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HelpTest Code TBSU Targeted Benzodiazepine Screen, Random, Urine
Additional Testing Requirements
In most cases, no additional testing is needed after the qualitative targeted benzodiazepine test is performed if the parent drug or metabolites found are consistent with the patient's prescribed medications. However, if unexpected benzodiazepine parent or metabolites are found, confirmatory testing can be requested at an additional charge.
Specimen Required
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 5-mL tube
Specimen Volume: 1 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative
Secondary ID
604262Useful For
Determining compliance or identifying illicit benzodiazepine drug use
This test is not intended for employment-related testing.
Highlights
This test uses high-resolution accurate mass spectrometry to identify 27 different benzodiazepines and metabolites for situations when immunoassays are not adequate.
This test offers lower detection limits than previous Mayo Clinic Laboratories-offered screens.
This test has the ability to detect "spiked" samples.
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| LPPB | List prescribed benzodiazepines | No | Yes |
| TABSU | Targeted Benzodiazepine Screen, U | No | Yes |
Method Name
Liquid Chromatography Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
Reporting Name
Targeted Benzodiazepine Screen, USpecimen Type
UrineSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Reject Due To
| Gross hemolysis | Reject |
| Gross icterus | Reject |
Clinical Information
Benzodiazepines represent a large family of medications used to treat a wide range of disorders from anxiety to seizures, and they are also used in pain management. With a high risk for abuse and diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. However, traditional benzodiazepine immunoassays suffer from a lack of cross-reactivity with all the benzodiazepines, so many compliant patients taking either clonazepam (Klonopin) or lorazepam (Ativan) may screen negative by immunoassay but are positive when confirmatory testing is done. The new targeted benzodiazepine screening test provides a more sensitive and specific test to check for compliance to all the commonly prescribed benzodiazepines and looks for both the parent drug and its metabolites in the urine.
Reference Values
Not detected
Cutoff concentrations:
Alprazolam: 10 ng/mL
Alpha-hydroxyalprazolam: 10 ng/mL
Alpha-hydroxyalprazolam glucuronide: 50 ng/mL
Chlordiazepoxide: 10 ng/mL
Clobazam: 10 ng/mL
N-Desmethylclobazam: 200 ng/mL
Clonazepam: 10 ng/mL
7-Aminoclonazepam: 10 ng/mL
Diazepam: 10 ng/mL
Nordiazepam: 10 ng/mL
Flunitrazepam: 10 ng/mL
7-Aminoflunitrazepam: 10 ng/mL
Flurazepam: 10 ng/mL
2-Hydroxy ethyl flurazepam: 10 ng/mL
Lorazepam: 10 ng/mL
Lorazepam glucuronide: 50 ng/mL
Midazolam: 10 ng/mL
Alpha-hydroxy midazolam: 10 ng/mL
Oxazepam: 10 ng/mL
Oxazepam glucuronide: 50 ng/mL
Prazepam: 10 ng/mL
Temazepam: 10 ng/mL
Temazepam glucuronide: 50 ng/mL
Triazolam: 10 ng/mL
Alpha-hydroxy triazolam: 10 ng/mL
Zolpidem: 10 ng/mL
Zolpidem phenyl-4-carboxylic acid: 10 ng/mL
Interpretation
If a benzodiazepine or its corresponding metabolites is identified (present), it indicates that the patient has used the respective benzodiazepine in the recent past. The absence of expected benzodiazepines or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge.
Cautions
No significant cautionary statements
Clinical Reference
1. 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
2. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
Method Description
The urine sample is diluted with internal standard and then analyzed by liquid chromatography tandem mass spectrometry using a high-resolution accurate mass orbitrap detector.(Unpublished Mayo method)
Day(s) Performed
Monday through Sunday
Report Available
3 to 4 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
80347
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| TBSU | Targeted Benzodiazepine Screen, U | 94117-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| LPPB | List prescribed benzodiazepines | 29305-0 |
| 604871 | Alprazolam | 94116-1 |
| 604867 | Alpha-Hydroxyalprazolam | 19325-0 |
| 604891 | Alpha-Hydroxyalprazolam Glucuronide | 94115-3 |
| 604872 | Chlordiazepoxide | 19385-4 |
| 604889 | Clobazam | 94114-6 |
| 604890 | N-Desmethylclobazam | 94113-8 |
| 604873 | Clonazepam | 19399-5 |
| 604267 | 7-aminoclonazepam | 94112-0 |
| 604874 | Diazepam | 19443-1 |
| 604880 | Nordiazepam | 19624-6 |
| 604875 | Flunitrazepam | 19466-2 |
| 604866 | 7-aminoflunitrazepam | 94111-2 |
| 604876 | Flurazepam | 19474-6 |
| 604868 | 2-Hydroxy Ethyl Flurazepam | 94110-4 |
| 604877 | Lorazepam | 19520-6 |
| 604878 | Lorazepam Glucuronide | 94109-6 |
| 604879 | Midazolam | 19585-9 |
| 604869 | Alpha-Hydroxy Midazolam | 94108-8 |
| 604881 | Oxazepam | 19638-6 |
| 604882 | Oxazepam Glucuronide | 94107-0 |
| 604883 | Prazepam | 19678-2 |
| 604884 | Temazepam | 19698-0 |
| 604885 | Temazepam Glucuronide | 94106-2 |
| 604886 | Triazolam | 19714-5 |
| 604870 | Alpha-Hydroxy Triazolam | 94105-4 |
| 604887 | Zolpidem | 94104-7 |
| 604888 | Zolpidem Phenyl-4-Carboxylic acid | 94103-9 |
| 604949 | Benzodiazepine Interpretation | 69050-3 |
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.