Ordering Recommendation

Optimize drug therapy and monitor patient adherence.

Mnemonic
CYA
Methodology

Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Performed

Sun-Sat

Reported

Within 24 hours

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation

Pre-dose (trough) levels should be drawn.

Collect

Lavender (EDTA) or pink (K2EDTA).

Specimen Preparation

Transfer 1 mL well-mixed whole blood to a plastic vial. (Min: 0.25 mL)

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

Serum or plasma. Specimens left at room temperature for longer than 24 hours. Clotted specimens.

Remarks
Stability

Ambient: 24 hours; Refrigerated: 2 weeks; Frozen: 2 months

Reference Interval

Effective November 17, 2014

Therapeutic Range:
Cyclosporine A, Therapeutic Range 100-400 ng/mL
Kidney transplant (in combination with Everolimus) 1 month post-transplant: 100-200 ng/mL
2-3 months post-transplant: 75-150 ng/mL
4-5 months post-transplant: 50-100 ng/mL
6-12 months post-transplant: 25-50 ng/mL
Heart transplant Up to 3 months post-transplant: 350-525 ng/mL
4 months and older post-transplant: 145-350 ng/mL
Liver transplant 290-525 ng/mL
Toxic value Greater than 700 ng/mL

Interpretive Data

The general therapeutic range for cyclosporine A is 100-400 ng/mL. The optimal therapeutic range for a given patient may differ from this suggested range based on the indication for therapy, treatment phase (initiation or maintenance), use in combination with other drugs, time of specimen collection relative to prior dose, type of transplanted organ, and/or the therapeutic approach of the transplant center.

Compliance Category

Laboratory Developed Test (LDT)

Note

Cyclosporine (Sandimmune) whole blood concentrations can be measured by either chromatographic or immunoassay methodologies. These two methodologies are not directly interchangeable, and the measured cyclosporine whole blood concentration depends on the methodology used. Reference ranges may vary according to the specific immunoassay or HPLC-MS/MS test. Generally, immunoassays have been reported to have a positive bias relative to HPLC-MS/MS assays due to the detection of antibody cross-reactivity with cyclosporine metabolites.

Hotline History
N/A
CPT Codes

80158

Components
Component Test Code* Component Chart Name LOINC
0070035 Cyclosporine A by HPLC-MS/MS 3520-4
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • Cyclosporine
  • Gengraf
  • Neoral
  • Restasis
  • Sandimmune
Cyclosporine A by Tandem Mass Spectrometry