Drugs of abuse and medication reconciliation testing can benefit from analysis methods capable of detecting a broader range of drug classes and analytes. Mass spectrometry analysis of a wide variety of commonly prescribed medications and over-the-counter drugs per sample also allows for application of a drug–drug interaction (DDI) algorithm to detect adverse drug reactions. In order to prevent adulteration of commonly collected clinical samples such as urine, dried blood spots (DBS) present a reliable alternative. A novel method is described for qualitative and quantitative multiplex analysis of 230 parent drugs, 30 illicit drugs and 43 confirmatory metabolites by HPLC–MS-MS This method is applicable to DBS specimens collected by volumetric absorptive microsamplers and confirmable in urine specimens. A patient cohort (n = 67) providing simultaneous urine specimens and DBS resulted in 100% positive predictive values of medications or illicits confirmed by detection of a parent drug and/or its metabolite during routine medication adherence analysis. An additional 5,508 DBS specimens screened (n = 5,575) showed 5,428 (97%) with an inconsistent positive compared to the provided medication list (including caffeine, cotinine or ethanol metabolites), 29 (0.5%) with no medication list and no unexpected positive results (consistent negative) and 22 (0.4%) showed all positive results matching the provided medication list (consistent positive). A DDI algorithm applied to all positive results revealed 17% with serious and 56% with moderate DDI warnings. Comprehensive DBS analysis proves a reliable alternative to urine drug testing for extended medication reconciliation, with the added advantage of detecting DDIs.

中文翻译：

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干血斑和尿液中 230 种药物和 30 种违禁化合物的多重分析

滥用药物和药物协调测试可以受益于能够检测更广泛的药物类别和分析物的分析方法。每个样本的各种常用处方药和非处方药的质谱分析还允许应用药物相互作用 (DDI) 算法来检测药物不良反应。为了防止通常收集的临床样本（如尿液）掺假，干血斑 (DBS) 是一种可靠的替代方法。描述了一种通过 HPLC-MS-MS 对 230 种母体药物、30 种违禁药物和 43 种确证代谢物进行定性和定量多重分析的新方法。该方法适用于体积吸收微量采样器采集的 DBS 标本，并可在尿液标本中进行确证。一个患者队列 ( n = 67）同时提供尿液样本和 DBS 导致药物或非法药物的 100% 阳性预测值通过在常规药物依从性分析期间检测母体药物和/或其代谢物得到证实。另外筛选了 5,508 个 DBS 标本（n = 5,575) 显示 5,428 (97%) 与提供的药物列表（包括咖啡因、可替宁或乙醇代谢物）相比呈不一致的阳性，29 (0.5%) 没有药物列表且没有意外的阳性结果（一致阴性）和 22 ( 0.4%) 显示与提供的药物清单匹配的所有阳性结果（一致阳性）。应用于所有阳性结果的 DDI 算法显示 17% 为严重 DDI 警告，56% 为中等 DDI 警告。综合 DBS 分析证明了一种可靠的替代尿液药物测试的方法，可用于扩展药物协调，并具有检测 DDI 的额外优势。