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HelpTest Code TRAMS Tramadol and Metabolite, Serum
Specimen Required
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.
Secondary ID
623268Useful For
This test is useful to help determine compliance and/or to monitor adverse drug reactions or efficacy
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Tramadol and metabolite, SSpecimen Type
Serum RedSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days |
| Ambient | 28 days | |
| Frozen | 28 days |
Reject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Clinical Information
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
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
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
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
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
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)
Day(s) Performed
Wednesday
Report Available
3 to 9 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 |
|---|---|---|
| TRAMS | Tramadol and metabolite, S | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 623268 | Tramadol | 12437-0 |
| 623269 | O-desmethyltramadol | 82974-7 |