DOI QR코드

DOI QR Code

Retrospective Analysis Study of False-Positive Amphetamine Immunoassay Cases and Negative Cases after Withdrawal while Taking Herbal Medicine-Containing Ephedra Sinica Confirmed in a Korean Medicine Obesity Clinic

한의 비만 클리닉에서 확인된 마황 함유 한약 복용 중 암페타민 면역측정법의 위양성 사례 및 휴약 후 음성 사례의 후향적 분석연구

  • Byungsoo Kang (Daeat Korean Medicine Clinic Seoulgangnam) ;
  • Suyong Shin (Daeat Korean Medicine Clinic Incheonbupyeng) ;
  • Jungsang Kim (Daeat Korean Medicine Clinic Gyeonggisuwon) ;
  • Minwhee Kang (Daeat Korean Medicine Clinic Gyeonggiilsan) ;
  • Donghoon Lee (Daeat Korean Medicine Clinic Seoulgangnam) ;
  • Seonghyeon Jeon (Daeat Korean Medicine Clinic Seoulgangnam) ;
  • Minwoo Bang (Daeat Korean Medicine Clinic Seoulgangnam)
  • 강병수 (다이트 한의원 서울강남점) ;
  • 신수용 (다이트 한의원 인천부평점) ;
  • 김정상 (다이트 한의원 경기수원점) ;
  • 강민휘 (다이트 한의원 경기일산점) ;
  • 이동훈 (다이트 한의원 서울강남점) ;
  • 전성현 (다이트 한의원 서울강남점) ;
  • 방민우 (다이트 한의원 서울강남점)
  • Received : 2024.03.19
  • Accepted : 2024.06.01
  • Published : 2024.06.30

Abstract

Herbal medicine (HM)-containing Ephedra Sinica (ES) has been associated with false-positive amphetamine immunoassay (FP IA) results. This study retrospectively evaluated the effects of dose, duration, and withdrawal instructions on FP IA and the safety of HM-containing ES at a clinic in Seoul from 2022 to 2023. The study included 6 patients in the FP IA group and 5 patients in the withdrawal instruction negative (Neg) group. The pre-test ephedrine alkaloids dose in the FP IA group was 95.17±31.90 mg, compared with 88.6±20.43 mg in the Neg group. The FP IA group had taken HM for 226.67±152.87 days before testing, and testing was performed while taking HM. In contrast, the Neg group had taken HM for 147.6±23.49 days and had 5.4±1.50 days of withdrawal period before the test following instructions of Korean medicine doctors. All adverse events (AEs) were moderate in severity, and the number of occurrences was similar: 5 in the FP IA group and 7 in the Neg group. AEs included constipation, insomnia (3 cases each), and palpitations (2 cases). The results of this study show that ES-induced FP IA can be resolved with withdrawal instructions and ES can be safely prescribed and administered by Korean medicine doctors. Further studies are needed to determine how to prevent FP IA after taking ES.

다이트 한의원 서울강남점에서 마황 함유 한약을 복용한 비만 환자 중 면역측정법 위양성 사례와 휴약 지시 후 면역측정법 음성 사례에 대해 후향적으로 관찰하였다. 마황에 의해 면역측정법 위양성 사례가 발생할 수 있고 이에 대한 주의가 필요하며, 면역측정법 위양성 결과가 나타나는 마황의 복용량, 복용 기간, 위양성 결과를 피하기 위한 마황 복용 중 휴약 기간 및 암페타민에 대한 민감도와 특이도가 높은 새로운 검사방법의 개발 등에 대한 추가 연구가 필요하다.

