Purpose
Exclusion Screen
Method(s)
Gas Chromatography (GC)
Suggested CPT Code(s)
80307
New York State Approval Status

Approved

Known Interference(s)
Protriptyline [GC]: Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
Turnaround Time

5 days (If Positive: 12 days)

Test Includes
1 Amitriptyline Elavil®; Endep® Gas Chromatography (GC) ng/mL 10 Antidepressant
2 Nortriptyline Amitriptyline Metabolite; Aventyl®; Pamelor® Gas Chromatography (GC) ng/mL 10 Antidepressant
3 Clomipramine Anafranil® Gas Chromatography (GC) ng/mL 10 Antidepressant
4 Desmethylclomipramine Clomipramine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
5 Imipramine Tofranil® Gas Chromatography (GC) ng/mL 10 Antidepressant
6 Desipramine Imipramine Metabolite; Norpramin®; Pertofrane® Gas Chromatography (GC) ng/mL 10 Antidepressant
7 Doxepin Sinequan® Gas Chromatography (GC) ng/mL 10 Antidepressant
8 Desmethyldoxepin Doxepin Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
9 Trimipramine Surmontil® Gas Chromatography (GC) ng/mL 10 Antidepressant
10 Desmethyltrimipramine Trimipramine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
11 Fluoxetine Prozac® Gas Chromatography (GC) ng/mL 10 Antidepressant
12 Norfluoxetine Fluoxetine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
13 Protriptyline Vivactil® Gas Chromatography (GC) ng/mL 10 Antidepressant Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
14 Maprotiline Ludiomil® Gas Chromatography (GC) ng/mL 10 Antidepressant
15 Trazodone Desyrel® Gas Chromatography (GC) mcg/mL 0.1 Antidepressant
16 Amoxapine Asendin® Gas Chromatography (GC) ng/mL 50 Antidepressant
17 Mirtazapine Remeron® Gas Chromatography (GC) ng/mL 5 Antidepressant

Test Also Known As
Adapin®; Rhotrimine®; Triptil®
Reflex Tests
Test Code Test Name
5450SP Antidepressants Confirmation, Serum/Plasma
Specimen Type
Serum or Plasma
Requested Volume
5 mL
Minimum Volume
2.4 mL
Special Handling
Serum: Collect sample in Red top tube
Plasma: Collect sample in Lavender top tube (EDTA) or Pink top tube.
Promptly centrifuge and separate Serum or Plasma into a plastic screw capped vial using approved guidelines.
Specimen Container
Plastic container (preservative-free)

Additional Collection Instructions

Transport Temperature
Refrigerated
Light Protection
Not Required
Rejection Criteria
Received Room Temperature. Polymer gel separation tube (SST or PST).

Rejection criteria pertain to clinical specimen submissions only.

Stability
Room Temperature: 2 day(s)
Refrigerated: 14 day(s)
Frozen (-20 °C): 14 day(s)
1 Amitriptyline Elavil®; Endep® Gas Chromatography (GC) ng/mL 10 Antidepressant
2 Nortriptyline Amitriptyline Metabolite; Aventyl®; Pamelor® Gas Chromatography (GC) ng/mL 10 Antidepressant
3 Clomipramine Anafranil® Gas Chromatography (GC) ng/mL 10 Antidepressant
4 Desmethylclomipramine Clomipramine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
5 Imipramine Tofranil® Gas Chromatography (GC) ng/mL 10 Antidepressant
6 Desipramine Imipramine Metabolite; Norpramin®; Pertofrane® Gas Chromatography (GC) ng/mL 10 Antidepressant
7 Doxepin Sinequan® Gas Chromatography (GC) ng/mL 10 Antidepressant
8 Desmethyldoxepin Doxepin Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
9 Trimipramine Surmontil® Gas Chromatography (GC) ng/mL 10 Antidepressant
10 Desmethyltrimipramine Trimipramine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
11 Fluoxetine Prozac® Gas Chromatography (GC) ng/mL 10 Antidepressant
12 Norfluoxetine Fluoxetine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
13 Protriptyline Vivactil® Gas Chromatography (GC) ng/mL 10 Antidepressant Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
14 Maprotiline Ludiomil® Gas Chromatography (GC) ng/mL 10 Antidepressant
15 Trazodone Desyrel® Gas Chromatography (GC) mcg/mL 0.1 Antidepressant
16 Amoxapine Asendin® Gas Chromatography (GC) ng/mL 50 Antidepressant
17 Mirtazapine Remeron® Gas Chromatography (GC) ng/mL 5 Antidepressant

Interface Map

LOINC® Information