Benzodiazepine Confirmation, Urine
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Benzodiazepines are any of a group of compounds having a common molecular structure and acting similarly as depressants of the central nervous system. As a class of drugs, benzodiazepines are among the most commonly prescribed drugs in the western hemisphere because of their efficacy, safety, low addiction potential, minimal side effects, and high public demand for sedative and anxiolytic agents.
Detecting drug use involving benzodiazepines such as alprazolam, flunitrazepam, chlordiazepoxide, diazepam, flurazepam, lorazepam, and triazolam
Benzodiazepines are extensively metabolized, and the parent compounds are not detected in urine. This test screens for (and confirms) the presence of:
-Nordiazepam, oxazepam (metabolites of chlordiazepoxide)
-Nordiazepam, oxazepam and temazepam (metabolites of diazepam)
-Hydroxyethylfluorazepam (metabolite of flurazepam)
-Alpha hydroxyalprazolam (metabolite of alprazolam)
-Alpha hydroxytriazolam (metabolite of triazolam)
-7-aminoclonazepam (metabolite of clonazepam)
-7-aminoflunitrazepam (metabolite of flunitrazepam)
The clearance half-life of long-acting benzodiazepines is >24 hours. It takes 5 to 7 half-lives to clear 98% of a drug dose. Therefore, the presence of a long-acting benzodiazepine greater than the limit of quantification indicates exposure within a 5-day to 20-day interval preceding specimen collection. Following a dose of diazepam, the drug and its metabolites appear in the urine within 30 minutes. Peak urine output is reached between 1 and 8 hours. See Mayo Medical Laboratories Drugs of Abuse Testing Guide at http://www.mayomedicallaboratories.com/articles/drug-book/print-on-demand-select.php for additional information including metabolism, clearance (half-life), and approximate detection times.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements.
For chain-of-custody information, see COCH/9426 Chain-of-Custody Processing.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Positives are reported with a quantitative GC-MS result.
NORDIAZEPAM BY GC-MS
OXAZEPAM BY GC-MS
LORAZEPAM BY GC-MS
TEMAZEPAM BY GC-MS
OH-ETHYL-FLURAZEPAM BY GC-MS
7-NH-CLONAZEPAM BY GC-MS
ALPHA OH-ALPRAZOLAM BY GC-MS
7-NH-FLUNITRAZEPAM BY GC-MS
ALPHA OH-TRIAZOLAM BY GC-MS
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Disposition of Toxic Drugs and Chemicals in Man. Eighth edition. Edited by RC Baselt. Foster City, CA: Biomedical Publications, 2008
2. Porter W. Clinical toxicology. In Tietz Textbook of Clinical Chemistry. Edited by CA Burtis, DE Bruns. Fourth edition. St. Louis, MO. Elsevier Saunders, 2006, pp 1287-1369