 0.90 A (urine 2
and brompheniramine may cause false-pos- diluted 100-fold). Because the dilution
Antlpsychotic Drug Therapy itive urine amphetamine results with of samples in the assay cuvette is only
monoclonal EMiT d.a.u. immunoasaay. 18-fold, the initial absorbances were
To the Editor: Clin Chem 1992;38:611-2. beyond the limits of the instrument
As a result of work first carried out in used. The dilution required to produce
Terry Crane
this laboratory in 1989, the Syva Co. low enough absorbances would de-
Christine M. Dawson
(Palo Alto, CA) warns in its EMiT” T. R. Tickner crease the sensitivity of the assays.
product insert and its EMIT Drug Further investigation of the two
Abuse Urine Assay Cross-Reactivity Dept. of Chem. Pat/wi. samples by Toxilab demonstrated the
Norfolk and Norwich Hosp. presence of mefenamic acid. The spec-
List that positive results may be ob-
Norwich NR1 3SR, UK tra obtained are consistent with the
tained with the EMiT d.a.u. monoclonal
amphetamine assay in patients taking
presence of mefenamic acid, and con-
sultation with clinicians confirmed the
chlorpromazine. This interference is not Mefenamlc Acid Prevents prescription of this drug for both pa-
seen with the EMIT d.a.u. polyclonal
Assessment of Drug Abuse with tients. The same laboratory results
amphetamine assay. These observa- were seen in a urine sample from a
EMIT”' Assays
tions were confirmed recently (1). volunteer who had taken two 500-mg
Urine samples patients being
from tablets of Ponstan (mefenamic acid) on
prescribed antipsychotic drugs
other To the Editor:
the previous day. A blood sample was
were tested for amphetamine by both Problems of interference in drugs of
taken from the volunteer 1 h after the
mono- and polyclonal amphetamine abuse in urine immunoassay methods
first 500-mg dose and an EMIT assay
EMiT d.a.u. assays. The findings are are well documented and include false- for serum phenytoin was performed to
shown in Table 1, as are the normal positive results caused by prescribed
check for possible interferences in
doses of the drugs studied. All the urine medication (1) and false-positive or neg-
therapeutic drug assays. The initial
samples were examined by our amphet- ative results caused by the addition of absorbance on the Fara was 0.44 A, a
amine confirmatory method, i.e., gas common household chemicals (2). value that allows the measurement of
chromatography on an Apiezon/KOH Our routine drugs of abuse screen-
serum drugs by EMIT.
column, and found to be negative. ing involves EMiTTh (Syva Co., Palo Mefenamic acid is a nonopioid anal-
As can be seen from Table 1, there Alto, CA) assays for opiates, amphet- gesic commonly used for the relief of
were no thise-positive results with the amines (polyclonal), barbiturates, ben- mild to moderate pain, including men-
polyclonal assay. The lack of cross-reac- zoyleegonine, benzodiazepines, and strual pains (which was the reason for
tivity of thioridazine in the monoclonal cannabinoids (100 pg/L cutoft) per- its prescription in the two patients
assay confirms information supplied by formed with a Cobas Fara centrifugal described here). In conclusion, no re-
Syva Co. in the aforementioned list. All analyzer (Hoffmann-La Roche, Basle,
sults are obtainable by Syva EMiT
patients taking chiorpromazine and Switzerland) and thin-layer chroma- assays of drugs of abuse in urine from
fluspirilene were positive in the mono- tography on silica plates with Tox- patients being prescribed mefanamic
clonal assay. The variable results for ilabtm (Toxilab Inc., Irvine, CA) as acid, and laboratory staff as well as
pipothiazine treatment may be related back-up if needed. Recently we re- cliniciansneed to be aware of this.
to the uncertainty of the timing of the ceived urine samples for drug screens
urine sample relative to the once per of two young women, both known drug References
month depot injection of the drug. abusers. It was not possible to obtain 1. Rollins DE, Jennison TA, Jones G. In-
Clearly, results obtained with the EMiT results on either sample be- vestigation of interference by nonsteroidal
Syva EMIT monoclonal amphetamine cause of very high initial absorbance anti-inflammatory drugs in urine tests for
assay should be interpreted with care, readings. Examination of the ultravi- abused drugs. Clin Chem 1990;36:602-6.
especially if the patient is being pre- olet spectra of the diluted urine sam- 2. Warner A. Interference of common house-
scribed chlorpromazine, pipothiazine, ples showed two peaks, with maxima hold chemicals in immunoasaay methods for
drugs of abuse. Clin Chem 1989;35:648-51.
or fluspirilene. at 290 and 350 nm. The absorbances
Terry Crane
Michael N. Badminton
Christine M. Dawson
Table 1. Amphetamine Results for Patients Taking Antipsychotlc Drugs Sandra J. Rainbow
Monoclonal Polyclonal Dept. of Chem. Pat/wi.
Drug (usualdes.) No. of patiants + - + - Norfolk and Norwich Hosp.
Norwich NRI 3SR, UK
Chlorpromazine (100-300 13 13 0 0 13
mg/day)
Thioridazino (150-600 12 0 12 0 12
mg/day) Poiymerase Chain Reaction
Trlfluoperazine(2-4 1 0 1 0 1 Detection of a Highly Polymorphic
mg/day) VNTR Segment in Intron 1 of the
Pipothiazlne(25-50 mg 4 2 2 0 4 Human p53 Gene
Injection/month)
Flusplnlene(2-8 mg 5 5 0 0 5 TotheEditor:
injection/week)
Some segments of the human ge-
‘Reported as positive (+) or negative (-) with cutoffs of 0.3 mg/L.
nome exhibit polymorphism due to a

CLINICALCHEMISTRY, Vol. 39, No. 3, 1993 549

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