Quinolones and False-Positive Urine Screening for Opiates by Immunoassay Technology

Abstract

Greater attention to the cross-reactivity of quinolones with immunoassays for opiates is needed to minimize the potential for invalid test interpretation.

Commonly prescribed medications and potential false-positive urine drug screens

“…False-positive UDS results for opiates also have been reported with the use of quinolones. 1 Thirteen available agents were tested for falsepositive results using five commercially available test kits (AxSym, CEDIA, EMIT II, Roche, and Synchron). The opiate test solution was morphine at concentrations of 0, 225, 300, and 375 ng/mL.…”

“…10,26 Reagent specificity or sensitivity is another concern. 1,6,41 Patient-specific factors, such as the physiological effects of weight or diet (as they apply to urine acidity or alkalinity) were not included in this review of formulary agents. Based on the reports reviewed, no single reagent was identified with false-positive results.…”

Chemoinformatic Methods for Predicting Interference in Drug of Abuse/Toxicology Immunoassays

“…We compiled cross-reactivity data for 84 marketed versions of 18 DOA/Tox screening assays (amphetamines, barbiturates, benzodiazepines, benzoylecgonine, buprenorphine, cannabinoids, cotinine, 6-AM, LSD, MDMA, methadone, EDDP, methaqualone, opiates, oxycodone, phencyclidine, propoxyphene, and TCAs) using information from package inserts, supplemental manufacturers' data, and five peer-reviewed articles (Data Supplement 1) (5, 6, 22-24). Top prescribed medications in the United States in 2007 (29) are also highlighted.…”

“…For the opiate assays (Fig. 4C), several fluoroquinolone antibiotics, identified in the literature as cross-reacting with some opiate screening assays (5, 6), have similarity coefficients that overlap with those of the True Negatives but that are higher than the majority of compounds classified as True Negatives. In addition, fentanyl has relatively high similarity (MDL: 0.621, FCFP: 0.152) to LSD, consistent with studies indicating cross-reactivity of fentanyl with LSD immunoassays (10, 11).…”

A Difficult Challenge for the Clinical Laboratory: Accessing and Interpreting Manufacturer Cross-Reactivity Data for Immunoassays Used in Urine Drug Testing

“…Perhaps the best example of this is cross-reactivity of quinolone antibiotics to opiates immunoassays, a finding published in a high-impact general medical journal ( JAMA ) 17 years ago. 20 Only 2 of 28 opiate immunoassay package inserts analyzed in the present study contained any information on quinolone antibiotic cross-reactivity. Similar low rates were seen for other compounds previously shown to be cross-reactive.…”