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HelpTest Code TRMP Trimipramine, Serum
Reporting Name
Trimipramine, SUseful For
Monitoring trimipramine concentration during therapy
Evaluating potential trimipramine toxicity
May aid in evaluating patient compliance
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Serum RedSpecimen 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 mL
Collection Instructions:
1. Collect specimen immediately before next scheduled dose (minimum 12 hours after last dose).
2. Centrifuge and aliquot serum into a plastic vial. Serum must be separated from cells within 2 hours of collection.
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 7 days |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Reference Values
Therapeutic concentration: 150-300 ng/mL
Note: Therapeutic ranges are for specimens collected at trough (ie, immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Day(s) Performed
Tuesday, Thursday, Sunday
CPT Code Information
80299
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| TRMP | Trimipramine, S | 4083-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 64269 | Trimipramine, S | 4083-2 |
Clinical Information
Trimipramine is a tricyclic antidepressant with additional anxiety-reducing sedative activity. Daily dosages for adults range from 50 mg to 300 mg and are usually divided into 2 to 3 doses per day. Therapeutic ranges are based on serum samples collected at trough (ie, immediately before the next dose). Peak serum concentrations are typically achieved after 1 to 6 hours post dosage.
Common adverse effects include hypotension, tachycardia, constipation, dizziness, somnolence, and blurred vision. Risk of toxicity increases when concentrations exceed 500 ng/mL. Serious adverse effects include coma, seizures, and QRS prolongation with ventricular dysrhythmias.
Interpretation
Most individuals display optimal response to trimipramine with serum levels of 150 to 300 ng/mL. Risk of toxicity is increased with trimipramine levels above 500 ng/mL.
Some individuals may respond well outside of this range or may display toxicity within the therapeutic range; thus, interpretation should include clinical evaluation.
Therapeutic ranges are based on specimens collected at trough (ie, immediately before the next dose).
Cautions
This test cannot be performed on whole blood. Serum must be separated from cells within 2 hours of collection; if serum is not removed within this time, tricyclic antidepressant levels may be falsely elevated due to drug release from red blood cells.
Specimens that are obtained from gel tubes are not acceptable because the drug can absorb on the gel and lead to falsely decreased concentrations.
Coadministration of fluvoxamine, moclobemide, or quinidine inhibits the metabolism and markedly increases the serum concentrations of trimipramine.
Method Description
The tricyclic antidepressants are extracted from serum using a solvent to precipitate proteins. The supernatant is removed, and analysis is by liquid chromatography tandem mass spectrometry.(Unpublished Mayo method)
Report Available
3 to 5 daysSpecimen Retention Time
14 daysTest 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.Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
Clinical Reference
1. Wille SM, Cooreman SG, Neels HM, Lambert WE. Relevant issues in the monitoring and the toxicology of antidepressants. Crit Rev Clin Lab Sci. 2008;45(1):25-89
2. Thanacoody HK, Thomas SHL. Antidepressant poisoning. Clin Med (Lond). 2003;3(2):114-118
3. Hiemke C, Bergemann N, Clement HW, et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: Update 2017. Pharmacopsychiatry. 2018;51(1-01):9-62
4. 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