알코올의존증 치료약물 복용 여부 모니터링을 위한 소변 중 크레아티닌 농도로 보정된 날트렉손 및 6β-날트렉솔 측정값 평가

Assessment of Urinary Naltrexone and 6β-naltrexol Corrected with Creatinine for Monitoring Medical Treatment

This study aimed to detect naltrexone (NTX) and its metabolite 6β-naltrexol (6βNTX) in the urine samples of parolees or probationers who were legally bound to participate in an alcohol dependence treatment program to determine whether to follow the medical treatment ordered by the court. The developed liquid chromatography-tandem mass spectrometry method was suitable for the simultaneous detection of NTX as well as its active metabolite 6βNTX in urine samples. The ratio of creatinine to the analyte ([analyte, ng/mL]/[creatinine, mg/dL]) was used to exclude inaccuracies caused by urine dilution, and this value was further corrected by the average urine creatinine concentration in Korean adults (male 132.6 mg/dL, female 93.3 mg/dL). The cut-off values for NTX and 6βNTX were set at 10 ng/mL. If both the parent drug and its metabolite were found in urine and the corrected creatinine concentrations of NTX and 6βNTX were more than 10 ng/mL, it was considered that the participants were following their treatment protocol accordingly. The results showed that 81 (94.2%, male 69 and female 12) of 86 participants were taking NTX, whereas five (four males, one female) were not adhering to the protocol accordingly. It was found that the four male participants (4.9%) of the 81 participants who were taking the drug initially had urinary NTX and 6βNTX concentrations below the cut-off level without correcting creatinine level, but the values met the acceptance criteria (i.e., >10 ng/mL) of the medical treatment program after correcting the creatinine level. The proposed method can be applied to other drugs in the future.