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Test Code TBSU Targeted Benzodiazepine Screen, Random, Urine


Additional Testing Requirements


In most cases, no additional testing is needed after the qualitative targeted benzodiazepine test is performed if the parent or metabolites found are consistent with the patients prescribed medications. However, if unexpected benzodiazepine parent or metabolites are found, confirmatory testing can be requested at an additional charge.



Specimen Required


Supplies: Aliquot Tube, 5 mL (T465)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 5-mL tube

Specimen Volume: 3 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative


Secondary ID

604262

Useful For

Determining compliance or identifying illicit benzodiazepine drug use

 

This test is not intended for employment-related testing

Profile Information

Test ID Reporting Name Available Separately Always Performed
LPPB List prescribed benzodiazepines No Yes
TABSU Targeted Benzodiazepine Screen, U No Yes

Method Name

Liquid Chromatography-Tandem Mass Spectrometry, High Resolution Accurate Mass (LC-MS/MS HRAM)

Reporting Name

Targeted Benzodiazepine Screen, U

Specimen Type

Urine

Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 14 days
  Frozen  28 days
  Ambient  72 hours

Reject Due To

Gross hemolysis Reject
Gross icterus Reject

Clinical Information

Benzodiazepines represent a large family of medications used to treat a wide range of disorders from anxiety to seizures and they are also used in pain management. With a high risk for abuse and diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. However, traditional benzodiazepine immunoassays suffer from a lack of cross-reactivity with all the benzodiazepines, so many compliant patients taking clonazepam (Klonopin) or lorazepam (Ativan) may screen negative by immunoassay, but are positive when confirmatory testing is done. The new targeted benzodiazepine screening test provides a more sensitive and specific test to check for compliance to all the commonly prescribed benzodiazepines and looks for both parent and metabolites in the urine.

Reference Values

Not Detected

 

Cutoff concentrations:

 

Alprazolam: 10 ng/mL

Alpha-Hydroxyalprazolam: 10 ng/mL

Alpha-Hydroxyalprazolam Glucuronide: 50 ng/mL

Chlordiazepoxide: 10 ng/mL

Clobazam: 10 ng/mL

N-Desmethylclobazam: 200 ng/mL

Clonazepam: 10 ng/mL

7-aminoclonazepam: 10 ng/mL

Diazepam: 10 ng/mL

Nordiazepam: 10 ng/mL

Flunitrazepam: 10 ng/mL

7-aminoflunitrazepam: 10 ng/mL

Flurazepam: 10 ng/mL

2-Hydroxy Ethyl Flurazepam: 10 ng/mL

Lorazepam: 10 ng/mL

Lorazepam Glucuronide: 50 ng/mL

Midazolam: 10 ng/mL

Alpha-Hydroxy Midazolam: 10 ng/mL

Oxazepam: 10 ng/mL

Oxazepam Glucuronide: 50 ng/mL

Prazepam: 10 ng/mL

Temazepam: 10 ng/mL

Temazepam Glucuronide: 50 ng/mL

Triazolam: 10 ng/mL

Alpha-Hydroxy Triazolam: 10 ng/mL

Zolpidem: 10 ng/mL

Zolpidem Phenyl-4-Carboxylic acid: 10 ng/mL

Interpretation

If a benzodiazepine or its corresponding metabolites are identified (present), it indicates that the patient has used the respective benzodiazepine in the recent past. The absence of expected benzodiazepines or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge.

Clinical Reference

1. Jannetto PJ, Bratanow NC, Clark WA, et al: Executive Summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients. J Appl Lab Med 2018;2:489

2. Nader R, Horwath AR, Wittwer CT: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Sixth edition. St. Louis. Elsevier 2017

Day(s) and Time(s) Performed

Monday through Saturday

Analytic Time

3 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

80347

G0480 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
TBSU Targeted Benzodiazepine Screen, U In Process

 

Result ID Test Result Name Result LOINC Value
LPPB List prescribed benzodiazepines 29305-0
604871 Alprazolam 94116-1
604867 Alpha-Hydroxyalprazolam 19325-0
604891 Alpha-Hydroxyalprazolam Glucuronide 94115-3
604872 Chlordiazepoxide 19385-4
604889 Clobazam 94114-6
604890 N-Desmethylclobazam 94113-8
604873 Clonazepam 19399-5
604267 7-aminoclonazepam 94112-0
604874 Diazepam 19443-1
604880 Nordiazepam 19624-6
604875 Flunitrazepam 19466-2
604866 7-aminoflunitrazepam 94111-2
604876 Flurazepam 19474-6
604868 2-Hydroxy Ethyl Flurazepam 94110-4
604877 Lorazepam 19520-6
604878 Lorazepam Glucuronide 94109-6
604879 Midazolam 19585-9
604869 Alpha-Hydroxy Midazolam 94108-8
604881 Oxazepam 19638-6
604882 Oxazepam Glucuronide 94107-0
604883 Prazepam 19678-2
604884 Temazepam 19698-0
604885 Temazepam Glucuronide 94106-2
604886 Triazolam 19714-5
604870 Alpha-Hydroxy Triazolam 94105-4
604887 Zolpidem 94104-7
604888 Zolpidem Phenyl-4-Carboxylic acid 94103-9
604949 Benzodiazepine Interpretation 69050-3

Forms

If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.