Test ID: ALPA
Alprazolam, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring patient compliance
Helping to achieve desired blood levels and avoid toxicity
Method Name A short description of the method used to perform the test
High-Performance Liquid Chromatography (HPLC)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Alprazolam (Xanax)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Red top
Specimen Volume: 3 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | NA |
| Other | Serum gel tube |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | |
| Ambient | ||
| Frozen | ||
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Alprazolam (Xanax), a drug used to treat panic and anxiety disorders, is a triazolobenzodiazepine with the same ring structures as triazolam. It is considered an intermediate benzodiazepine with a half-life of 6 to 20 hours and a rapid onset of action with peak plasma levels reached within 1 to 2 hours of dosing. Typical daily doses range from 0.75 to 3.0 mg and Xanax tablets are available in 0.25 mg, 0.5 mg, 1 mg, or 2 mg doses.
Hepatic biotransformation of alprazolam produces hydroxylated metabolites, which are excreted in urine as glucuronide metabolites. Alprazolam has 2 major metabolites: alpha-hydroxy-alprazolam and 4-hydroxyalprazolam. A benzophenone derivative is also found in humans. Only the hydroxy-alprazolams are biologically active with approximately one half the activity of the parent drug. Since the metabolites are only present in trace amounts in serum, quantitation of metabolites is not clinically significant.
Alprazolam may have central nervous system (CNS) depressant effects. Patients using alprazolam should avoid other CNS depressant drugs, as well as ingestion of alcohol.
When discontinuing therapy in patients who have used alprazolam for prolonged periods, the dose should be decreased gradually over 4 to 8 weeks to avoid the possibility of withdrawal symptoms, especially in patients with a history of seizures or epilepsy, regardless of their concomitant anticonvulsant drug therapy. Patients on short-acting benzodiazepines may be switched to longer-acting drugs (eg, diazepam), which produce a gradual decrease in drug concentration and decrease the risk of withdrawal symptoms.
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.
Therapeutic range: 5-25 ng/mL
Some patients respond well to levels of 25-55 ng/mL.
Interpretation Provides information to assist in interpretation of the test results
The assessment of treatment with alprazolam should be based on clinical response. Effectiveness of treatment can be determined by the reduction of symptoms of anxiety and panic disorders.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Malseed RT, Harrigan GS: Antianxiety drugs. In Textbook of Pharmacology and Nursing Care. JB Lippincott Company 1989, p 519
2. Fraser AD, Bryan W: Evaluation of the Abbott ADx and TDx serum benzodiazepine immunoassays for analysis of alprazolam. J Anal Toxicol 1991;15:63-65
3. Miller RL, Devane CL: Alprazolam, alpha-hydroxy-and 4-hydroxyalprazolam analysis in plasma by high-performance liquid chromatography. J Chromatogr 1988;430:180-186
4. Labrosse KR, McCoy HG: Reliability of antidepressant assays: a reference laboratory perspective on antidepressant monitoring. Clin Chem 1988;34:859-862
5. Physicians’ Desk Reference (PDR) 2007
Method Description Describes how the test is performed and provides a method-specific reference
Alprazolam is extracted from neutral serum into an organic phase that is then dried under nitrogen to concentrate the specimen. A small aliquot of the specimen is then analyzed by HPLC. (Unpublished Mayo method)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Varies, batched 2 times per week
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82491
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 11236 | Alprazolam, S | 3312-6 |
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