Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America.
Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, MA, United States of America.
Clin Chim Acta. 2019 Dec;499:1-3. doi: 10.1016/j.cca.2019.08.026. Epub 2019 Aug 27.
Urine immunoassays are frequently employed for methadone screening because they are relatively inexpensive and widely available. However, immunoassays are notoriously prone to false positives. We report that the use of vortioxetine (Trintellix® in the USA and Canada, Brintellix® worldwide) could cause false positives in the Roche KIMS Methadone II Urine immunoassay (MDN2).
We performed a spiking study using a parent drug vortioxetine concentration of 7500 ng/ml.
Urine specimens from seven patients on typical vortioxetine doses tested positive for methadone in the Roche assay but negative for methadone in a confirmatory (GC/MS) assay and two other immunoassay platforms. Because of the pharmacokinetics of vortioxetine and the high cross-reactivity of a metabolite in the MDN2 assay, routine use of the drug could cause false positives even without detectible parent drug in the urine.
Vortioxetine is commonly prescribed for mood disorders, which have high prevalence in patients treated for opioid addiction. For that reason, it is important that clinicians are aware of this interference.
由于尿免疫分析相对廉价且广泛可用，因此常用于美沙酮筛查。然而，免疫分析容易出现假阳性。我们报告称，使用文拉法辛（美国和加拿大的 Trintellix®，全球的 Brintellix®）可能会导致罗氏 KIMS 美沙酮 II 尿液免疫分析（MDN2）出现假阳性。
我们使用 7500ng/ml 的母体药物文拉法辛浓度进行了加标研究。
七名接受典型文拉法辛剂量治疗的患者的尿液样本在罗氏检测中呈美沙酮阳性，但在确证性（GC/MS）检测和另外两种免疫分析平台中呈美沙酮阴性。由于文拉法辛的药代动力学和 MDN2 检测中一种代谢物的高交叉反应性，即使尿液中检测不到母体药物，常规使用该药物也可能导致假阳性。
文拉法辛常用于治疗心境障碍，而心境障碍在接受阿片类药物成瘾治疗的患者中患病率很高。因此，临床医生了解这种干扰非常重要。
