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25092 Benzodiazepines, Urine, Confirm Only by LCMS/MS

Benzodiazepines, Urine, Confirm Only by LCMS/MS
Test Code: CO-BENZ
Synonyms/Keywords
Clonazepam, Temazepam, Diazepam, Chlordiazepoxide, Alprazolam, Flunitrazepam, Flurazepam, Nordiazepam, Chlorazepate, Lorazepam, Xanax, Librium, Valium, Ativan, Serax, Restoril​, Date Rape Drug, 7-Aminoflunitrazepam, Roofies, Rohypnol
Useful For
Detecting exposure to benzodiazepines to monitor compliance in taking prescribed medications or to detect abuse​
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 5 mL​ 3 mL​ 1.5 mL
Specimen Stability Information
Specimen Type Temperature Time
Urine​ Ambient​ 72 hours​
Refrigerate (Preferred)​ 30 days​
Frozen​ 30 days​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 2 days​ Liquid Chromatography/Tandem Mass Spectrometry (LCMS/MS) using Multiple Reaction Monitoring
Test Information
This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.
 
This test is an LCMS/MS confirmation only for the following benzodiazepines: desalkylflurazepam, nordiazepam, 7-aminoflunitrazepam, oxazepam, temazepam, diazepam, 7-aminoclonazepam, lorazepam, and alphahydroxyalprazolam. It is intended for use only in patients where an initial drug screening test has already been performed at the time of specimen collection (i.e. Point-of-Care drug screening cup, dipstick, etc.). The specimen will not be screened by immunoassay in the laboratory; it will only be tested by LCMS/MS. If an initial drug screen has not been performed at the specimen collection site, it is more appropriate to order the “Benzodiazepines, Urine” test code (BENZ) which includes an initial screen.
Reference Range Information
Performing Location Reference Range
Marshfield​

Negative.  Positives are reported with a quantitative LCMS/MS result.

Interpretation
 
The benzodiazepine group metabolizes quickly and thus, many of the parent drugs are generally not detected in urine. The detection of a metabolite(s) of the parent drug confirm the use of the drug. Below is a description of some of the more commonly prescribed benzodiazepines and the metabolites that would be present in urine. Please call the lab at ext 93734 or 800-331-3734 with any further interpretive issues.
Clonazepam (Klonopin) metabolizes to 7-aminoclonazepam.
Flunitrazepam (Rohypnol) metabolizes to 7-aminoflunitrazepam.
Chlordiazepoxide metabolizes to nordiazepam and oxazepam.
Chlorazepate metabolizes to nordiazepam and oxazepam.
Diazepam (Valium) metabolizes to nordiazepam, temazepam and oxazepam.
Temazepam metabolizes to oxazepam.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80346​ ​ 1​ Benzodiazepine Confirmation by LCMS/MS​ ​
​G0480 ​ ​1 ​Benzodiazepine Confirmation by LCMS/MS ​For Medicare/Medicaid
Classification
This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.
Synonyms/Keywords
Clonazepam, Temazepam, Diazepam, Chlordiazepoxide, Alprazolam, Flunitrazepam, Flurazepam, Nordiazepam, Chlorazepate, Lorazepam, Xanax, Librium, Valium, Ativan, Serax, Restoril​, Date Rape Drug, 7-Aminoflunitrazepam, Roofies, Rohypnol
Ordering Applications
Ordering Application Description
​COM ​Benzodiazepine, Urine, Confirm
​Cerner ​Benzodiazepine, Urine, Confirm Only by LCMS/MS
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 5 mL​ 3 mL​ 1.5 mL
Specimen Stability Information
Specimen Type Temperature Time
Urine​ Ambient​ 72 hours​
Refrigerate (Preferred)​ 30 days​
Frozen​ 30 days​
Useful For
Detecting exposure to benzodiazepines to monitor compliance in taking prescribed medications or to detect abuse​
Reference Range Information
Performing Location Reference Range
Marshfield​

Negative.  Positives are reported with a quantitative LCMS/MS result.

Interpretation
 
The benzodiazepine group metabolizes quickly and thus, many of the parent drugs are generally not detected in urine. The detection of a metabolite(s) of the parent drug confirm the use of the drug. Below is a description of some of the more commonly prescribed benzodiazepines and the metabolites that would be present in urine. Please call the lab at ext 93734 or 800-331-3734 with any further interpretive issues.
Clonazepam (Klonopin) metabolizes to 7-aminoclonazepam.
Flunitrazepam (Rohypnol) metabolizes to 7-aminoflunitrazepam.
Chlordiazepoxide metabolizes to nordiazepam and oxazepam.
Chlorazepate metabolizes to nordiazepam and oxazepam.
Diazepam (Valium) metabolizes to nordiazepam, temazepam and oxazepam.
Temazepam metabolizes to oxazepam.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 2 days​ Liquid Chromatography/Tandem Mass Spectrometry (LCMS/MS) using Multiple Reaction Monitoring
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80346​ ​ 1​ Benzodiazepine Confirmation by LCMS/MS​ ​
​G0480 ​ ​1 ​Benzodiazepine Confirmation by LCMS/MS ​For Medicare/Medicaid
Classification
This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.
For most current information refer to the Marshfield Laboratory online reference manual.