Ordering Recommendation

Optimize drug therapy and monitor patient adherence.

Mnemonic
TADQNT SP
Methodology

Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Performed

Mon, Wed, Fri

Reported

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.

Collect

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

Refrigerated.

Unacceptable Conditions

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

Remarks
Stability

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

Reference Interval

Effective November 18th, 2013

Drug
Therapeutic Range
Toxic
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

This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

Compliance Category

Laboratory Developed Test (LDT)

Note

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

Hotline History
N/A
CPT Codes

80337 (Alt code: G0480)

Components
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.
Aliases
  • Tricyclic Antidepressant Screen
  • Tricyclic Screen
Tricyclic Antidepressants, Quantitative, Serum or Plasma