The trazodone metabolite meta-chlorophenylpiperazine can cause false-positive urine amphetamine immunoassay results

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Abstract

Amphetamines and methamphetamines are part of an important class of drugs included in most urine drugs of abuse screening panels, and a common assay to detect these drugs is the Amphetamines II immunoassay (Roche Diagnostics). To demonstrate that meta-chlorophenylpiperazine (m-CPP), a trazodone metabolite, cross-reacts in the Amphetamines II assay, we tested reference standards of m-CPP at various concentrations (200 to 20,000 μg/L).We also tested real patient urine samples containing m-CPP (detected and quantified by HPLC) with no detectable amphetamine, methamphetamine, or MDMA (demonstrated by GC-MS). In both the m-CPP standards and the patient urine samples, we found a strong association between m-CPP concentration and Amphetamines II immunoreactivity (r = 0.990 for the urine samples). Further, we found that patients taking trazodone can produce urine with sufficient m-CPP to result in false-positive Amphetamines II results. At our institution, falsepositive amphetamine results occur not infrequently in patients taking trazodone with at least 8 trazodone-associated false-positive results during a single 26-day period. Laboratories should remain cognizant of this interference when interpreting results of this assay.

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Baron, J. M., Griggs, D. A., Nixon, A. L., Long, W. H., & Flood, J. G. (2011). The trazodone metabolite meta-chlorophenylpiperazine can cause false-positive urine amphetamine immunoassay results. Journal of Analytical Toxicology, 35(6), 364–368. https://doi.org/10.1093/anatox/35.6.364

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