Test Id : TRAMS
Tramadol and Metabolite, Serum
Useful For
Suggests clinical disorders or settings where the test may be helpful
This test is useful to help determine compliance and/or to monitor adverse drug reactions or efficacy
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.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
ConZip
Tramadol
Ultracet
Ultram
Ryzolt
Qdolo
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
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: Within 2 hours of collection, centrifuge and aliquot serum into a plastic vial.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 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) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
This test is useful to help determine compliance and/or to monitor adverse drug reactions or efficacy
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Tramadol is a synthetic opioid that is approximately equipotent with codeine but is considered to cause less respiratory depression and have less abuse potential. It is US Food and Drug Administration-approved for moderate to severe pain. It is available in immediate-release and extended-release tablets. It is extensively metabolized by CYP2D6 and CYP3A4 and has an active metabolite (O-desmethyltramadol). The eliminate half-life is approximately 5 hours to 7 hours (immediate-release) and approximately 6 hours to 10 hours (extended-release).
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.
Tramadol:
Peak plasma levels following a single 100 mg oral dose: 230-380 ng/mL
Steady-state plasma levels following a 100 mg 4 times daily regimen: 420-770 ng/mL
O-desmethyltramadol:
Peak plasma concentration following a single 100 mg oral dose: 35-75 ng/mL
Steady-state plasma concentration following a 100 mg 4 times daily regimen: 80-140 ng/mL
Cutoff concentrations by liquid chromatography tandem mass spectrometry:
Tramadol: 10 ng/mL
O-desmethyltramadol: 5.0 ng/mL
Interpretation
Provides information to assist in interpretation of the test results
Serum concentrations of tramadol and its active metabolite can be used to determine compliance and usage of tramadol within the past several days. In a group of 28 adult patients receiving daily oral immediate-release doses of 200 mg to 400 mg for 4 weeks, serum concentrations measured 12 hours after the last dose averaged 365 ng/mL (range: 95-841 ng/mL) for tramadol and 59 ng/mL (range: 5-123 ng/mL) for O-desmethyltramadol.(1)
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
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. Sindrup SH, Madsen C, Brosen K, Jensen TS. The effect of tramadol in painful polyneuropathy in relation to serum drug and metabolite levels. Clin Pharmacol Ther. 1999;66(6):636-641. doi:10.1053/cp.1999.v66.103171001
2. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
3. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020
4. Jannetto PJ, Bratanow NC, Clark WA, et al. Executive summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526
Method Description
Describes how the test is performed and provides a method-specific reference
The serum samples are mixed with internal standard and extracted by protein crash with methanol. The supernatant after centrifugation is diluted with clinical laboratory reagent water. The sample is then analyzed by liquid chromatography tandem mass spectrometer.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
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.
Wednesday
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.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
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 account representative. 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. It 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.
CPT codes are provided by the performing laboratory.
80299
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 |
|---|---|---|
| TRAMS | Tramadol and metabolite, S | In Process |
| 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.
|
|---|---|---|
| 623268 | Tramadol | 12437-0 |
| 623269 | O-desmethyltramadol | 82974-7 |