(R)- and (S)-methadone and buprenorphine concentration ratios in maternal and umbilical cord plasma following chronic maintenance dosing in pregnancy

Andrea L. Gordon, Olga V. Lopatko, Andrew A. Somogyi, David J R Foster, Jason M. White

Research output: Contribution to journalArticle

Abstract

AIMS: The aim of this study was to compare the transfer of buprenorphine and methadone between maternal and cord blood in women under chronic dosing conditions and to determine if differences exist in the transfer of the two methadone enantiomers. METHODS: Maternal and cord blood samples were collected at delivery from women maintained on methadone (35, 25-140 mg day-1) (median; range) or buprenorphine (6.00, 2-20 mg day-1) during pregnancy. Plasma concentration ratios are presented as an indicator of foetal exposure relative to the mother. RESULTS: Methadone was quantified in all samples, with cord:maternal plasma methadone concentration ratios (n= 15 mother-infant pairs) being significantly higher (P < 0.0001; mean difference (MD) 0.07; 95% confidence interval (CI) 0.048, 0.092) for the active (R)-methadone enantiomer (0.41; 0.19, 0.56) (median; range) compared with (S)-methadone (0.36; 0.15, 0.53). (R)-:(S)-methadone concentration ratios were also significantly higher (P < 0.0001; MD 0.24 95% CI 0.300, 0.180) for cord (1.40; 0.95, 1.67) compared with maternal plasma (1.16; 0.81, 1.38). Half the infant buprenorphine samples were below the assay lower limit of quantification (LLOQ) (0.125 ng ml-1). The latter was four-fold lower than the LLOQ for methadone (0.50 ng ml-1). The cord:maternal plasma buprenorphine concentration ratio (n= 9 mother-infant pairs) was 0.35; 0.14, 0.47 and for norbuprenorphine 0.49; 0.24, 0.91. CONCLUSIONS: The transfer of the individual methadone enantiomers to the foetal circulation is stereoselective. Infants born to buprenorphine maintained women are not exposed to a greater proportion of the maternal dose compared with methadone and may be exposed to relatively less of the maternal dose compared with infants born to women maintained on methadone during pregnancy.

Original languageEnglish (US)
Pages (from-to)895-902
Number of pages8
JournalBritish Journal of Clinical Pharmacology
Volume70
Issue number6
DOIs
StatePublished - Dec 2010
Externally publishedYes

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Buprenorphine
Umbilical Cord
Methadone
Maintenance
Mothers
Pregnancy
Fetal Blood
Confidence Intervals

Keywords

  • Buprenorphine
  • Methadone
  • Neonatal abstinence syndrome
  • Placental transfer
  • Plasma concentration

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

(R)- and (S)-methadone and buprenorphine concentration ratios in maternal and umbilical cord plasma following chronic maintenance dosing in pregnancy. / Gordon, Andrea L.; Lopatko, Olga V.; Somogyi, Andrew A.; Foster, David J R; White, Jason M.

In: British Journal of Clinical Pharmacology, Vol. 70, No. 6, 12.2010, p. 895-902.

Research output: Contribution to journalArticle

Gordon, Andrea L. ; Lopatko, Olga V. ; Somogyi, Andrew A. ; Foster, David J R ; White, Jason M. / (R)- and (S)-methadone and buprenorphine concentration ratios in maternal and umbilical cord plasma following chronic maintenance dosing in pregnancy. In: British Journal of Clinical Pharmacology. 2010 ; Vol. 70, No. 6. pp. 895-902.
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abstract = "AIMS: The aim of this study was to compare the transfer of buprenorphine and methadone between maternal and cord blood in women under chronic dosing conditions and to determine if differences exist in the transfer of the two methadone enantiomers. METHODS: Maternal and cord blood samples were collected at delivery from women maintained on methadone (35, 25-140 mg day-1) (median; range) or buprenorphine (6.00, 2-20 mg day-1) during pregnancy. Plasma concentration ratios are presented as an indicator of foetal exposure relative to the mother. RESULTS: Methadone was quantified in all samples, with cord:maternal plasma methadone concentration ratios (n= 15 mother-infant pairs) being significantly higher (P < 0.0001; mean difference (MD) 0.07; 95{\%} confidence interval (CI) 0.048, 0.092) for the active (R)-methadone enantiomer (0.41; 0.19, 0.56) (median; range) compared with (S)-methadone (0.36; 0.15, 0.53). (R)-:(S)-methadone concentration ratios were also significantly higher (P < 0.0001; MD 0.24 95{\%} CI 0.300, 0.180) for cord (1.40; 0.95, 1.67) compared with maternal plasma (1.16; 0.81, 1.38). Half the infant buprenorphine samples were below the assay lower limit of quantification (LLOQ) (0.125 ng ml-1). The latter was four-fold lower than the LLOQ for methadone (0.50 ng ml-1). The cord:maternal plasma buprenorphine concentration ratio (n= 9 mother-infant pairs) was 0.35; 0.14, 0.47 and for norbuprenorphine 0.49; 0.24, 0.91. CONCLUSIONS: The transfer of the individual methadone enantiomers to the foetal circulation is stereoselective. Infants born to buprenorphine maintained women are not exposed to a greater proportion of the maternal dose compared with methadone and may be exposed to relatively less of the maternal dose compared with infants born to women maintained on methadone during pregnancy.",
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T1 - (R)- and (S)-methadone and buprenorphine concentration ratios in maternal and umbilical cord plasma following chronic maintenance dosing in pregnancy

