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| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
Drug Monitoring, Tramadol, Quantitative, Urine
Test Code16906
CPT Codes
80373 (HCPCS: G0480)
Includes
Desmethyltramadol, Tramadol
Preferred Specimen
20 mL random urine collected in a Clinical Drug Test transport vial
Minimum Volume
7 mL
Other Acceptable Specimens
Urine collected in urine collection container
Transport Temperature
Room temperature
Specimen Stability
Room temperature: 14 days
Refrigerated: 14 days
Frozen: 30 days
Refrigerated: 14 days
Frozen: 30 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Preserved samples
Methodology
Mass Spectrometry (MS)
Setup Schedule
Set up: Daily; Report available: 3 days
Reference Range
| Desmethyltramadol | <100 ng/mL |
| Tramadol | <100 ng/mL |
Clinical Significance
This test measures levels of tramadol and its metabolite desmethyltramadol in urine. Tramadol and desmethyltramadol are biomarkers for monitoring possible use or non-use of tramadol. The test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis.
Tramadol is an opioid-like analgesic used to treat moderate to moderately severe pain. Approximately 30% of the dose is excreted as unchanged drug, while 60% is excreted as metabolites [1,2].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [3].
Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [3].
Note: No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
References
1. Ultram [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc; 2003.
2. Vazzana M, et al. Biomed Pharmacother. 2015;70:234-238.
3. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017. https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf?la=en&hash=19670524407619F78999AB60731A24CB4901939D. Accessed November 21, 2019.
Tramadol is an opioid-like analgesic used to treat moderate to moderately severe pain. Approximately 30% of the dose is excreted as unchanged drug, while 60% is excreted as metabolites [1,2].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [3].
Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [3].
Note: No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
References
1. Ultram [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc; 2003.
2. Vazzana M, et al. Biomed Pharmacother. 2015;70:234-238.
3. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017. https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf?la=en&hash=19670524407619F78999AB60731A24CB4901939D. Accessed November 21, 2019.
