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Drug Interferences in
Clinical Analyses
P R E V E C A L D E P A R T M E N T
TRIGLYCERIDES
T his is the first in a series of Bulletins on the account a patient’s clinical history as well as their current interferences caused by drugs in clinical trails that the state of health, since underlying illnesses may affect Prevecal Department at BioSystems is going to issue for laboratory professionals. Given the large number of active compounds interfering with results, each bulletin will deal Interferences are also an important cause of the poor with a single test so that the information given can be as interpretation of a patient’s analytical results. There are The diagnosis of a patient should not only be based on the findings of one trial but also include clinical and laboratory data. There are many variables conditioning analytical results and these must always be borne in mind In this bulletin we are going to focus on drug interferences in order to give a correct diagnosis. These variables can although mention will also be made of those concerning be divided into three main categories.
methodology. The total number of drugs or active compounds producing effects on laboratory tests is too large for them to be rigorously set out in this bulletin.
The intention of the Prevecal Department at BioSystems is to boil down all the most active compounds to those that have a greater relationship with a specific test. There Preanalitical variables are a long list of conditions that is an excellent reference book on the subject, Young DS. take into account a patient’s characteristics and lifestyle.
Effects of drugs on clinical laboratory tests, 5th ed. AACC Some of these factors are age, gender, race, diet, alcohol, Press, 1999, which contains the greatest number of drug tobacco and coffee consumption, obesity, physical interferences. This book is a must for any clinical exercise, etc. It is also of basic importance to take into TRIGLYCERIDES
DRUG INTERFERENCES
(Glycerol Phosphate Oxidase/Peroxidase) CLINICAL SIGNIFICANCE
ARTERIAL HYPERTENSION
Triglycerides are glycerol and fatty acid esters that comefrom a dietary source or are synthesised mainly in the ACETYLCHOLINESTERASE (AChE) INHIBITORS liver. They are transported in plasma in the lipoproteinsand are used by adipose tissue, muscles and others. Their 4.2 mg/dL average decrease occurs with regard to main function is to provide energy to cells. High serum reference values in treatments lasting 12 months,especially in patients with hypercholesterolemia concentrations of triglycerides may be due to hepatobiliarydisorders, diabetes mellitus, nephrosis, hypothyroidism, alcoholism, familial hyperlipoproteinemia type IV and Vand others.
Moderate to average hypertense patients treated with100 mg/day for 24 weeks caused 10.6% average METHODOLOGY INTERFERENCES
reduction. Patients with essential hypertension treatedwith 75 mg/day showed average reduction from Each point is the average of three. Horizontal lines show 181.8±26.4 mg/dL to 154.6±18.8 mg/dL.
the tolerance for the value obtained in the presence ofinterferent, calculated as: the average in the absence of interferent ± 3 x interseries standard deviation.
Patients with grade 1 diastolic hypertension treated with Sample: human serum without (a) and with growing 5 mg/day caused average change from 1.6±1.16 mmol/Lto -0.36±0.06 mmol/L after 12 months treatment and to –0.14±0.08 mmol/L after 48 months. Significant reductionof average from 1.74±1.04 mmol/L to 1.63±0.054 mmol/Lreported for patients with essential hypertension treated Serum triglyceride concentration increase reported. Non uniform increase with variations depending on hypertension type and patient’s history.
Plasma triglyceride concentration increase reported.
Increase more acute in average, moderate and essential hypertense patients than in patients with hypercholesterolemia and normocholesterolemia.
Triglyceride concentration increase in hypertense patients treated with beta blockers as opposed to those not treated HYPERLIPEMIAS
As can be seen in the graphs, hemoglobin (10 g/L) does Serum triglyceride concentration baseline decrease not interfere while bilirubin (2.5 mg/dL) does.
Clear reduction of serum triglycerides reported. Range Estrogens reported to increase triglyceride concentration oscillates between 27% and 58% depending on pathology in postmenopausal women from 15% to 20% above the Triglyceride concentration reduction between 3% and 9% Significant triglyceride concentration reduction in patients reported depending on pathology type and length of with chronic dialysis reported after 4 months treatment.
16% triglyceride concentration increase with a low dosage Triglyceride concentration reduction between 30% and 60% reported depending on pathology type and lengthof treatment.
NON INTERFERING DRUGS
Triglyceride concentration reduction between 12% and The following drugs do not interfere at therapeutic 25% reported depending on pathology type and length Acetylsalicylic acid, Amphotericin B, Ampicillin, Ascorbicacid, Barbital, Bromazepam, Chloroquine, Codeine, DIABETES (NIDDM)
Diazepam, Gentamicin, Ibuprophen, Morphine, PenicillinG, Phenobarbital and Sulphanilamide.
Triglyceride concentration baseline decrease from5.02±1.22 mmol/L to 2.16±0.46 mmol/L after 3 monthsand to 2.0±0.30 mmol/L after 6 months treatmentreported.
Significant reduction of triglyceride serum concentrationbetween 15% and 26% reported.
Patients treated for hypothyroidism show acute reduction of serum triglyceride concentration. Baseline reductionmay be higher than 30%.
Over 40% above baseline serum triglyceride concentration increase when oral contraceptives administered.
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Source: http://www.limarco.com.pl/public/publications/triglycerides.pdf