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From: Robert Swotinsky MD
Password: orange
Date: 16 Feb 2008
Time: 05:06:57 -0800
Remote Name: 71.233.246.147
With due respect to the usual warnings about interpreting urine concentrations, I do believe the result with a hydromorphone level of 6127 ng/mL and hydrocodone undetected (at a 300? 2000? cutoff) is not explainable by use of hydrocodone. According to Baselt's Disposition of Toxic Drugs and Chemicals in Man (7th ed), 1 - 6% of a hydrocodone dose is excreted as hydromorphone. That means the ratio of hydromorphone to hydrocodone should be around 1:20 - 1:100 -- very different than the ratio in Dr. K's post. Baselt's book offers these references as backup:
Otton S, Schadel M, Cheung S, et al. CYP2D6 phenotype determines the metabolic conversion of hydrocodone to hydromorphone. Clin Pharm Ther. 54:463-472, 1993.
Smith M, Hughes R, Levine B. Forensic drug testing for opioates. VI. Urine testing for hydromorphone, hydrocodone, oxymorphone, and oxycodone with commercial opiate immunoassays and gas chromatography-mass spectrometry. J Anal Tox. 19:18-26, 1995.
Cone E, Darwin W, Gorodetzky C, Tan T, Comparative metabolism of hydrocodone in man, rat, guinea pig, rabbit, and dog. Drug Met Disp. 6:488-493, 1978.
Cone E, Darwin W. Simultaneous determination of hydromorphone, hydrocodone and their 6-alpha- and 6-beta-hydroxy metabolites in urine using selected ion recording with methane chemical ionization. Biomed Mass Spec. 5:291-295, 1978.