AU - Gordon, Andrea L.

AU - Lopatko, Olga V.

AU - Somogyi, Andrew A.

AU - Foster, David J R

AU - White, Jason M.

PY - 2010/12

Y1 - 2010/12

N2 - AIMS: The aim of this study was to compare the transfer of buprenorphine and methadone between maternal and cord blood in women under chronic dosing conditions and to determine if differences exist in the transfer of the two methadone enantiomers. METHODS: Maternal and cord blood samples were collected at delivery from women maintained on methadone (35, 25-140 mg day-1) (median; range) or buprenorphine (6.00, 2-20 mg day-1) during pregnancy. Plasma concentration ratios are presented as an indicator of foetal exposure relative to the mother. RESULTS: Methadone was quantified in all samples, with cord:maternal plasma methadone concentration ratios (n= 15 mother-infant pairs) being significantly higher (P < 0.0001; mean difference (MD) 0.07; 95% confidence interval (CI) 0.048, 0.092) for the active (R)-methadone enantiomer (0.41; 0.19, 0.56) (median; range) compared with (S)-methadone (0.36; 0.15, 0.53). (R)-:(S)-methadone concentration ratios were also significantly higher (P < 0.0001; MD 0.24 95% CI 0.300, 0.180) for cord (1.40; 0.95, 1.67) compared with maternal plasma (1.16; 0.81, 1.38). Half the infant buprenorphine samples were below the assay lower limit of quantification (LLOQ) (0.125 ng ml-1). The latter was four-fold lower than the LLOQ for methadone (0.50 ng ml-1). The cord:maternal plasma buprenorphine concentration ratio (n= 9 mother-infant pairs) was 0.35; 0.14, 0.47 and for norbuprenorphine 0.49; 0.24, 0.91. CONCLUSIONS: The transfer of the individual methadone enantiomers to the foetal circulation is stereoselective. Infants born to buprenorphine maintained women are not exposed to a greater proportion of the maternal dose compared with methadone and may be exposed to relatively less of the maternal dose compared with infants born to women maintained on methadone during pregnancy.

AB - AIMS: The aim of this study was to compare the transfer of buprenorphine and methadone between maternal and cord blood in women under chronic dosing conditions and to determine if differences exist in the transfer of the two methadone enantiomers. METHODS: Maternal and cord blood samples were collected at delivery from women maintained on methadone (35, 25-140 mg day-1) (median; range) or buprenorphine (6.00, 2-20 mg day-1) during pregnancy. Plasma concentration ratios are presented as an indicator of foetal exposure relative to the mother. RESULTS: Methadone was quantified in all samples, with cord:maternal plasma methadone concentration ratios (n= 15 mother-infant pairs) being significantly higher (P < 0.0001; mean difference (MD) 0.07; 95% confidence interval (CI) 0.048, 0.092) for the active (R)-methadone enantiomer (0.41; 0.19, 0.56) (median; range) compared with (S)-methadone (0.36; 0.15, 0.53). (R)-:(S)-methadone concentration ratios were also significantly higher (P < 0.0001; MD 0.24 95% CI 0.300, 0.180) for cord (1.40; 0.95, 1.67) compared with maternal plasma (1.16; 0.81, 1.38). Half the infant buprenorphine samples were below the assay lower limit of quantification (LLOQ) (0.125 ng ml-1). The latter was four-fold lower than the LLOQ for methadone (0.50 ng ml-1). The cord:maternal plasma buprenorphine concentration ratio (n= 9 mother-infant pairs) was 0.35; 0.14, 0.47 and for norbuprenorphine 0.49; 0.24, 0.91. CONCLUSIONS: The transfer of the individual methadone enantiomers to the foetal circulation is stereoselective. Infants born to buprenorphine maintained women are not exposed to a greater proportion of the maternal dose compared with methadone and may be exposed to relatively less of the maternal dose compared with infants born to women maintained on methadone during pregnancy.

KW - Buprenorphine

KW - Methadone

KW - Neonatal abstinence syndrome

KW - Placental transfer

KW - Plasma concentration

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