Test Catalog

Test Id : TBSU

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Targeted Benzodiazepine Screen, Random, Urine

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Determining compliance or identifying illicit benzodiazepine drug use

 

This test is not intended for employment-related testing.

Highlights

This test uses high-resolution accurate mass spectrometry to identify 27 different benzodiazepines and metabolites for situations when immunoassays are not adequate.

 

This test offers lower detection limits than previous Mayo Clinic Laboratories-offered screens.

 

This test has the ability to detect "spiked" samples.

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

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

Method Name
A short description of the method used to perform the test

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

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Targeted Benzodiazepine Screen, U

Aliases
Lists additional common names for a test, as an aid in searching

2-Hydroxy Ethyl Flurazepam (Metabolite of Flurazepam)

7-aminoclonazepam (Metabolite of Clonazepam)

7-aminoflunitrazepam (Metabolite of Flunitrazepam)

Alpha-Hydroxy Midazolam (Metabolite of Midazolam)

Alpha-Hydroxy Triazolam (Metabolite of Triazolam)

Alpha-Hydroxyalprazolam (Metabolite of Alprazolam)

Alpha-Hydroxyalprazolam Glucuronide (Metabolite of Alprazolam)

Alprazolam (Xanax)

Ativan (Lorazepam)

Benzodiazepines

Chlordiazepoxide (Librium)

Clobazam (Frisium, Onfi)

Clonazepam (Klonopin, Rivotril)

Dalmane (Flurazepam)

Diazepam (Valium)

Flunitrazepam (Rohypnol)

Flurazepam (Dalmane)

Halcion (Triazolam)

Hydroxy-Ethyl Flurazepam (Metabolite of Flurazepam)

Librium (Chlordiazepoxide)

Lorazepam (Ativan)

Lorazepam Glucuronide (Metabolite of Lorazepam)

N-Desmethylclobazam (Metabolite of Clobazam)

Nordiazepam (Metabolite of Chlordiazepoxide, Diazepam, or Prazepam.)

Oxazepam (Serax)

Oxazepam Glucuronide (Metabolite of Oxazepam)

Restoril (Temazepam)

Rohypnol (Flunitrazepam)

Serax (Oxazepam)

Temazepam (Restoril)

Temazepam Glucuronide (Metabolite of Temazepam)

Triazolam (Halcion)

Valium (Diazepam)

Xanax (Alprazolam)

Zolpidem (Ambien)

Zolpidem Phenyl-4-Carboxylic acid (Metabolite of Zolpidem)

Specimen Type
Describes the specimen type validated for testing

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.

ORDER QUESTIONS AND ANSWERS

Question ID Description Answers
LPPB List prescribed benzodiazepines

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Sarstedt 5 mL Aliquot Tube (T914)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 5-mL tube

Specimen Volume: 1 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative

Forms

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

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross icterus Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

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

Useful For
Suggests clinical disorders or settings where the test may be helpful

Determining compliance or identifying illicit benzodiazepine drug use

 

This test is not intended for employment-related testing.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

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
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

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
Provides information to assist in interpretation of the test results

If a benzodiazepine or its corresponding metabolites is 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.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Jannetto PJ: 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(4):489-526. doi: 10.1373/jalm.2017.023341

2. Langman LJ, Bechtel L, Meier BM, Holstege CP: Clinical toxicology In: Rifai N, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887

Method Description
Describes how the test is performed and provides a method-specific reference

The urine sample is diluted with internal standard and then analyzed by liquid chromatography-tandem mass spectrometry using a high resolution-accurate mass orbi-trap detector.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Saturday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

80347

G0480 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
TBSU Targeted Benzodiazepine Screen, U 94117-9
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
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
LPPB List prescribed benzodiazepines 29305-0

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | PHP Pdf | CMS Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports