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AMITRIPTYLINE AND METABOLITE

Test Code
AMITR
 
This test is a lab developed test. For further information, see the Compliance Remarks section below.
SynonymsElavil; Endep; Etrafon; Triavil
SPECIMEN REQUIREMENTS
Container TypeRed top tube (plain)
Supply Item Numberpicture1372
Specimen TypeSerum
Preferred Volume0.5 mL
Emergency Minimum Volume0.2 mL
Collection ProcedureOptimal time to collect sample: Draw 10-14 hours post-dose. If a divided dose is given, draw before morning dose.
Specimen ProcessingBlood samples should be collected by venipuncture in a plain red top and serum samples must be allowed to clot naturally at room temperature. Separate serum from cells within 4 hours and place in separate polypropylene (not polystyrene) tube.
Store and TransportRefrigerated
Required Patient InfoDate and time of dose and draw.
StabilityRoom Temp 5 days  Refrigerated 1 week  Frozen (-20 °C) 1 month  Frozen (-70 °C) 1 year  
Unacceptable ConditionDO NOT use gel separator tubes (Corvac®, SST or equivalent) for the collection of blood samples for this test.
LimitationsProtriptyline interferes with nortriptyline.
CPT Codes80335, (HCPCS G0480)
Interface Order Code80152
Billing CodeAMI
Test ScheduleMon, Wed, Fri
Turnaround Time1-3 days
MethodTandem Mass Spectrometry
Reference Ranges
TitleDescriptorRangesUnits
AmitriptylineNo reference range established for parent drug. See Total for reference range, which takes into account all metabolites.ng/mL
NortriptylineTherapeutic50-150ng/mL
Toxic> 500
Total (Amitriptline + Nortriptline)Therapeutic95-250ng/mL
Toxic> 500
Studies have determined that Norpace will interfere with the measurement of the Amitriptyline metabolite, Nortriptyline. Nortriptyline results and total tricyclic results are not valid for patients on Norpace.
Compliance RemarksThis test was developed and its performance characteristics determined by PAML. The U.S. Food and Drug Administration (FDA) has not approved or cleared this test. However, FDA approval or clearance is currently not required for clinical use of this test. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions. PAML is authorized under Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity testing.
NotesNortriptyline is an active metabolite.

Interface Codes
typeorder codetest descriptionresult coderesult descriptionunitsdecimal placesloinc code
o80152Amitriptyline and Metabolite
r80152Amitriptyline and Metabolite80152.Z1Amitriptylineng/mL03333-2
r80152Amitriptyline and Metabolite80152.Z3Total Amit+Nortripng/mL03335-7
r80152Amitriptyline and Metabolite80182Nortriptylineng/mL03872-9

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