Amitriptyline, Confirmation
CPT Code(s):
80335
Turnaround Time:
24 - 72 hours
Specimen Requirements
Preferred Specimen:
Urine
Minimum Volume:
5.0 mL
Transport Container:
Yellow Top Tube or Sterile Cup
Transport Temperature:
Room Temperature
Collection Instructions:
Collect urine in plastic container and transfer to plain yellow top tube (without preservative).
Rejection Criteria:
Specimen received outside stability requirements; Excessive blood, particulates, viscosity present. Preservative (speckled top) tube.
Stability Criteria
Room Temperature:
24 hours
Refrigerated:
7 days
Frozen:
30 days
Clinical Significance
Amitriptyline with quantitative results, performed using liquid chromatography-tandem mass spectrometry (LC/MS-MS), holds specific clinical significance and diagnostic use in the field of toxicology and medication monitoring.
Amitriptyline is a tricyclic antidepressant commonly prescribed for the treatment of depression, neuropathic pain, and other conditions. Amitriptyline measures the concentration of amitriptyline and its active metabolite, nortriptyline, in a patient's blood or urine sample. The test provides quantitative measurements, allowing for accurate assessment of drug levels in the body.
LC/MS-MS is a highly sensitive and specific analytical technique used for the quantification of substances in biological samples. It combines liquid chromatography, which separates the components of a sample, with tandem mass spectrometry, which identifies and quantifies the separated components based on their molecular characteristics. LC/MS-MS provides precise and reliable measurements of amitriptyline and nortriptyline levels.
The clinical significance and diagnostic use of Amitriptyline with LC/MS-MS include:
1. Therapeutic Drug Monitoring: The test aids in therapeutic drug monitoring of amitriptyline therapy. By measuring amitriptyline and nortriptyline levels, healthcare providers can assess the adequacy of drug dosing, optimize treatment regimens, and ensure patients are within the therapeutic range. Monitoring drug levels helps achieve desired clinical outcomes while minimizing the risk of side effects or therapeutic failure.
2. Assessment of Medication Compliance: The test assists in monitoring patient compliance with amitriptyline therapy. By quantifying drug levels, it provides objective evidence of recent amitriptyline use. Monitoring compliance is particularly relevant in cases where non-adherence to prescribed treatment regimens may impact therapeutic efficacy or contribute to treatment resistance.
3. Identification of Toxic Levels: Amitriptyline helps identify potential toxic levels of the drug. Amitriptyline overdose can lead to serious adverse effects, including cardiac arrhythmias, seizures, and coma. Quantitative measurement of amitriptyline and nortriptyline levels aids in assessing drug toxicity, guiding appropriate interventions, and monitoring the effectiveness of treatment interventions in overdose situations.
4. Forensic and Medicolegal Investigations: The test has forensic and medicolegal applications, especially in cases involving suspected amitriptyline misuse or overdose. Quantitative measurements of amitriptyline and nortriptyline levels can provide objective evidence of drug exposure, aiding in the determination of cause of death or assisting legal investigations.
In summary, Amitriptyline with quantitative results using LC/MS-MS has clinical significance in toxicology and medication monitoring. It assists in therapeutic drug monitoring, medication compliance assessment, identification of toxic levels, and supports forensic and medicolegal investigations. By providing accurate and reliable measurements of amitriptyline and nortriptyline levels, this test plays a vital role in optimizing treatment, ensuring patient safety, and providing valuable information to healthcare providers and legal professionals.