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22283 Clomipramine, S (CLOM)

Clomipramine, S (CLOM)
Test Code: CLOMIP
Synonyms/Keywords
Anafranil®
Anafranil (Clomipramine)
Clomipramine (Anafranil)
Desmethylchlorimipramine (Norclomipramine)
Norclomipramine
TCA (Tricyclic Antidepressants)
Tricyclic Antidepressants (TCA)
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 ​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
Frozen ​28 days
​Ambient ​7 days
Rejection Criteria
Serum Separator Tube (SST)
Interference

This test cannot be performed on whole blood. Serum must be separated from cells within 2 hours of drawing; if serum is not removed within this time, tricyclic antidepressant levels may be falsely elevated due to drug release from RBCs. Specimens that are obtained from gel tubes are also not acceptable, as the drug can absorb on the gel and lead to falsely decreased concentrations.

Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories​ Monday, Wednesday, Friday ​2 to 5 days
Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)
Reference Lab
Mayo Clinic Laboratories
Reference Range Information
Reference Range
CLOMIPRAMINE AND NORCLOMIPRAMINE
Therapeutic concentration: 230-450 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
​Studies investigating the relationship between serum concentrations of clomipramine and norclomipramine and therapeutic response have yielded conflicting results. However, the probability of therapeutic failure seems to increase if the sum of the clomipramine and norclomipramine serum concentrations is <230 ng/mL. Summed serum concentrations of clomipramine and norclomipramine which exceed 450 ng/mL seem to result in no additional enhancement in therapeutic response and may predispose the patient to greater risk of adverse side affects. A toxic range has not been well established at this time.
Outreach CPTs

CPT Modifier
(if needed)		 Quantity Description Comments
​80299​
 ​ ​1 ​ ​
Synonyms/Keywords
Anafranil®
Anafranil (Clomipramine)
Clomipramine (Anafranil)
Desmethylchlorimipramine (Norclomipramine)
Norclomipramine
TCA (Tricyclic Antidepressants)
Tricyclic Antidepressants (TCA)
Ordering Applications
Ordering Application Description
​Centricity Clomipramine, S (CLOM)
​Cerner ​Clomipramine, S (CLOM)
​Clinical Order Manager ​Clomipramine, S (CLOM)
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 ​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
Frozen ​28 days
​Ambient ​7 days
Rejection Criteria
Serum Separator Tube (SST)
Interference

This test cannot be performed on whole blood. Serum must be separated from cells within 2 hours of drawing; if serum is not removed within this time, tricyclic antidepressant levels may be falsely elevated due to drug release from RBCs. Specimens that are obtained from gel tubes are also not acceptable, as the drug can absorb on the gel and lead to falsely decreased concentrations.

Reference Range Information
Reference Range
CLOMIPRAMINE AND NORCLOMIPRAMINE
Therapeutic concentration: 230-450 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
​Studies investigating the relationship between serum concentrations of clomipramine and norclomipramine and therapeutic response have yielded conflicting results. However, the probability of therapeutic failure seems to increase if the sum of the clomipramine and norclomipramine serum concentrations is <230 ng/mL. Summed serum concentrations of clomipramine and norclomipramine which exceed 450 ng/mL seem to result in no additional enhancement in therapeutic response and may predispose the patient to greater risk of adverse side affects. A toxic range has not been well established at this time.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories​ Monday, Wednesday, Friday ​2 to 5 days
Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs

CPT Modifier
(if needed)		 Quantity Description Comments
​80299​
 ​ ​1 ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.