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Test Code TRAM Tramadol and Metabolite, Random, Urine

Reporting Name

Tramadol and Metabolite, U

Useful For

Monitoring of compliance utilizing tramadol

 

Detection and confirmation of the illicit use of tramadol

 

This test is not intended for use in employment-related testing.

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Urine


Ordering Guidance


 



Additional Testing Requirements


If urine creatinine is required or adulteration of the sample is suspected, the following test should also be ordered ADULT / Adulterants Survey, Random, Urine.

Specimen Required


Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative.

Additional Information:

1. No specimen substitutions.

2. STAT requests are not accepted for this test.

3. Submitting less than 1 mL will compromise our ability to perform all necessary testing.


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

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

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Reference Values

Cutoff: 25 ng/mL

Day(s) Performed

Tuesday, Thursday

CPT Code Information

80373

G0480 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
TRAM Tramadol and Metabolite, U 100734-3

 

Result ID Test Result Name Result LOINC Value
35914 Tramadol 20561-7
35915 O-desmethyltramadol 92639-4

Secondary ID

62595

Clinical Information

Tramadol, a centrally acting opioid analgesic, is utilized in the treatment of moderate to moderately severe pain. Tramadol acts as an opiate agonist through the binding of the parent drug and its O-desmethyl (M1) metabolite to mu-opioid receptors and through the weak inhibition of norepinephrine and serotonin reuptake. The active metabolite, O-desmethyltramadol, is a considerably more potent mu-opioid receptor agonist than its parent drug. In urine, approximately 30% of tramadol is excreted as unchanged drug, while approximately 60% is excreted as metabolites (N- and O-desmethyltramadol). The half-life of tramadol and O-desmethyltramadol is approximately 7 hours.

Interpretation

The presence of tramadol or O-desmethyltramadol levels of 25 ng/mL or higher is a strong indicator that the patient has used tramadol.

Cautions

Urine concentrations do not correlate well with serum drug levels and are not intended for therapeutic drug management.

 

Results are intended to be interpreted by a physician or health care professional.

Clinical Reference

1.Tramadol. In: Merative Micromedex. Merative; Accessed February 09, 2024. Available at: www.micromedexsolutions.com/

2. Jutkiewicz EM, Traynor JR. Opioid analgesics. In: Brunton LL, Knollmann BC, eds. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 14th ed. McGraw-Hill Education; 2023

3.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; 2023:454-454

Report Available

2 to 6 days

Specimen Retention Time

14 days

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.

Method Description

Isotopically labeled tramadol and O-desmethyltramadol are added to the sample as internal standards. The sample is then diluted with deionized water and the analytes are separated by liquid chromatography and then quantified by mass spectrometry using multiple reaction monitoring.(Patel BN, Sharma N, Sanyal M, Shrivastav PS. An accurate, rapid and sensitive determination of tramadol and its active metabolite O-desmethyltramadol in human plasma by LC-MS/MS. J Pharm Biomed Anal. 2009;49[2]:354-366)

Forms

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