Tricyclic Multi-Drug Screen

Label Mnemonic:	TADID
Epic code:	LAB7285
Order form:	Laboratory Requisition
Supply order:	Supply Order Form
Billing:	Billing Policies
CPT code:	80335

Specimen(s):

Plasma

Collection Medium:

Lavender top tube 3 mL (EDTA)

Minimum:

Preferred Minimum: 1 mL plasma
Absolute Minimum: 0.5 mL plasma

Rejection Criteria:

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

Turn Around Time:

1-7 days upon receipt at reference laboratory.

Reference Range:

Drug                                 Therapeutic Range       Toxic
Amitriptyline (Elavil, Vanatrip)      Not established   Not established
Nortriptyline (Aventyl, Pamelor)       50-150 ng/mL       > 500 ng/mL
Total Amitriptyline + Nortriptyline    95-250 ng/mL       > 500 ng/mL

Imipramine (Tofranil)                 Not established   Not established
Desipramine (Norpramin)                100-300 ng/mL      > 500 ng/mL
Total Imipramine + Desipramine         150-300 ng/mL      > 500 ng/mL

Doxepin (Sinequan, Zonalon)           Not established   Not established
Nordoxepin                            Not established   Not established
Total Doxepin + Nordoxepin             100-300 ng/mL      > 500 ng/mL

Protriptyline (Vivactil)                70-240 ng/mL      > 400 ng/mL

Clomipramine (Anafranil)              Not established   Not established
Norclomipramine                       Not established   Not established
Total Clomipramine + Norclomipramine   220-500 ng/mL      > 900 ng/mL

Methodology:

Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Sample Processing:

Centrifuge at 3000 RPM for 10 minutes.
Label transport tube with two patient identifiers, date and time of collection.
Within 2 hours of collection, transfer 1 mL plasma into transport tube.

Sample Storage:

Store plasma frozen.

Transport Instructions:

Place labeled specimen into zip-lock type biohazard bag; seal bag.
Place completed requisition into outside pocket of bag.
Place dry ice on top of specimen in Styrofoam container to maintain frozen temperature.

CPT Code:

80335