Benzodiazepines, Quantitative, Urine

Included Tests

Alphahydroxyalprazolam; Alphahydroxymidazolam; Alphahydroxytriazolam; Aminoclonazepam; Hydroxyethylflurazepam; Lorazepam; Nordiazepam; Oxazepam; Temazepam

Clinical Significance

Drug Monitoring, Benzodiazepines, Quantitative, Urine - This test measures levels of benzodiazepine metabolites in urine. Benzodiazepine metabolites are biomarkers for monitoring possible use or non-use of benzodiazepine drugs. The test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis.

Benzodiazepines are GABAergic drugs used as anxiolytics, anticonvulsants, and sedatives to treat alcohol dependence, seizures, anxiety, and panic disorders. Metabolites include alphahydroxyalprazolam, alphahydroxymidazolam, alphahydroxytriazolam, aminoclonazepam, hydroxyethylflurazepam, lorazepam, nordiazepam, oxazepam, and temazepam. Benzodiazepines are extensively metabolized and excreted as conjugated [1-9].

According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [10].

Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [10].

Note: No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.

Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.

Specimen Requirements

20 mL urine submitted in a Clinical Drug Test transport vial

Alternate Specimen

 20.0 mL Urine in a Non Sterile Yellow or Sterile Gray Capped Plastic Containers (No preservatives)

TransportAndStorage

14 days Ambient
14 days Refrigerated
30 days Frozen

Collection Instructions

 

Minimum Volume

5.0 mL Urine

Neonatal Volumne

Reference Range:

Alphahydroxyalprazolam	<25 ng/mL
Alphahydroxymidazolam	<50 ng/mL
Alphahydroxytriazolam	<50 ng/mL
Aminoclonazepam	<25 ng/mL
Hydroxyethylflurazepam	<50 ng/mL
Lorazepam	<50 ng/mL
Nordiazepam	<50 ng/mL
Oxazepam	<50 ng/mL
Temazepam	<50 ng/mL

Methodology:

• Mass Spectrometry (MS)

Clinical Significance

Drug Monitoring, Benzodiazepines, Quantitative, Urine - This test measures levels of benzodiazepine metabolites in urine. Benzodiazepine metabolites are biomarkers for monitoring possible use or non-use of benzodiazepine drugs. The test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis.

Benzodiazepines are GABAergic drugs used as anxiolytics, anticonvulsants, and sedatives to treat alcohol dependence, seizures, anxiety, and panic disorders. Metabolites include alphahydroxyalprazolam, alphahydroxymidazolam, alphahydroxytriazolam, aminoclonazepam, hydroxyethylflurazepam, lorazepam, nordiazepam, oxazepam, and temazepam. Benzodiazepines are extensively metabolized and excreted as conjugated [1-9].

According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [10].

Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [10].

Note: No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.

Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.

CDM

00913333

CPT Coding

80346 (HCPCS: G0480)