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HelpEpic Test Code LAB807 Nortriptyline, Serum
Additional Codes
MML:NOTRP
Useful For
Monitoring nortriptyline concentration during therapy
Evaluating potential nortriptyline toxicity
May aid in evaluating patient compliance
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Nortriptyline, SSpecimen Type
Serum RedSpecimen 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:
1. Collect specimen immediately before next scheduled dose (minimum 12 hours after last dose).
2. Centrifuge and aliquot serum into a plastic vial. Serum must be separated from cells within 2 hours of collection.
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 7 days |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Clinical Information
Nortriptyline is a tricyclic antidepressant used for treatment of endogenous depression. It also is a metabolite of the antidepressant amitriptyline. Nortriptyline is used when its stimulatory side effect is considered to be of clinical advantage; amitriptyline is used when the side effect of mild sedation is desirable.
Nortriptyline is unique among the antidepressants in that its blood level exhibits the classical therapeutic window effect, as blood concentrations above or below the therapeutic window correlate with poor clinical response. Thus, therapeutic monitoring to ensure that the blood level is within the therapeutic window is critical to accomplish successful treatment with this drug.
Like amitriptyline, nortriptyline can cause major cardiac toxicity when the concentration is above 500 ng/mL, characterized by QRS widening (intraventricular conduction delay), which leads to ventricular tachycardia and asystole. In some patients, toxicity may manifest at lower concentrations.
Reference Values
Therapeutic concentration: 70-170 ng/mL
Note: Therapeutic ranges are for specimens collected at trough (ie, immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Interpretation
Most individuals display optimal response to nortriptyline with serum levels of 70 to 170 ng/mL. Risk of toxicity is increased with nortriptyline levels above 500 ng/mL.
Some individuals may respond well outside of this range or may display toxicity within the therapeutic range; thus, interpretation should include clinical evaluation.
Therapeutic ranges are based on specimens collected at trough (ie, immediately before the next dose).
Cautions
This test cannot be performed on whole blood. Serum must be separated from cells within 2 hours of collection; if serum is not removed within this time, tricyclic antidepressant levels may be falsely elevated due to drug release from red blood cells.
Specimens that are obtained from gel tubes are not acceptable because the drug can absorb on the gel and lead to falsely decreased concentrations.
Day(s) Performed
Monday, Wednesday, Friday
Report Available
3 to 5 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
80299
NY State Approved
YesForms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.