A promising endogenous marker can perform differently under induction and inhibition.
Ten healthy men received midazolam during control, inhibitor and rifampicin conditions. A urinary hydroxy-deoxycholic-acid ratio correlated with selected midazolam measures and rose during induction, while its decrease during the short inhibition condition was not statistically clear.
The sample was small and male-only. The inhibitor exposure was brief, and the authors called for longer and larger validation. A baseline correlation does not establish reliable performance across every clinical state.
Specify which process the marker was tested to reflect. A modest or absent marker change cannot automatically exclude an important benzodiazepine interaction. In a case opinion, separate measured drug exposure from a proposed metabolic surrogate and disclose sampling-time and model limitations.
Source: PMC7923269, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
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