Test Catalog

Test Id : CDP

Chlordiazepoxide and Metabolite, Serum

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

Monitoring chlordiazepoxide therapy

 

Assessing 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

Chlordiazepoxide and metabolite, S

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

Benzodiazepines

Librium (Chlordiazepoxide)

Nordiazepam

Specimen Type
Describes the specimen type validated for testing

Serum Red

Shipping Instructions

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

Supplies: Sarstedt 5 mL Aliquot Tube (Amber) (T915)

Collection Container/Tube: Red top

Submission Container/Tube: Amber vial

Specimen Volume: 0.5 mL

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

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Neurology Specialty Testing Client Test Request (T732)

-Therapeutics Test Request (T831)

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

0.3 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 LIGHT PROTECTED
Frozen 14 days LIGHT PROTECTED
Ambient 24 hours LIGHT PROTECTED

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

Monitoring chlordiazepoxide therapy

 

Assessing toxicity

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

Chlordiazepoxide (Librium) is a benzodiazepine widely used in the treatment of anxiety, alcohol withdrawal symptoms, and as a premedication for anesthesia. The mechanism of action of all benzodiazepines remains unclear. However, it is known that benzodiazepines facilitate gamma-amino butyric acid (GABA)-mediated neurotransmission in the brain. Benzodiazepines most likely facilitate the inhibitory presynaptic or postsynaptic reactions of GABA.

 

Chlordiazepoxide is metabolized to long-acting metabolites in the liver to the active metabolite nordiazepam (desmethyldiazepam) and the clearance of the drug is reduced considerably in the elderly and in patients with hepatic disease.

 

Therapeutic assessment should include measurement of both the parent drug (chlordiazepoxide) and the active metabolite (nordiazepam).

 

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

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.

Therapeutic concentration:

Chlordiazepoxide: 400-3,000 ng/mL

Nordiazepam: 100-500 ng/mL

Interpretation
Provides information to assist in interpretation of the test results

Chlordiazepoxide and nordiazepoxide combined concentrations above 5000 ng/mL have been associated with toxicity.

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

The specimen must be protected from light. 

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Langman, LJ, Bechtel L, Meier BM, Holstege CP, 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. Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. WB Saunders Company; 2011:1109-1188

3. Hiemke C, Baumann P, Bergemann N, et al: AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011. Pharmacopsychiatry. 2011;44:195-235

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

The internal standard mixture containing chlordiazepoxide-d5, diazepam-d4, and nordiazepam-d5 is added to serum samples. The serum samples are treated with phosphate buffer and extracted via liquid/liquid extraction. The organic layer from the extraction is dried under nitrogen, reconstituted, and injected on a liquid chromatography-tandem mass spectrometer (LC-MS/MS).(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.

Monday, 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.

2 to 7 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 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.

80346

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
CDP Chlordiazepoxide and metabolite, S 33060-5
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.
8610 Chlordiazepoxide 3457-9
37321 Nordiazepam 3537-8

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 | 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