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HelpTest ID: TRAMS Tramadol and Metabolite, Serum
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Red top (Serum gel/SST are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions: Within 2 hours of collection, centrifuge and aliquot serum into a plastic vial.
Useful For
This test is useful to help determine compliance and/or to monitor adverse drug reactions or efficacy
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Tramadol and metabolite, SSpecimen Type
Serum RedSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days |
| Ambient | 28 days | |
| Frozen | 28 days |
Clinical Information
Tramadol is a synthetic opioid that is approximately equipotent with codeine but is considered to cause less respiratory depression and have less abuse potential. It is US Food and Drug Administration-approved for moderate to severe pain. It is available in immediate-release and extended-release tablets. It is extensively metabolized by CYP2D6 and CYP3A4 and has an active metabolite (O-desmethyltramadol). The eliminate half-life is approximately 5 hours to 7 hours (immediate-release) and approximately 6 hours to 10 hours (extended-release).
Reference Values
Tramadol:
Peak plasma levels following a single 100 mg oral dose: 230-380 ng/mL
Steady-state plasma levels following a 100 mg 4 times daily regimen: 420-770 ng/mL
O-desmethyltramadol:
Peak plasma concentration following a single 100 mg oral dose: 35-75 ng/mL
Steady-state plasma concentration following a 100 mg 4 times daily regimen: 80-140 ng/mL
Cutoff concentrations by liquid chromatography tandem mass spectrometry:
Tramadol: 10 ng/mL
O-desmethyltramadol: 5.0 ng/mL
Interpretation
Serum concentrations of tramadol and its active metabolite can be used to determine compliance and usage of tramadol within the past several days. In a group of 28 adult patients receiving daily oral immediate-release doses of 200 mg to 400 mg for 4 weeks, serum concentrations measured 12 hours after the last dose averaged 365 ng/mL (range: 95-841 ng/mL) for tramadol and 59 ng/mL (range: 5-123 ng/mL) for O-desmethyltramadol.(1)
Clinical Reference
1. Sindrup SH, Madsen C, Brosen K, Jensen TS. The effect of tramadol in painful polyneuropathy in relation to serum drug and metabolite levels. Clin Pharmacol Ther. 1999;66(6):636-641. doi:10.1053/cp.1999.v66.103171001
2. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
3. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020
4. Jannetto PJ, Bratanow NC, Clark WA, et al. Executive summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526
Day(s) Performed
Wednesday
Report Available
3 to 9 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80299
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| TRAMS | Tramadol and metabolite, S | 111526-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 623268 | Tramadol | 12437-0 |
| 623269 | O-desmethyltramadol | 82974-7 |
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
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