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HelpTest ID FENTU Fentanyl with Metabolite Confirmation, Urine
Useful For
Detection and confirmation of illicit drug use involving fentanyl
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Fentanyl w/metabolite Conf, USpecimen Type
UrineCollection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 10-mL urine tube (Supply T068)
Specimen Volume: 3 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
Additional Information:
1. No specimen substitutions.
2. No STATS are accepted for this procedure.
3. For situations where chain of custody is required, a Chain-of-Custody Kit (T282) is available. For chain-of-custody testing, order FENTX / Fentanyl with Metabolite Confirmation, Chain of Custody, Urine.
4. If urine creatinine is required or adulteration of the sample is suspected, the following test should be requested, ADULT / Adulterants Survey, Urine. For additional information, please refer to ADULT / Adulterants Survey, Urine.
5. Submitting less than 3 mL will compromise our ability to perform all necessary testing.
Forms: Chain-of-Custody Request Form is included in the Chain-of-Custody Kit (T282). A copy of this form is also available at http://www.mayomedicallaboratories.com/it-mmfiles/chain-of-custody-request-form.pdf.
Specimen Minimum Volume
2.1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 14 days |
| Frozen | 14 days | |
| Ambient | 72 hours |
Clinical Information
Fentanyl is an extremely fast acting synthetic opioid related to the phenylpiperidiens.(1,2) It is available in injectable as well as transdermal formulations.(1) The analgesic effects of fentanyl is similar to those of morphine and other opioids(1): it interacts predominantly with the opioid mu-receptor. These mu-binding sites are discretely distributed in the human brain, spinal cord, and other tissue.(1,3)
Fentanyl is approximately 80% to 85% protein bound. In plasma, the protein binding capacity of fentanyl decreases with increasing ionization of the drug. Alterations in pH may affect its distribution between plasma and the central nervous system (CNS). The average volume of distribution for fentanyl is 6 L/kg (range 3-8).(3,4)
In humans, the drug appears to be metabolized primarily by oxidative N-dealkylation to norfentanyl and other inactive metabolites that do not contribute materially to the observed activity of the drug. Within 72 hours of intravenous (IV) administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with <10% representing unchanged drug.(3,4)
The mean elimination half-life is (1-3):
-IV: 2 to 4 hours
-Iontophoretic transdermal system (Ionsys) terminal half-life: 16 hours
-Transdermal patch: 17 hours (13-22 hours, half-life is influenced by absorption rate)
-Transmucosal:
- Lozenge: 7 hours
- Buccal tablet
- 100 to 200 mcg: 3 to 4 hours
- 400 to 800 mcg: 11 to 12 hours
In clinical settings, fentanyl exerts its principal pharmacologic effects on the CNS. In addition to analgesia, alterations in mood (euphoria, dysphoria) and drowsiness commonly occur.(1,3) Because the biological effects of fentanyl are similar to those of heroin and other opioids, fentanyl has become a popular drug of abuse.
Reference Values
Negative
Cautions
Urine concentrations do not correlate well to serum drug levels. For therapeutic drug management, monitor serum levels using FENTS / Fentanyl, Serum.
For situations where chain of custody is required, a Chain-of-Custody Kit is available, see FENTX / Fentanyl with Metabolite Confirmation, Chain of Custody, Urine.
Day(s) Performed
Monday through Thursday
Report Available
2 daysPerforming Laboratory
Mayo Medical Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
80354
G0480 (if appropriate)