Urine drug testing: Difference between revisions
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+ | == Indications == |
+ | * May be used as a baseline for patients being considered for trial of opioids for chronic pain |
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+ | * Regular testing is done for patient on [[opioid agonist therapy]] to monitor for adherence, validate patient-reported use, and detect coingested substances like benzodiazepines that may affect safety |
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+ | |||
+ | ==Immunoassays== |
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+ | |||
+ | * Immunoassays are cheap and fast, but are subject to cross-reactivity |
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+ | * Window of detection for most metabolites is 1 to 3 days |
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+ | * An initial 5-panel IA tests for amphetamines, cocaine, benzodiazepines (though not clonazepam), opiates, and methadone |
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+ | * Validity is best when the urine temperature is 90 to 100ºF (within 4 minutes of voiding), urine pH 4.5 to 8, and urinary creatinine ≥20 mg/dL (if <5 mg/dL, it's not urine) |
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+ | |||
+ | === Interpretation === |
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{| class="wikitable" |
{| class="wikitable" |
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− | ! |
+ | !Substance |
− | ! |
+ | !False positives |
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+ | |Alcohol |
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+ | |Short-chain alcohols (e.g. isopropyl alcohol) |
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+ | |Amphetamines |
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+ | |Amantadine<br />Benzphetamine<br />Bupropion<br />Chlorpomazine<br />Clobenzorex<br />l-Deprenyl<br />Desipramine<br />Dextroamphetamine<br />Ephedrine<br />Fenproporex<br />Isometheptene<br />Isoxsuprine<br />Labetalol<br />MDMA<br />Methamphetamine<br />Methylphenidate<br />Phentermine<br />Phenylephrine<br />Phenylpropanolamine<br />Protethazine<br />Pseudoephedrine<br />Ranitidine<br />Ritodrine<br />Selegiline<br />Thioridazine<br />Trazodone<br />Trimethobenzamide<br />Trimipramine |
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+ | |Benzodiazepines |
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+ | |Oxaprozin<br />Setraline |
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+ | |Cannabinoids |
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+ | |Dronabinol<br />Efavirenz<br />Hemp-containing foods<br />NSAIDs<br />Proton pump inhibitors<br />Tolmetin |
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+ | |Cocaine |
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+ | |Coca leaf tea<br />Topical anesthetics containing cocaine |
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+ | |Opioids, opiates, and heroin |
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+ | |Dextromethorphan<br />Diphenhydramine<br />Heroin<br />Opiates (codeine, hydromorphone, hydrocodone, morphine)<br />Poppy seeds<br />Quinine<br />Quinolones<br />Rifampin<br />Verapamil and metabolites |
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+ | |Phencyclidine |
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+ | |Dextromethorphan<br />Diphenhydramine<br />Doxylamine<br />Ibuprofen<br />Imipramine<br />Ketamine<br />Meperidine<br />Mesoridazine<br />Thioridazine<br />Tramadol<br />Venlafaxine and desvenlafaxine |
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+ | |TCAs |
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+ | |Carbamazepine<br />Cyclobenzaprine<br />Cyproheptadine<br />Diphenhydramine<br />Hydroxyzine<br />Quetiapine |
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Revision as of 15:45, 9 July 2020
Indications
- May be used as a baseline for patients being considered for trial of opioids for chronic pain
- Regular testing is done for patient on opioid agonist therapy to monitor for adherence, validate patient-reported use, and detect coingested substances like benzodiazepines that may affect safety
Immunoassays
- Immunoassays are cheap and fast, but are subject to cross-reactivity
- Window of detection for most metabolites is 1 to 3 days
- An initial 5-panel IA tests for amphetamines, cocaine, benzodiazepines (though not clonazepam), opiates, and methadone
- Validity is best when the urine temperature is 90 to 100ºF (within 4 minutes of voiding), urine pH 4.5 to 8, and urinary creatinine ≥20 mg/dL (if <5 mg/dL, it's not urine)
Interpretation
Substance | False positives |
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Alcohol | Short-chain alcohols (e.g. isopropyl alcohol) |
Amphetamines | Amantadine Benzphetamine Bupropion Chlorpomazine Clobenzorex l-Deprenyl Desipramine Dextroamphetamine Ephedrine Fenproporex Isometheptene Isoxsuprine Labetalol MDMA Methamphetamine Methylphenidate Phentermine Phenylephrine Phenylpropanolamine Protethazine Pseudoephedrine Ranitidine Ritodrine Selegiline Thioridazine Trazodone Trimethobenzamide Trimipramine |
Benzodiazepines | Oxaprozin Setraline |
Cannabinoids | Dronabinol Efavirenz Hemp-containing foods NSAIDs Proton pump inhibitors Tolmetin |
Cocaine | Coca leaf tea Topical anesthetics containing cocaine |
Opioids, opiates, and heroin | Dextromethorphan Diphenhydramine Heroin Opiates (codeine, hydromorphone, hydrocodone, morphine) Poppy seeds Quinine Quinolones Rifampin Verapamil and metabolites |
Phencyclidine | Dextromethorphan Diphenhydramine Doxylamine Ibuprofen Imipramine Ketamine Meperidine Mesoridazine Thioridazine Tramadol Venlafaxine and desvenlafaxine |
TCAs | Carbamazepine Cyclobenzaprine Cyproheptadine Diphenhydramine Hydroxyzine Quetiapine |