Rapid and simultaneous determination of tacrolimus (FK506) and diltiazem in human whole blood by liquid chromatography–tandem mass spectrometry: Application to a clinical drug–drug interaction study

Tacrolimus (FK506) is a potent immunosuppressant widely used for organ transplantation patients while diltiazem (DTZ), a calcium-channel inhibitor, is often used in renal transplantation patients to prevent post-transplant hypertension. However, DTZ has a significant pharmacokinetic interaction with FK506. In this study, a rapid and sensitive ammonium-adduct based liquid chromatography–tandem mass spectrometry (LC/MS/MS) method has been developed and validated for the simultaneous determination of FK506 and DTZ in human whole blood using ascomycin as the internal standard (IS). After extraction of the whole blood samples by ethyl acetate, FK506, DTZ and the IS were subjected to LC/MS/MS analysis using electro-spray positive-ion mode ionization (ESI+). Chromatographic separation was performed on a Hypersil BDS C18 column (50 mm × 2.1 mm, i.d., 3 μm). The MS/MS detection was conducted by monitoring the fragmentation of 821.7 → 768.9 (m/z) for FK506, 415.5 → 310.3 (m/z) for DTZ and 809.8 → 757.0 (m/z) for IS. The method had a chromatographic running time of approximately 2 min and linear calibration curves over the concentrations of 0.5–200 ng/mL for FK506 and 2–250 ng/mL for DTZ. The recoveries of liquid–liquid extraction method were 58.3–62.6% for FK506 and 50.4–58.8% for DTZ. The lower limit of quantification (LLOQ) of the analytical method was 0.5 ng/mL for FK506 and 2 ng/mL for DTZ. The intra- and inter-day precision was less than 15% for all quality control samples at concentrations of 2, 10, and 50 ng/mL for FK506 and 5, 25, and 100 ng/mL for DTZ. The validated LC/MS/MS method has been successfully used to analyze the concentrations of FK506 and DTZ in whole blood samples from pharmacokinetic studies in renal transplanted patients.