OVERVIEW

Purpose: Detection and quantification of meperidine/pethidine, normeperidine, naloxone, naltrexone, tapentadol and tramadol in urine.

CLINICAL INFORMATION

This comprehensive panel encompasses a range of prominent synthetic opioid drugs, including meperidine/pethidine, naloxone, naltrexone, tapentadol and tramadol. It can be ordered in its standard composition or customized to incorporate additional opioids such as fentanyl, methadone, buprenorphine, heroin or other substances as detailed on our website.

Notably, naloxone and naltrexone serve distinct purposes compared to the other drugs included in this panel. Naloxone is widely employed as an opioid antagonist to prevent opioid overdose, while naltrexone is primarily used for managing opioid use disorder.

Meperidine

Meperidine/pethidine (Demerol) is a synthetic opioid analgesic widely utilized for the treatment of moderate to severe pain. Its primary applications include pain management during labor and delivery, although its use has declined in recent years due to the availability of alternative medications.

Distinctive to meperidine among opioids are its neurotoxic properties, which manifest in adverse effects such as convulsions. Furthermore, meperidine exhibits serotonergic activity, warranting extreme caution to prevent concomitant administration with other serotonergic drugs. This cautionary approach is crucial, considering the potential life-threatening consequences associated with combining meperidine with serotonergic agents like certain antidepressants, tramadol, tapentadol, amphetamines, cocaine and select botanical preparations such as St. John's wort.

Naloxone

Naloxone (Narcan, Kloxxado) is an opioid antagonist used to reverse opioid overdose. Unlike other opioid compounds, naloxone does not cause any pain-relieving or euphoric effects, and it prevents other opioids from binding to opioid receptors. When administered by injection or as a nasal spray, naloxone rapidly diffuses through the body and blocks the effects of other opioids. Thus, it is used to rapidly reverse life-threatening opioid overdose and respiratory depression. Naloxone also works to reverse overdoses of the high blood pressure medication clonidine (Catapres). This use is more common in children, as small doses of clonidine are potentially fatal. This test is recommended for detection of recent use of naloxone, and thus evidence of a recent opioid overdose.

Naltrexone

Naltrexone (Revia, Vivatrol) is a long-lasting opioid antagonist used to treat chronic opioid use disorder and alcohol use disorder. It is also used in combination with bupropion as Contrave to manage obesity, and in combination with morphine as Embeda to manage moderate to severe pain. Naltrexone binds very strongly to opioid receptors and prevents other opioids from binding to these receptors for up to three days per dose; it is thus used for long-term reduction of cravings to maintain abstinence. Naltrexone should not be used until one week of abstinence has been achieved, as abrupt blockage of opioids will cause severe and long-lasting withdrawal effects. This test is useful for monitoring therapeutic use of naltrexone for chronic opioid use disorder.

Tramadol

Tramadol (Ultram, Zytram, Ralivia) is an opioid pain-relieving medication. It is approximately one-tenth as potent as morphine and is used for both acute and chronic pain. It may be used off-label as a second-line treatment for fibromyalgia. It is also sold in combination with acetaminophen/paracetamol as Ultracet. Tramadol withdrawal includes symptoms typical of opioid withdrawal along with withdrawal symptoms of serotonin-norepinephrine reuptake inhibitors (hallucinations, paranoia, anxiety, confusion). Overdose effects are potentially life-threatening, including low blood pressure, heart arrhythmia, difficulty breathing and respiratory depression. Respiratory depression is exacerbated by using opioids in combination with other drugs such as sedatives or anesthetics. Naloxone (Narcan) is only moderately effective in reversing a tramadol overdose and increases the risk of seizures; tramadol overdoses must therefore be managed carefully.

Tramadol is known to cause serotonin syndrome in combination with many antidepressants, amphetamines and other serotonergic drugs. These drugs should not be combined as serotonin syndrome is potentially lethal. Negative effects of opiate/opioid use include long-term imbalances in brain function and severe withdrawal symptoms. Tramadol is tested with its primary metabolite, O-desmethyl-cis-tramadol (desmetramadol), in order to best reflect the amount and timing of tramadol exposure. Desmetramadol is more potent than tramadol and is occasionally encountered as a designer drug on its own, often blended with kratom as Krypton. This test is recommended for therapeutic monitoring of tramadol, screening and confirmation of illicit use, and identification of tramadol exposure if adverse drug interactions are suspected.

Tapentadol

Tapentadol, sold under various brand names such as Nucynta, Palexia, Yantil, Tapenta and Tapal, is an opioid medication used for relieving both acute and chronic pain, particularly diabetic neuropathy. Unlike other opioids that require metabolism to provide pain relief, tapentadol is suitable for patients who exhibit poor responses to common opioids. Prolonged use of opiates/opioids can lead to imbalances in brain function and severe withdrawal symptoms. Overdose can be life-threatening, causing low blood pressure, heart arrhythmia, difficulty breathing, and respiratory depression. Combining opioids with sedatives or anesthetics further exacerbates the risk of respiratory depression.

Tapentadol is contraindicated in patients prone to seizures (e.g., individuals with epilepsy), those with head injuries or brain tumors (due to increased intracranial pressure) and patients with pancreatitis (as it induces spasms in the sphincter of Oddi). Combining tapentadol with certain antidepressants, amphetamines or other serotonergic drugs can lead to serotonin syndrome, a potentially lethal condition.

To assess tapentadol exposure accurately, the test measures both tapentadol itself and its primary metabolite, N-desmethyltapentadol. This testing is recommended for therapeutic monitoring of tapentadol, screening and confirmation of illicit use, and identification of tapentadol exposure in cases where adverse drug interactions are suspected.

SPECIMEN COLLECTION

Specimen Type: Random urine
Preferred Collection Container: Non-sterile specimen container
Specimen Required: 3 mL urine; minimum 1 mL

TEST DETAILS

Methodology: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Compliance Category: Laboratory Developed Test (LDT)
This test was developed and assessed by DMD in compliance with CLIA requirements for its analytical performance characteristics and clinical application. This test has not been cleared or approved by the U.S. Food and Drug Administration.
Reference Interval: Negative
Drug/Metabolite Tested:
Drug/Metabolite Cutoff concentration 500 mg/mL
Meperidine/Pethidine: 100 ng/mL
Normeperidine: 50 ng/mL
Naloxone: 25 ng/mL
Naltrexone: 50 ng/mL
Tapentadol: 50 ng/mL
N-desmethyltapentadol: 100 ng/mL
Tramadol: 25 ng/mL
O-desmethyl-cis-tramadol: 25 ng/mL
CPT code(s): 80346
Turnaround Time: 90% < 48 hours, 50% < 24 hours

SPECIMEN PROCESSING

Transport Temperature: Refrigerated (preferred) or room temperature overnight shipping.
Specimen Stability: 3 days at room temperature and 14 days at refrigerated and frozen temperatures.
Rejection Criteria: Stability limits exceeded.

Director: Cheryl Hanau, MD; Donald Hall Jr., PhD; Garth Ehrlich, PhD; Yinghua Qiu, PhD, DABCC

Review Date: 08/28/2023

Note: The billing party has sole responsibility for CPT coding. Any questions regarding coding should be directed to the payer being billed. The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

 
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