Ordering Recommendation

Optimize drug therapy and monitor patient adherence.


Quantitative Liquid Chromatography-Tandem Mass Spectrometry


Mon, Wed, Fri


1-5 days

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

Timing of specimen collection: Pre-dose (trough) draw - At steady-state concentration.


Plain red. Also acceptable: Lavender (K2 or K3EDTA) or pink (K2EDTA).

Specimen Preparation

Separate serum or plasma from cells within 2 hours of collection. Transfer 1 mL serum or plasma to an ARUP Standard Transport Tube. (Min: 0.5 mL)

Storage/Transport Temperature


Unacceptable Conditions

Whole blood. Gel separator tubes, light blue (citrate), or yellow (SPS or ACD solution).


After separation from cells: Ambient: 5 days; Refrigerated: 2 weeks; Frozen: 6 months

Reference Interval

Effective November 18th, 2013

Therapeutic Range
Amitriptyline (Elavil, Vanatrip) Not established Not established
Nortriptyline (Aventyl, Pamelor) 50-150 ng/mL Greater than 500 ng/mL
Total Amitriptyline + Nortriptyline 95-250 ng/mL Greater than 500 ng/mL
Imipramine (Tofranil) Not established Not established
Desipramine (Norpramin) 100-300 ng/mL Greater than 500 ng/mL
Total Imipramine + Desipramine 150-300 ng/mL Greater than 500 ng/mL
Doxepin (Sinequan, Zonalon) Not established Not established
Nordoxepin Not established Not established
Total Doxepin + Nordoxepin 100-300 ng/mL Greater than 500 ng/mL
Protriptyline (Vivactil) 70-240 ng/mL Greater than 400 ng/mL
Clomipramine (Anafranil) Not established Not established
Norclomipramine Not established Not established
Total Clomipramine + Norclomipramine 220-500 ng/mL Greater than 900 ng/mL

Interpretive Data

Compliance Category

Laboratory Developed Test (LDT)


This test is used to quantitate the following tricyclic antidepressants: amitriptyline, clomipramine, desipramine, doxepin, imipramine, norclomipramine, nordoxepin, nortriptyline, and protriptyline.

Hotline History
CPT Codes

80337 (Alt code: G0480)

Component Test Code* Component Chart Name LOINC
0090020 Amitriptyline/Nortriptyline, Total, SP 3335-7
0090024 Amitriptyline, SP 3333-2
0090065 Desipramine, SP 3531-1
0090100 Doxepin, SP 3579-0
0090101 Doxepin/Nordoxepin Total, SP 3582-4
0090105 Nordoxepin, SP 3862-0
0090106 Protriptyline, SP 3999-0
0090135 Imipramine/Desipramine Total, SP 9627-1
0090139 Imipramine, SP 3690-5
0090210 Nortriptyline, SP 3872-9
0099320 Clomipramine/Norclomipramine, Total, SP 3493-4
0099335 Norclomipramine, SP 3536-0
0099437 Clomipramine (Anafranil), SP 3491-8
* 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.
  • Tricyclic Antidepressant Screen
  • Tricyclic Screen
Tricyclic Antidepressants, Quantitative, Serum or Plasma