Solid Phase-Based Microextraction Techniques in Therapeutic Drug Monitoring

Abstract

Therapeutic drug monitoring is an established practice for a small group of drugs, particularly those presenting narrow therapeutic windows, for which there is a direct relationship between concentration and pharmacological effects at the site of action. Drug concentrations in biological fluids are used, in addition to other clinical observation measures, to assess the patient’s status, since they are the support for therapy individualization and allow assessing adherence to therapy. Monitoring these drug classes is of great importance, as it minimizes the risk of medical interactions, as well as toxic effects. In addition, the quantification of these drugs through routine toxicological tests and the development of new monitoring methodologies are extremely relevant for public health and for the well-being of the patient, and it has implications in clinical and forensic situations. In this sense, the use of new extraction procedures that employ smaller volumes of sample and organic solvents, therefore considered miniaturized and green techniques, is of great interest in this field. From these, the use of fabric-phase extractions seems appealing. Noteworthy is the fact that SPME, which was the first of these miniaturized approaches to be used in the early ‘90s, is still the most used solventless procedure, providing solid and sound results. The main goal of this paper is to perform a critical review of sample preparation techniques based on solid-phase microextraction for drug detection in therapeutic monitoring situations.

Solid-phase microextraction – a future technique in pharmacology and coating trends

“…Therapeutic drug monitoring (TDM) is an important aspect of pharmacotherapy especially when the therapeutic range is very limited, and toxicity is suspected or when the patient does not respond to the dose used. 69,70 The most commonly used matrix in TDM in hospitals is whole blood or serum. Hospitals use instruments based on Enzyme-Linked Multiplex Immunoassay Technology (EMIT), while mass spectrometry is more commonly used in advanced institutions.…”

Opioid Monitoring in Clinical Settings: Strategies and Implications of Tailored Approaches for Therapy

“…Miniaturised techniques in analytical chemistry, including microextraction and microscale separation methods, present numerous advantages when compared to conventional approaches like liquid-liquid extraction (LLE) and solid-phase extraction (SPE) (Table 2) [48,56,58,59]. While miniaturised techniques offer numerous advantages, it is essential to note that their successful implementation requires careful consideration of factors such as reproducibility, robustness, and compatibility with specific analytical goals.…”

“…Monitoring opioid therapy serves multiple crucial purposes in clinical practice. Firstly, it facilitates the assessment of treatment efficacy in managing pain, ensuring that patients receive optimal relief, and allowing for adjustments based on individual responses [ 48 ]. Secondly, monitoring aids in the identification and prompt management of potential adverse effects linked to opioids, such as nausea, constipation, sedation, and respiratory depression, thereby enhancing patient safety and comfort.…”

“…Lastly, ongoing monitoring provides valuable opportunities for patient education, covering the risks and benefits of opioid therapy, proper usage, safe storage, and the importance of compliance with prescribed regimens. Overall, the multifaceted approach of monitoring contributes significantly to optimising opioid therapy outcomes and ensuring patient well-being [ 48 , 49 , 50 ].…”

“…A variety of methodologies and tools are routinely utilised for the comprehensive monitoring of opioid therapy, each serving a distinct role in ensuring the safe and effective management of pain [ 48 , 51 ]. Among these techniques is urine drug testing (UDT), which not only confirms the presence of prescribed opioids but also detects illicit substance use, offering a valuable means of identifying potential misuse or diversion [ 52 ].…”