title: Fenofibric Acid Can Cause False-Positive Urine Methylenedioxymethamphetamine Immunoassay Results.
abstract: We present a false-positive result of ecstasy (3,4-methylenedioxy-NN-methylamphetamine) screening due to the therapeutic use of fenofibrate, an antihyperlipidemic drug. Our hypothesis was that the main metabolite of fenofibrate, fenofibric acid, was responsible for this cross-reactivity on a DRI(®) Ecstasy Assay, using a cut-off of 500 ng/mL. We estimated that the addition of 225 µg/mL pure fenofibric acid to blank urine would be sufficient to result in a positive DRI(®) Ecstasy Assay. The results obtained on the urine samples analyses of the patient show that the DRI(®) Ecstasy Assay resulted negative 2 days after discontinuing fenofibrate treatment, when the urine fenofibric acid concentration corrected by creatinine and determinated by gas chromatography-mass spectrometry was 20.3 µg/mg creatinine. The cross-reactivity data for fenofibric acid would seem to indicate that there was insufficient concentration of measured compound to account for the positive immunochemical results for ecstasy. This apparent discrepancy can be explained in several ways, one of them is that the β-glucuronidase-resistent fenofibric acid isomers are responsible. This process could explain the low recovery of free fenofibric acid when we use the developed method for its quantification in urine samples. Positive results on immunoassay screening must be considered presumptive until confirmation with another method based on a different principle, preferably gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry.
authors.affiliation: Servicio de Análisis Clínicos and Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Carretera Valldemossa 79, Palma de Mallorca 07120, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Quesada
authors.affiliation: Servicio de Análisis Clínicos and Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Carretera Valldemossa 79, Palma de Mallorca 07120, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Gomila
authors.affiliation: Centro de Salud Coll d'en Rabassa, Atención Primaria de Mallorca, Ib-Salut, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Fe
authors.affiliation: Servicio de Análisis Clínicos, Hospital Son Llàtzer, Palma de Mallorca, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Servera
authors.affiliation: Servicio de Urgencias Médicas and Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.
authors.forename: Christopher
authors.initials: C
authors.lastname: Yates
authors.affiliation: Servicio de Análisis Clínicos and Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Carretera Valldemossa 79, Palma de Mallorca 07120, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Morell-Garcia
authors.affiliation: Servicio de Análisis Clínicos and Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Carretera Valldemossa 79, Palma de Mallorca 07120, Spain.
authors.forename: Bartomeu
authors.initials: B
authors.lastname: Castanyer
authors.affiliation: Servicio de Análisis Clínicos and Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Carretera Valldemossa 79, Palma de Mallorca 07120, Spain bernardino.barcelo@ssib.es.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Barceló
mesh_terms: D005189:False Positive Reactions; D005260:Female; D011345:Fenofibrate / Q000031:analogs & derivatives* / Q000652:urine; D008401:Gas Chromatography-Mass Spectrometry; D005966:Glucuronidase / Q000378:metabolism; D006801:Humans; D007118:Immunoassay; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000652:urine*; D015813:Substance Abuse Detection; D055815:Young Adult
chemical_list: C006012:fenofibric acid; D005966:Glucuronidase; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D011345:Fenofibrate