Determination of amphetamine and methylphenidate in exhaled breath of patients undergoing attention-deficit/hyperactivity disorder treatment.
OBJECTIVE
It has been discovered recently that exogenous substances are detectable in exhaled breath after intake. Exhaled breath therefore constitutes a new possible matrix in clinical pharmacology and toxicology. The present work was aimed at exploring this possibility further by a study on patients treated for attention-deficit/hyperactivity disorder with D-amphetamine and methylphenidate.


METHODS
Thirteen patients (age range: 32-61 years; 5 women) were included in the study, and breath and urine samples were collected at different times in the dose interval. Analyses of breath and urine samples were done with liquid chromatography-mass spectrometry methods. Urine was examined for amphetamine, methylphenidate, and its metabolite ritalinic acid.


RESULTS
Among the 9 patients who received D-amphetamine medication in daily doses of 20-100 mg, amphetamine was detected in all subjects in amounts ranging from 1200 to 30,800 picogram per filter. Among 8 patients receiving methylphenidate medication in daily doses of 80-400 mg, it was detected and quantified in 7 of the cases in amounts ranging from 150 to 10,400 picogram per filter and ritalinic acid was detected and quantified in 3 of the cases ranging from 35 to 360 picogram per filter. In 1 case, methylphenidate was only detectable in breath and urine, whereas ritalinic acid was quantifiable in urine, which could indicate noncompliance, with the 4 hours of dose regimen prescribed. In a number of cases, the sampling was performed 24 hours after the last dose intake. Identification of amphetamine and methylphenidate was based on correct chromatographic retention time and correct product ion ratio with detection performed in selected reaction monitoring mode.


CONCLUSIONS
The results confirm that amphetamine is present in exhaled breath after intake and demonstrate for the first time the presence of methylphenidate and ritalinic acid after its intake. This gives further support to the potential use of exhaled breath for detecting drug intake.
*Department of Laboratory Medicine, Section of Clinical Pharmacology, Karolinska Institutet; and †Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Olof
O
Beck
Niclas
N
Stephanson
Sören
S
Sandqvist
Johan
J
Franck
D000328:Adult; D000661:Amphetamine / Q000737:chemistry* / Q000378:metabolism / Q000652:urine; D001289:Attention Deficit Disorder with Hyperactivity / Q000000981:diagnostic imaging* / Q000378:metabolism*; D002853:Chromatography, Liquid / Q000379:methods; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D008774:Methylphenidate / Q000031:analogs & derivatives* / Q000737:chemistry* / Q000378:metabolism / Q000652:urine; D008875:Middle Aged; D015813:Substance Abuse Detection / Q000379:methods; D014463:Ultrasonography
D008774:Methylphenidate; D000661:Amphetamine; C009189:ritalinic acid