Keywords

References

  1. Supreme Prosecution Service. White paper on drug-related crimes 2022. 1st ed. Seoul : Sungmin Enterprise. 2023 : 97-102. 
  2. Doriety LJ, Farrington EA. Urine drug screening: what pediatric clinicians need to know to optimize patient care. J Pediatr Health Care. 2021 ; 35(4) : 449-55. 
  3. Pope JD, Drummer OH, Schneider HG. False-positive amphetamines in urine drug screens: a 6-year review. J Anal Toxicol. 2023 ; 47(3) : 263-70. 
  4. Lee SK, Choi S. Availability of urine toxicologic screening tests in the emergency department: focused on illegal drugs. J Korean Soc Clin Toxicol. 2021 ; 19(1) : 24-0. 
  5. Han KH. 2020 Health technology reassessment report, tetrabromophenolphthalein ethylester. 1st ed. Seoul : National Evidence-based Healthcare Collaborating Agency. 2021 : 7-20. 
  6. Ok YB, Kim JY, Lee KR, Hong DY, Baek KJ, Park SO, et al. A clinical review of patients who visited emergency medical center with positive methamphetamine tests: a single institute study. J Korean Soc Clin Toxicol. 2018 ; 16(1) : 25-32. 
  7. Johnson-Davis KL, Sadler AJ, Genzen JR. A retrospective analysis of urine drugs of abuse immunoassay true positive rates at a national reference laboratory. J Anal Toxicol. 2016 ; 40(2) : 97-107. 
  8. Tseng YL, Hsu HR, Kuo FH, Shieh MH, Chang CF. Ephedrines in over-the-counter cold medicines and urine specimens collected during sport competitions. J Anal Toxicol. 2003 ; 27(6) : 359-65. 
  9. Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. 2009 ; 104(7) : 1085-99. 
  10. Nakae H, Hebiguchi M, Shirasaki S, Okuyama M, Masuda Y. Comparison of false-positive reactions for amphetamine analogs after maoto treatment using two urinary drug-screening kits. Tradit Kampo Med. 2014 ; 1(1) : 2-6. 
  11. Kim JR, Yun SJ, Lee YK, Lee HJ, Kim JS. A review on safety of herbal medicines for doping. J Korean Med. 2019 ; 40(3) : 139-76. 
  12. Strano-Rossi S, Leone D, de la Torre X, Botre F. The relevance of the urinary concentration of ephedrines in anti-doping analysis: determination of pseudoephedrine, cathine, and ephedrine after administration of over-thecounter medicaments. Ther Drug Monit. 2009 ; 31(4) : 520-6. 
  13. Song M, Kim JO, Leem HH, Kim H. Stimultaneous determination of ephedrine alkaloids in Ephedra sinica and Wolbigachul-tang by high performance liquid chromatography. J Korean Med Obes Res. 2020 ; 20(2) : 97-108. 
  14. Song MY, Kim HJ, Lee MJ. The safety guidelines for use of Ma-huang in obesity treatment. J Korean Med Obes Res. 2006 ; 6(2) : 17-27. 
  15. Cho M, Kim S, Kim H, Song MY. Analysis of safety of Mahuang in studies for treatment of obesity. J Korean Med Obes Res. 2021 ; 21(2) : 95-104. 
  16. White LM, Gardner SF, Gurley BJ, Marx MA, Wang PL, Estes M. Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol. 1997 ; 37(2) : 116-22. 
  17. Levisky JA, Karch SB, Bowerman DL, Jenkins WW, Johnson DG , Davies D. False-positive RIA for methamphetamine following ingestion of an ephedra-derived herbal product. J Anal Toxicol. 2003 ; 27(2) : 123-4. 
  18. Nishiguchi M, Kinoshita H, Higasa K, Taniguchi T, Ouchi H, Minami T, et al. The false positive reaction of the triage panel drug-of-abuse by herbal drugs mahuang (Ephedra sinica (Ephedraceae)). Nihon Hoigaku Zasshi. 2001 ; 55(3) : 331-8. 
  19. Park M, Choi H, Choi S, Son H, Lim M, Chung H. Cross-reactivity of amphetamine analogues in various immunoassays. Yakhak Hoeji. 2003 ; 47(5) : 266-70.