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Epic Test Code LAB808 Primidone and Phenobarbital, Serum

Additional Codes

MML Code: PRMB

LIS Code: PRMI

Useful For

Assessing compliance

 

Monitoring for appropriate therapeutic levels of primidone and phenobarbital

 

Assessing toxicity

Profile Information

Test ID Reporting Name Available Separately Always Performed
PRIMD Primidone, S No Yes
PBR Phenobarbital, S Yes Yes

Testing Algorithm

Includes phenobarbital determination.

Method Name

PRIMD: Immunoassay

PBR: Kinetic Interaction of Microparticles in a Solution (KIMS)

Reporting Name

Primidone and Phenobarbital, S

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions:

1. Serum gel tubes should be centrifuged within 2 hours of collection.

2. Red-top tubes should be centrifuged, and the serum aliquoted into a plastic vial within 2 hours of collection.


Specimen Minimum Volume

0.25 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days
  Frozen  28 days
  Ambient  72 hours

Reject Due To

Gross hemolysis Reject

Clinical Information

Primidone is used for control of grand mal seizures that are refractory to other antiepileptics and seizures of psychomotor or focal origin.

 

Primidone is initially dosed in progressively increasing amounts starting with 100 mg at bedtime to 250 mg 3 times a day after 10 days of therapy in adults.

 

Primidone exhibits a volume of distribution of 0.6 L/kg and a half-life of 8 hours.

 

When monitoring primidone and phenobarbital levels simultaneously, the specimen should be drawn just before the next dose is administered.

 

Primidone is not highly protein bound, approximately 10%. Phenobarbital is a metabolite of primidone. Like phenobarbital, there are no known major drug-drug interactions that affect the pharmacology of primidone. Toxicity associated with primidone is primarily due to the accumulation of phenobarbital. Diagnosis and treatment are as described for PBAR / Phenobarbital, Serum.

Reference Values

Primidone

Therapeutic: 5.0-12.0 mcg/mL

Critical value: ≥15.0 mcg/mL

 

Phenobarbital

Therapeutic: 10.0-40.0 mcg/mL

Critical value: ≥60.0 mcg/mL

Interpretation

At steady-state, which is achieved approximately 2 weeks after therapy is initiated, blood levels of primidone that correlate with optimal response to the drug range from 9.0 to 12.5 mcg/mL for adults and 7.0 to 10.0 mcg/mL for children younger than 5 years.

 

The corresponding levels for phenobarbital are 20.0 to 40.0 mcg/mL for adults and 15.0 to 30.0 mcg/mL for children younger than 5 years.

 

Dosage adjustment based on blood level information is the best way to obtain optimal response to the drug.

Cautions

The phenobarbital level should be monitored at the same time the primidone level is monitored as phenobarbital is a metabolite of primidone.

Day(s) Performed

Monday through Sunday

Report Available

Same day/1 day

Specimen Retention Time

1 week

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

PRIMD-80188

PBR-80184

NY State Approved

Yes

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Neurology Specialty Testing Client Test Request (T732)

-Therapeutics Test Request (T831)