Test Catalog

Test Id : MDNS

Methadone and Metabolites, Serum

Useful For
Suggests clinical disorders or settings where the test may be helpful

Compliance monitoring of methadone

 

Assessment of methadone toxicity

Method Name
A short description of the method used to perform the test

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

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Methadone and Metabolite, S

Aliases
Lists additional common names for a test, as an aid in searching

Methadone (Dolophine)

Specimen Type
Describes the specimen type validated for testing

Serum Red

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

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

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial within 2 hours of collection.

Forms

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

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.2 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

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

Useful For
Suggests clinical disorders or settings where the test may be helpful

Compliance monitoring of methadone

 

Assessment of methadone toxicity

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Methadone, a long-acting synthetic opioid analgesic, is an agonist at the mu receptor. It has several actions qualitatively similar to those of morphine, primarily involving the central nervous system and organs composed of smooth muscles. Analgesia, sedation, and detoxification or maintenance in opioid addiction can be achieved with therapeutic use of methadone hydrochloride. Methadone acts by binding to the mu-opioid receptor but also has some affinity for the N-methyl-D-aspartate receptor (NMDA) ionotropic glutamate receptor. 

 

Methadone undergoes extensive biotransformation in the liver. Methadone is metabolized by cytochrome P450 (CYP) 3A4, CYP2B6, CYP2C19, and CYP2D6 enzymes. It is also a substrate for the P-glycoprotein efflux protein. The major inactive metabolite is a result of N-demethylation and cyclization, and forms 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidene (EDDP).

 

Substantial interindividual and intraindividual variabilities in metabolism and elimination have been noted. The half-life of methadone is highly variable and typically ranges from 7 to 59 hours; however, longer half-lives have been reported.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Not established

Interpretation
Provides information to assist in interpretation of the test results

There is a significant overlap between the reported therapeutic and toxic concentrations of methadone in blood specimens.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Methadone has a wide therapeutic index and dose-dependent toxicity. As a result, routine drug monitoring is not indicated in all patients.

 

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
Recommendations for in-depth reading of a clinical nature

1. Langman LJ, Bechtel LK, Meier BM, Holstege C: Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887

2. Yaksh TL, Wallace MS: Chapter 18: Opioids, analgesia, and pain management. In: Brunton LL, Chabner BA, Knollmann BC, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 12th ed. McGraw-Hill Book Company; 2011

3. Baselt RC: Disposition of Toxic Drugs and Chemical in Man. 9th ed. Biomedical Publications; 2011:1021-1025

Method Description
Describes how the test is performed and provides a method-specific reference

Liquid/liquid extraction of the serum sample followed by liquid chromatography-tandem mass spectrometry.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Tuesday, Thursday, Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 5 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

80358

G0480 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
MDNS Methadone and Metabolite, S 96602-8
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
36309 Methadone 3772-1
36310 EDDP 60071-8

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Create a PDF

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports