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Test Code SOFT: Z1000 Butalbital, Serum

Additional Codes

Ordering Mnemonic Mayo Test ID
EPIC NAME: MISC. LAB TEST BUTAS

 EPIC CODE: LAB000

Reporting Name

Butalbital, S

Useful For

Monitoring butalbital therapy

Method Name

Gas Chromatography-Mass Spectrometry (GC-MS)

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum Red


Specimen Required


Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube: Red top (serum gel/SST are not acceptable)

Submission Container/Tube: Plastic vial

Specimen Volume: 1.5 mL

Collection Instructions:

1. Draw blood immediately before the next scheduled dose.

2. Within 2 hours of collection centrifuge and aliquot serum into a plastic vial.


Specimen Minimum Volume

0.6 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Red Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Reference Values

Peak concentrations (100 mg single oral dose):

1.7-2.6 at 2 hours

1.3-1.7 at 24 hours

Toxic concentration: ≥10 mcg/mL

 

Cutoff concentrations by gas chromatography mass spectrometry:

Butalbital: 0.5 ng/mL

Day(s) Performed

Thursday

CPT Code Information

80299

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BUTAS Butalbital, S 6895-7

 

Result ID Test Result Name Result LOINC Value
8427 Butalbital, S 6895-7

Test Classification

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.

Clinical Information

Butalbital, a short-acting barbiturate with hypnotic properties, is used in combination with other drugs such as acetaminophen, salicylate, caffeine, and codeine.(1)

 

Butalbital is administered orally. The duration of its hypnotic effect is about 3 to 4 hours. The drug distributes throughout the body, with a volume of distribution of 0.8 L/kg, and about 26% of a dose is bound to plasma proteins. The half-life of butalbital is about 35 to 88 hours. Excretion occurs mainly in the urine.(1,2)

Interpretation

Butalbital concentrations of 10 mcg/mL or greater have been associated with toxicity.

Cautions

Specimens collected in serum gel tubes are not acceptable because the drug can absorb on the gel and lead to falsely decreased concentrations.

Clinical Reference

1. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43

2. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020

3. Milone MC, Shaw LM. Therapeutic drugs and their management. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:420-453

4. Mihic SJ, Mayfield J. Hypnotics and sedatives. In: Brunton LL, Knollmann BC, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 14th ed. McGraw-Hill Education; 2023

Method Description

Barbiturates are extracted from serum using solid-phase extraction techniques. The serum is buffered and eluted with organic solvent. The organic phase is dried, reconstituted, and the analysis performed by gas chromatography-mass spectrometry using selected ion monitoring. The assay utilizes deuterated barbiturates as internal standards.(Unpublished Mayo method)

Report Available

3 to 9 days

Specimen Retention Time

2 weeks

Forms

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

Secondary ID

8427