Ordering Recommendation
Optimize drug therapy and monitor patient adherence.
Mnemonic
Methodology
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Performed
Mon, Wed, Fri
Reported
1-5 days
New York DOH Approval Status
Specimen Required
Timing of specimen collection: Pre-dose (trough) draw - At steady-state concentration.
Plain red. Also acceptable: Lavender (K2 or K3EDTA) or pink (K2EDTA).
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)
Refrigerated.
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
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.
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
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 |
Aliases
- Tricyclic Antidepressant Screen
- Tricyclic Screen