Elimination profile of low‐dose chlortalidone and its detection in hair for doping analysis—Implication for unintentional non‐therapeutic exposure

• Published in: Drug testing and analysis 2024-11, Vol.16 (11), p.1378-1383
• Main Authors: Thieme, Detlef, Weigel, Kai, Anielski, Patricia, Krumbholz, Aniko, Sporkert, Frank, Keiler, Annekathrin M.
• Format: Article
• Language: English
• Subjects: Adult; Chlorthalidone - administration & dosage; Chlorthalidone - analysis; Chromatography, Liquid - methods; diuretics; Diuretics - administration & dosage; Diuretics - analysis; Diuretics - urine; Doping in Sports - prevention & control; hair; Hair - chemistry; Humans; Hydrochlorothiazide - administration & dosage; Hydrochlorothiazide - analysis; LC–MS/MS; Male; Substance Abuse Detection - methods; Tandem Mass Spectrometry - methods; urine
• ISSN: 1942-7603; 1942-7611; 1942-7611
• DOI: 10.1002/dta.3661

Chlortalidone (CLT) is a thiazide‐type diuretic with high affinity for the erythrocyte carbonic anhydrase. Therapeutically, it is mostly used to treat edema and hypertension due to liver cirrhosis, heart insufficiency, or renal dysfunction. Although diuretics and masking agents are prohibited by the World Anti‐Doping Agency (WADA) at all times in sports, substances belonging to this category are constantly detected in athlete samples, according to WADA's annual testing figures. Within this group of structurally diverse compounds, a threshold of 20 ng/mL has been introduced for six substances solely due to their presence as contaminants in other permitted drugs because of pharmaceutical production processes. In a recent presumptive doping case with a low urinary CLT concentration, the question of unintentional doping, for example, by contaminated non‐steroidal anti‐inflammatory drug intake, arose. To examine this potential scenario, a co‐elimination of low‐dose CLT and hydrochlorothiazide (HCTA; 20 × 50 μg, 0.2 mg/day each) was conducted on five consecutive days in two volunteers. Urine samples were subjected to liquid chromatography‐tandem mass spectrometry (LC–MS/MS). Moreover, we examined the incorporation of CLT in scalp hair. HCTA is rapidly excreted renally in comparatively high concentrations. In contrast, the elimination of CLT is considerably slower (terminal elimination half‐life extended by a factor of 12) and, consequently, much less concentrated in corresponding urine samples (45 and 53 ng/mL, respectively). Conversely, a higher hair incorporation of chlorthalidone was observed with simultaneous dosing of both. The results suggest that an unintentional intake of sub‐therapeutic CLT doses due to contamination might result in an adverse analytical finding. An elimination of low‐dose chlortalidone and hydrochlorothiazide (HCTA) was conducted on five consecutive days in two volunteers. The urine concentrations were measured by LC–MS/MS. The chlortalidone concentration 10 days after the last ingestion of a sub‐therapeutic dose would have still caused an adverse analytical finding in an athlete's sample. Moreover, chlortalidone was quantified in hair; the respective incorporation is most likely mediated by sweat or sebum.