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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.
Synonyms
Elavil; Endep; Etrafon; Triavil
SPECIMEN REQUIREMENTS
Container Type
Red top tube (plain)
Supply Item Number
1372
Specimen Type
Serum
Preferred Volume
0.5 mL
Emergency Minimum Volume
0.2 mL
Collection Procedure
Optimal time to collect sample: Draw 10-14 hours post-dose. If a divided dose is given, draw before morning dose.
Specimen Processing
Blood 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 Transport
Refrigerated
Required Patient Info
Date and time of dose and draw.
Stability
Room Temp 5 days  Refrigerated 1 week  Frozen (-20 °C) 1 month  Frozen (-70 °C) 1 year  
Unacceptable Condition
DO NOT use gel separator tubes (Corvac®, SST or equivalent) for the collection of blood samples for this test.
Limitations
Protriptyline interferes with nortriptyline.
Reference Laboratory
PAML
Reference Lab Test Code
LCA code 911162
CPT Codes
80335, (HCPCS G0480)
Interface Order Code
80152
Billing Code
AMI
Test Schedule
Mon, Wed, Fri
Turnaround Time
1-3 days
Method
Tandem 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 Remarks
This 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.
Notes
Nortriptyline 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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