Urine testing for antipsychotics: a pilot trial for a method to determine detection levels Jennifer Miller 1,4 , Heidi Wehring 2 , Robert P. McMahon 2 , Bethany A. DiPaula 1 , Raymond C. Love 1 , Ayodele Antoinette Morris 3 , Heather Raley 2 , Stephanie Feldman 2 and Deanna L. Kelly 1,2 * 1 University of Maryland, School of Pharmacy, Baltimore, Maryland, USA 2 University of Maryland, School of Medicine, Baltimore, Maryland, USA 3 Ameritox, Ltd, Baltimore, Maryland, USA 4 Wilkes-Barre Veterans Affairs Medical Center (VAMC), Wilkes-Barre, Pennsylvania, USA 1 Objective The goal of the present study was to demonstrate that the analytical assay of interest can detect antipsychotics in human urine specimens. Method Forty inpatients treated with haloperidol, quetiapine, risperidone, or olanzapine were recruited to participate in a one visit study. During the study visit, demographic and clinical information was collected as well as one urine sample that was forwarded to the Ameritox Laboratory and assayed for the presence of antipsychotic medications and/or metabolites. Urine samples were analyzed to determine detec- tion sensitivity for four antipsychotic medications and their metabolites (risperidone, quetiapine, olanzapine, and/or haloperidol) using Ultra Performance Liquid Chromatography–Tandem Mass Spectrometry. Results All urine samples produced positive results for the antipsychotic(s) the participants were known to be taking. Urine concentrations (level of quantification) for parent drugs ranged from <25–417 ng/mL for haloperidol, <25–4017 ng/mL for quetiapine, 0–997 ng/mL for risperidone, and 57–700 ng/mL for olanzapine. Conclusion The analytical assay produced by Ameritox, Ltd using Ultra Performance Liquid Chromatography–Tandem Mass Spectrom- etry can qualitatively detect antipsychotics in human urine specimens. The present study highlights the potential utility of the urine assay to help monitor adherence to antipsychotic medications. Copyright © 2015 John Wiley & Sons, Ltd. key words—risperidone; olanzapine; haloperidol; quetiapine; adherence; urine INTRODUCTION Antipsychotics are widely prescribed for a variety of psychiatric disorders, including schizophrenia. Unfor- tunately, these medications are typically associated with significant side effects, residual symptoms, and poor adherence (Marder et al., 2004; Lieberman et al., 2005). A landmark trial conducted from January 2001 to December 2004 highlighted these therapeutic challenges. The study evaluated the efficacy of various antipsychotic drugs in people with chronic schizophre- nia through a primary outcome of time to treatment discontinuation. Although some antipsychotics were associated with longer treatment duration, all groups exhibited a high discontinuation rate. Overall, 74% of participants discontinued their antipsychotic medication before the study endpoint (Lieberman et al., 2005). Similar discontinuation rates have been reported among Medicaid and Veteran’s Hospital pa- tients (Chen et al., 2008; Kilzieh et al., 2008). Evidence shows high rates of relapse and symptom exacerbation if the prescribed antipsychotic medica- tion is discontinued (Gitlin et al., 2001; Wunderlink et al., 2007). In a study published by Wunderlink et al. (2007), only 20% of participants were able to successfully stop their antipsychotic after remitted first-episode psychosis. Authors found twice the rate of relapse in these participants versus those continuing treatment (Wunderlink et al., 2007). Therefore, it is clinically necessary for the health care provider to have an accurate assessment of medication adherence in or- der to develop appropriate interventions. The risks associated with not taking a prescribed an- tipsychotic support the importance of having a reliable method for monitoring drug concentrations in the body. Although it is controversial whether therapeutic efficacy can be determined based on antipsychotic *Correspondence to: D. Kelly, Maryland Psychiatric Research Center, University of Maryland, Box 21247, Baltimore, MD 21228, USA. Tel: 410-402-6860; Fax: 410-402-6038 E-mail: dkelly@mprc.umaryland.edu 1 Affiliation with the Wilkes-Barre VAMC started on December 2012. The research was performed at an outside facility not affiliated with the VAMC. Received 30 September 2014 Accepted 20 March 2015 Copyright © 2015 John Wiley & Sons, Ltd. human psychopharmacology Hum. Psychopharmacol Clin Exp 2015; 30: 350–355 Published online 25 May 2015 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/hup.2482