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22607 Imipramine and Desipramine, P (IMIPR)

Imipramine and Desipramine, P (IMIPR)
Test Code: IMDESSO
Synonyms/Keywords
Imipramine (Tofranil), Serum, Norpramin (Desipramine), Norpramin, TCA (Tricyclic Antidepressants), Tofranil (Imipramine), Tofranil (Imipramine), Serum, Tricyclic Antidepressants (TCA) 
Useful For
​Monitoring imipramine and desipramine concentrations during therapy
 
Evaluating potential imipramine and desipramine toxicity
 
The test may also be useful to evaluate patient compliance
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ 1 mL​ 0.25 mL​
Collection Processing Instructions
​1. Draw specimen immediately before next scheduled dose (minimum 12 hours after last dose).
2. Serum must be separated from cells within 2 hours of draw.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Refrigerated (preferred)​ 28 days​
Ambient ​ 7 days​
Frozen ​ 28 days​
Rejection Criteria
Gross hemolysis
​Gross lipemia
​Gross icterus
​Serum gel tube
Interference

​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.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories
Monday, Wednesday, Friday 2-5 days​
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
Test Information

Imipramine and its metabolite desipramine are tricyclic antidepressants used to treat endogenous depression requiring 1 to 3 weeks of treatment before therapeutic effectiveness becomes apparent. Desipramine is used for treatment of endogenous depression when the patient needs a drug with significant stimulatory side effects. These drugs have also been employed in the treatment of enuresis (involuntary urination) in childhood and severe obsessive-compulsive neurosis.

Imipramine:

The optimal dosage of imipramine yields trough (just before the next dose) blood levels of imipramine and desipramine combined from 175 to 300 ng/mL. If desipramine is given, no imipramine should be detected and the therapeutic concentration for desipramine alone is 100 to 300 ng/mL.

Toxicity associated with imipramine is characterized by QRS widening leading to ventricular tachycardia and asystole. In some patients, toxicity may manifest at lower concentrations or at therapeutic concentrations in the early state of therapy. Cardiac toxicity (first-degree heart block) is usually associated with blood concentrations in excess of 400 ng/mL.

Desipramine:

Desipramine is the antidepressant of choice in patients where maximal stimulation is indicated.

The therapeutic concentration of desipramine is 100 to 300 ng/mL. About 1 to 3 weeks of treatment are required before therapeutic effectiveness becomes apparent.

The most frequent side effects are those attributable to anticholinergic effects, such as dry mouth, constipation, dizziness, tachycardia, palpitations, blurred vision, and urinary retention. These occur at blood concentrations in excess of 400 ng/mL, although they may occur at therapeutic concentrations in the early stage of therapy. Cardiac toxicity (first-degree heart block) is usually associated with blood concentrations in excess of 400 ng/mL.

Reference Range Information
​Imipramine and Desipramine
    Total therapeutic concentration: 175-300 ng/mL
    Total toxic concentration: >=300 ng/mL
Desipramine Only
    Therapeutic concentration: 100-300 ng/mL 
Note: Therapeutic ranges are for specimens drawn at trough (i.e. immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Interpretation
​Most individuals display optimal response to imipramine when combined serum levels of imipramine and desipramine are between 175 and 300 ng/mL. Risk of toxicity is increased with levels > or =400 ng/mL.
 
Most individuals display optimal response to desipramine with serum levels of 100 to 300 ng/mL. Risk of toxicity is increased with desipramine levels > or =400 ng/mL.
 
Some individuals may respond well outside of these ranges, or may display toxicity within the therapeutic range, thus interpretation should include clinical evaluation.
 
Therapeutic ranges are based on specimen drawn at trough (ie, immediately before the next dose).
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
80299​
Synonyms/Keywords
Imipramine (Tofranil), Serum, Norpramin (Desipramine), Norpramin, TCA (Tricyclic Antidepressants), Tofranil (Imipramine), Tofranil (Imipramine), Serum, Tricyclic Antidepressants (TCA) 
Ordering Applications
Ordering Application Description
​Centricity ​Imipramine and Desipramine, S (IMPR)
​Cerner Imipramine and Desipramine Level (IMPR)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ 1 mL​ 0.25 mL​
Collection Processing
​1. Draw specimen immediately before next scheduled dose (minimum 12 hours after last dose).
2. Serum must be separated from cells within 2 hours of draw.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Refrigerated (preferred)​ 28 days​
Ambient ​ 7 days​
Frozen ​ 28 days​
Rejection Criteria
Gross hemolysis
​Gross lipemia
​Gross icterus
​Serum gel tube
Interference

​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.

Useful For
​Monitoring imipramine and desipramine concentrations during therapy
 
Evaluating potential imipramine and desipramine toxicity
 
The test may also be useful to evaluate patient compliance
Reference Range Information
​Imipramine and Desipramine
    Total therapeutic concentration: 175-300 ng/mL
    Total toxic concentration: >=300 ng/mL
Desipramine Only
    Therapeutic concentration: 100-300 ng/mL 
Note: Therapeutic ranges are for specimens drawn at trough (i.e. immediately before next scheduled dose). Levels may be elevated in non-trough specimens.
Interpretation
​Most individuals display optimal response to imipramine when combined serum levels of imipramine and desipramine are between 175 and 300 ng/mL. Risk of toxicity is increased with levels > or =400 ng/mL.
 
Most individuals display optimal response to desipramine with serum levels of 100 to 300 ng/mL. Risk of toxicity is increased with desipramine levels > or =400 ng/mL.
 
Some individuals may respond well outside of these ranges, or may display toxicity within the therapeutic range, thus interpretation should include clinical evaluation.
 
Therapeutic ranges are based on specimen drawn at trough (ie, immediately before the next dose).
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories
Monday, Wednesday, Friday 2-5 days​
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
80299​
For most current information refer to the Marshfield Laboratory online reference manual.