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HelpTest Code CZPS Clonazepam and 7-Aminoclonazepam, Serum
Test Down Notes
This test is temporarily unavailable due to instrumentation issues. As an alternate, order FCLMS. For additional details, see test update here.
Useful For
Assessing patient compliance
Monitoring for appropriate therapeutic level
Assessing clonazepam toxicity
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Clonazepam and 7-Aminoclonazepam, SSpecimen Type
Serum RedSpecimen Required
Collection Container/Tube: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1.2 mL
Collection Instructions:
1. Draw blood immediately before next scheduled dose (minimum 12 hours after last dose).
2. Within 2 hours of collection, the specimen must be centrifuged and the serum aliquoted into a plastic vial.
Specimen Minimum Volume
0.6 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Reject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | Reject |
Clinical Information
Clonazepam (5 [2-chlorophenyl]-2, 3-dihydro-7-nitro-1, 4-benzodiazepin-2-one), a benzodiazepine is useful alone or as an adjunct in the treatment of certain seizures. In addition, it may be useful in patients with panic disorder and restless legs syndrome.
Clonazepam has no definite antiseizure and antipanic mechanism of action, although it is believed to be related to its capacity to enhance gamma-aminobutyric acid (GABA) activity, which is the major inhibitory neurotransmitter in the central nervous system. It is able to suppress the spike and wave discharges in absence seizures and decreases the frequency, duration, amplitude, and spread of discharge in minor motor seizures.
Clonazepam is highly protein bound (approximately 85%). It is extensively metabolized by hepatic cytochrome P450, family 3, subfamily A (CYP3A) to inactive metabolites and has a half-life of 30 to 40 hours.
Reference Values
Clonazepam
Anticonvulsant: 20-70 ng/mL
Anxiolytic: 4-80 ng/mL
Some individuals may show therapeutic response outside of these ranges or may display toxicity within the therapeutic range, thus interpretation should include clinical evaluation.
Note: Therapeutic ranges are for specimens collected at trough (ie, immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Interpretation
The therapeutic range varies depending on the indication.
Some individuals may respond well outside of these ranges or may display toxicity within the therapeutic range, and thus, interpretation should include clinical evaluation.
The possibility of toxicity is increased when levels exceed 100 ng/mL.
Cautions
Specimens that are obtained from gel tubes must be removed from the gel within 2 hours.
Clinical Reference
Hiemke C, Baumann P, Bergemann N, et al: AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011. Pharmacopsychiatry. 2011;44(6):195-235
Method Description
Clonazepam and 7-aminoclonazepam are extracted from serum using a liquid-liquid extraction technique. The organic layer is removed, dried, and reconstituted. Analysis is by liquid chromatography-tandem mass spectrometry.(Unpublished Mayo method)
Day(s) Performed
Monday, Wednesday
Report Available
3 to 7 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
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
80299
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CZPS | Clonazepam and 7-Aminoclonazepam, S | 104541-8 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 65044 | Clonazepam | 3494-2 |
| 41782 | 7-Aminoclonazepam | 28059-4 |
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.