Does the urinary concentration of an inhaled beta-2 agonist always reflect the inhaled dose and method of administration?

Research output: Contribution to journalArticle

Abstract

The urinary threshold of 1000 ng/mL for salbutamol was established by the International Olympic Committee (IOC) in 2001 following a study that was not undertaken for that purpose. At least 25 athletes have exceeded this concentration and some after inhaling no more than the permitted daily maximum dose of 1600 μg. However, there is concern that some providing expert evidence and tribunal members hearing such cases are unaware of the occasional unpredictability of the pharmacokinetics of beta-2 agonists. The World Anti-Doping Agency's (WADA's) change from 1 March 2018 to allow correction of urinary specific gravity (SG) down to 1.020 for prohibited substances with a urinary threshold is a major advance and will assist in some instances. However, future cases are anticipated to occur when athletes unexpectedly exceed the urinary threshold for salbutamol after inhaling no more than the allowable dose and within WADA's stated time frame. They will then be required to appear before doping tribunals. The rapidity by which salbutamol is inhaled can influence the resultant urinary concentration and is yet to be addressed adequately in WADA's 2019 Prohibited List. The list's recommended pharmacokinetic study fails to replicate the circumstances that prevailed when the athlete was competing and the adverse analytical finding (AAF) occurred. Tribunals, and experts who advise them, need to be cognizant that the urinary concentration of salbutamol does not invariably reflect the inhaled dose and that a high urinary salbutamol concentration is not always ipso facto evidence of super-dosing with inhaled salbutamol.

Original languageEnglish
Pages (from-to)194-199
Number of pages6
JournalDrug Testing and Analysis
Volume11
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

Fingerprint

Albuterol
Doping (additives)
Athletes
Pharmacokinetics
hearing
Olympic Games
Inhalation
gravity
Specific Gravity
Audition
Density (specific gravity)
Hearing
method
dose
world
pharmacokinetics

Cite this

@article{b259f089a8df4cbdbd03fb9f827494a8,
title = "Does the urinary concentration of an inhaled beta-2 agonist always reflect the inhaled dose and method of administration?",
abstract = "The urinary threshold of 1000 ng/mL for salbutamol was established by the International Olympic Committee (IOC) in 2001 following a study that was not undertaken for that purpose. At least 25 athletes have exceeded this concentration and some after inhaling no more than the permitted daily maximum dose of 1600 μg. However, there is concern that some providing expert evidence and tribunal members hearing such cases are unaware of the occasional unpredictability of the pharmacokinetics of beta-2 agonists. The World Anti-Doping Agency's (WADA's) change from 1 March 2018 to allow correction of urinary specific gravity (SG) down to 1.020 for prohibited substances with a urinary threshold is a major advance and will assist in some instances. However, future cases are anticipated to occur when athletes unexpectedly exceed the urinary threshold for salbutamol after inhaling no more than the allowable dose and within WADA's stated time frame. They will then be required to appear before doping tribunals. The rapidity by which salbutamol is inhaled can influence the resultant urinary concentration and is yet to be addressed adequately in WADA's 2019 Prohibited List. The list's recommended pharmacokinetic study fails to replicate the circumstances that prevailed when the athlete was competing and the adverse analytical finding (AAF) occurred. Tribunals, and experts who advise them, need to be cognizant that the urinary concentration of salbutamol does not invariably reflect the inhaled dose and that a high urinary salbutamol concentration is not always ipso facto evidence of super-dosing with inhaled salbutamol.",
keywords = "pharmacokinetic, salbutamol, urinary concentration, variability",
author = "Ken Fitch",
year = "2019",
month = "2",
day = "1",
doi = "10.1002/dta.2546",
language = "English",
volume = "11",
pages = "194--199",
journal = "Drug Testing and Analysis",
issn = "1942-7603",
publisher = "John Wiley & Sons",
number = "2",

}

TY - JOUR

T1 - Does the urinary concentration of an inhaled beta-2 agonist always reflect the inhaled dose and method of administration?

AU - Fitch, Ken

PY - 2019/2/1

Y1 - 2019/2/1

N2 - The urinary threshold of 1000 ng/mL for salbutamol was established by the International Olympic Committee (IOC) in 2001 following a study that was not undertaken for that purpose. At least 25 athletes have exceeded this concentration and some after inhaling no more than the permitted daily maximum dose of 1600 μg. However, there is concern that some providing expert evidence and tribunal members hearing such cases are unaware of the occasional unpredictability of the pharmacokinetics of beta-2 agonists. The World Anti-Doping Agency's (WADA's) change from 1 March 2018 to allow correction of urinary specific gravity (SG) down to 1.020 for prohibited substances with a urinary threshold is a major advance and will assist in some instances. However, future cases are anticipated to occur when athletes unexpectedly exceed the urinary threshold for salbutamol after inhaling no more than the allowable dose and within WADA's stated time frame. They will then be required to appear before doping tribunals. The rapidity by which salbutamol is inhaled can influence the resultant urinary concentration and is yet to be addressed adequately in WADA's 2019 Prohibited List. The list's recommended pharmacokinetic study fails to replicate the circumstances that prevailed when the athlete was competing and the adverse analytical finding (AAF) occurred. Tribunals, and experts who advise them, need to be cognizant that the urinary concentration of salbutamol does not invariably reflect the inhaled dose and that a high urinary salbutamol concentration is not always ipso facto evidence of super-dosing with inhaled salbutamol.

AB - The urinary threshold of 1000 ng/mL for salbutamol was established by the International Olympic Committee (IOC) in 2001 following a study that was not undertaken for that purpose. At least 25 athletes have exceeded this concentration and some after inhaling no more than the permitted daily maximum dose of 1600 μg. However, there is concern that some providing expert evidence and tribunal members hearing such cases are unaware of the occasional unpredictability of the pharmacokinetics of beta-2 agonists. The World Anti-Doping Agency's (WADA's) change from 1 March 2018 to allow correction of urinary specific gravity (SG) down to 1.020 for prohibited substances with a urinary threshold is a major advance and will assist in some instances. However, future cases are anticipated to occur when athletes unexpectedly exceed the urinary threshold for salbutamol after inhaling no more than the allowable dose and within WADA's stated time frame. They will then be required to appear before doping tribunals. The rapidity by which salbutamol is inhaled can influence the resultant urinary concentration and is yet to be addressed adequately in WADA's 2019 Prohibited List. The list's recommended pharmacokinetic study fails to replicate the circumstances that prevailed when the athlete was competing and the adverse analytical finding (AAF) occurred. Tribunals, and experts who advise them, need to be cognizant that the urinary concentration of salbutamol does not invariably reflect the inhaled dose and that a high urinary salbutamol concentration is not always ipso facto evidence of super-dosing with inhaled salbutamol.

KW - pharmacokinetic

KW - salbutamol

KW - urinary concentration

KW - variability

UR - http://www.scopus.com/inward/record.url?scp=85059062950&partnerID=8YFLogxK

U2 - 10.1002/dta.2546

DO - 10.1002/dta.2546

M3 - Article

VL - 11

SP - 194

EP - 199

JO - Drug Testing and Analysis

JF - Drug Testing and Analysis

SN - 1942-7603

IS - 2

ER -