Therapeutic Drug Monitoring of Suramin and Protein Binding

Abstract

A liquid chromatographic method of suramin has been used for the determination of the polysulfonated naphtylurea in both plasma and plasma filtrate from prostate cancer patients treated with the drug. The chromatographic system is based on the use of tetrabutylammonium bromide as an ion-pairing agent, while UV detection at 237 nm and 313 nm is applied. The sample pretreatment is a simple deproteination step by an organic solvent. The same counter-ion as used in the phase system is added in order to increase the recovery of the almost complete protein-bound suramin. The minimum detectable concentration in plasma is ca. 20 ng/mL at 237 nm, in plasma filtrate 10 ng/mL at 237 nm.

The method was routinely applied in plasma level guided treatment of prostate cancer patients with suramin, as well as in protein binding studies. The data of the study demonstrated the necessity of therapeutic drug monitoring in suramin treatment: development of severe, irreversible toxicity could be prevented owing to timed withdrawal of suramin administration when total drug levels were beyond 300 μg/mL. Data of protein binding studies explained in part the development of severe toxicity associated with plasma levels beyond 300–350 μg/mL: at that point free fraction of suramin sharply increases from 500 ng/mL at a total plasma level of 500 μg/mL to 10 μg/mL at a total plasma concentration of 1000 μg/mL, which corresponds with a twenty-fold dose increase (2000%).