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22233 Amitriptyline and Nortriptyline, Serum (AMTRP)

Amitriptyline and Nortriptyline, Serum (AMTRP)
Test Code:  AMNORSO
Synonyms/Keywords
​Ref Lab Code: 8125, Amitriptyline (Elavil), Elavil (Amitriptyline), Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl, Saroten, Triptyl, Redomex (Amitriptyline), Nortriptyline (Pamelor), Pamelor (Nortriptyline), Sensoval, Aventyl, Pamelor, Norpress, Allegron, and Nortrilen (Nortriptyline), TCA (Tricyclic Antidepressants), Tricyclic Antidepressants (TCA)
Useful For
​Monitoring serum concentration during therapy
 
Evaluating potential toxicity
 
The test may also be useful to evaluate patient compliance
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum Red Top Tube (RTT)​ ​ 1 mL​ 0.25 mL​ ​
Collection Processing Instructions
​1. Draw specimen immediately before next scheduled dose (minimum 12 hours after last dose).
2. Serum must be separated from cells within 2 hours of draw.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Refrigerated (preferred)​ 28 days​
Ambient ​ 7 days​
Frozen​ 28 days​
Rejection Criteria
Gross hemolysis
​Gross lipemia
​Gross icterus
Serum gel tube​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Medical Laboratories​
 Monday through Friday; Varies​ 2 days​
High-Performance Liquid Chromatography (HPLC)​
Reference Lab
Mayo Clinic Laboratories
Reference Range Information
AMITRIPTYLINE AND NORTRIPTYLINE
Total therapeutic concentration: 80-200 ng/mL
Total toxic concentration: > or =300 ng/mL
 
NORTRIPTYLINE ONLY
Therapeutic concentration: 70-170 ng/mL
Toxic concentration: > or =300 ng/mL
 
Note: Therapeutic ranges are for specimens drawn at trough (ie, immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Interpretation
​Most individuals display optimal response to amitriptyline when combined serum levels of amitriptyline and nortriptyline are between 80 and 200 ng/mL. Risk of toxicity is increased with combined levels > or =300 ng/mL.
 
Most individuals display optimal response to nortriptyline with serum levels between 70 and 170 ng/mL. Risk of toxicity is increased with nortriptyline levels > or =300 ng/mL.
 
Some individuals may respond well outside of these ranges, or may display toxicity within the therapeutic range, thus interpretation should include clinical evaluation.
 
Therapeutic ranges are based on specimens drawn at trough (ie, immediately before the next dose).
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​80335 ​ ​ ​ ​
Synonyms/Keywords
​Ref Lab Code: 8125, Amitriptyline (Elavil), Elavil (Amitriptyline), Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl, Saroten, Triptyl, Redomex (Amitriptyline), Nortriptyline (Pamelor), Pamelor (Nortriptyline), Sensoval, Aventyl, Pamelor, Norpress, Allegron, and Nortrilen (Nortriptyline), TCA (Tricyclic Antidepressants), Tricyclic Antidepressants (TCA)
Ordering Applications
Ordering Application Description
​Centricity ​Amitriptyline-Nortriptyline, S (8125)
​Cerner ​Amitriptyline and Nortriptyline Levels (AMT)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum Red Top Tube (RTT)​ ​ 1 mL​ 0.25 mL​ ​
Collection Processing
​1. Draw specimen immediately before next scheduled dose (minimum 12 hours after last dose).
2. Serum must be separated from cells within 2 hours of draw.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Refrigerated (preferred)​ 28 days​
Ambient ​ 7 days​
Frozen​ 28 days​
Rejection Criteria
Gross hemolysis
​Gross lipemia
​Gross icterus
Serum gel tube​
Useful For
​Monitoring serum concentration during therapy
 
Evaluating potential toxicity
 
The test may also be useful to evaluate patient compliance
Reference Range Information
AMITRIPTYLINE AND NORTRIPTYLINE
Total therapeutic concentration: 80-200 ng/mL
Total toxic concentration: > or =300 ng/mL
 
NORTRIPTYLINE ONLY
Therapeutic concentration: 70-170 ng/mL
Toxic concentration: > or =300 ng/mL
 
Note: Therapeutic ranges are for specimens drawn at trough (ie, immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Interpretation
​Most individuals display optimal response to amitriptyline when combined serum levels of amitriptyline and nortriptyline are between 80 and 200 ng/mL. Risk of toxicity is increased with combined levels > or =300 ng/mL.
 
Most individuals display optimal response to nortriptyline with serum levels between 70 and 170 ng/mL. Risk of toxicity is increased with nortriptyline levels > or =300 ng/mL.
 
Some individuals may respond well outside of these ranges, or may display toxicity within the therapeutic range, thus interpretation should include clinical evaluation.
 
Therapeutic ranges are based on specimens drawn at trough (ie, immediately before the next dose).
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Medical Laboratories​
 Monday through Friday; Varies​ 2 days​
High-Performance Liquid Chromatography (HPLC)​
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​80335 ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.