Dextrometorphan

Note not all patients with mastocytosis have reactions provoked by all factors. For example, many patients with mastocytosis tolerate radiocontrast media, anesthesia, morphine, dextrometorphan, aspirin, and other analgesics. When in question, patients should undergo graded challenges to determine sensitivity. 

Fig. 12.11. The effect of SRM as compared to SIM in the detection of dextrometorphan. Reproduced from Ref. [25] by permission. Elsevier Science, 2001.

Owing to strategic reasons, Lonza exited the dextrometorphan business before the process could be transferred. Subsequently a further study of the hydrogenation of 10, using iridium complexes with chiral amidophosphine-phosphonite ligands, was published by another group [14]. An enantioselectivity of 86% ee was reached, but the chemoselectivity was low. 

Dextrometorphan (30 mg once) Lee et at. (2000) 44 Placebo = drug effect Placebo = drug effect (> 50% effect)... 

There is no more evidence for most of these connections than there is for the one between cleft palates and butchered animals. We still don t really know why the upper lip and palate fail to close completely in about one in seven hundred unborn babies. Certainly, there is a genetic aspect to this, but environmental factors come into play as well. Tests have implicated alcohol intake during pregnancy, as well as the use of the cough suppressant dextrometorphan. Seizure medications, the acne drug isotretinoin, excessive vitamin A consumption, certain... 

LC-MS detection of 100 pg dextrometorphan (DEX) spiked into 1 ml of human plasma. The corresponding signal of the [M+H]" ion in toe SIM trace at m/z 272 is barely detectable, whereas toe SRM chromatogram obtained from the reaction [M+H]" -> [M-CgHisN]" shows a clean background and a signal-to-noise enhancement of more than 50-fold (Fig. 14.19) [27]. 

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