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Voriconazole LC-MS/MS

Test Code: 3300
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Clinical Utility

Monitoring trough levels of voriconazole is suggested in patients with impaired liver function, patients with pharmacogenomics polymorphisms associated with lower metabolism of voriconazole (e.g. genotypes CYP2C19*2 and CYP2C19*3), and in patients taking other medications that affect CYP2C19 activity. Additionally, results may be clinically useful to determine if current dosing levels have achieved adequate therapeutic concentrations when treating at-risk patients prophylactically or when treating patients with invasive fungal infections. Results may also be used to evaluate reasons for therapeutic failure due to suboptimal drug levels or for toxicity potentially attributable to voriconazole.

Procedure

Voriconazole is extracted from biological matrix by simple protein precipitation with methanol followed by centrifugation. Chromatographic separation and quantitative analysis of the drug containing supernatant is performed using reversed-phase UPLC-MS/MS method. This test has not been cleared or approved for diagnostic use by the U.S. Food and Drug Administration.

Same day (within 8 - 12 hours from receipt of specimen), Monday through Saturday.

Specimen Type Order Code CPT Code NY Approved Volume Assay Range Special Instructions
plasma 3301 80299 Yes 1 mL (min. 0.5 mL) 0.1-10 mcg/mL
  • Collect 4-5 mL whole blood in EDTA tube (ACD and Sodium Heparin tubes are not acceptable).
  • Separate plasma by centrifugation within 30 minutes of draw time.
  • Transfer 1 mL to a sterile, screw top tube. DO NOT draw in a gel tube.
  • Ship frozen on dry ice Monday through Friday.
serum 3310 80299 Yes 1 mL (min. 0.5 mL) 0.1-10 mcg/mL
  • Collect 4-5 mL whole blood in red top tube.
  • Allow to clot for 30 to 60 minutes and centrifuge to isolate the serum.
  • Transfer 1 mL to a sterile, screw top tube. DO NOT draw in a gel tube.
  • Ship frozen on dry ice Monday through Friday.
Shipping

Ship Monday through Friday. Friday shipments must be labeled for Saturday delivery. All specimens must be labeled with patient's name and collection date. A Viracor Eurofins test requisition form must accompany each specimen. Multiple tests can be run on one specimen. Ship specimens FedEx Priority Overnight® to: Viracor Eurofins, 1001 NW Technology Dr, Lee's Summit, MO 64086.

Causes for Rejection

Specimens received not frozen, whole blood collected in serum or plasma gel, serum gel tubes, or specimen types other than those listed are not accepted.

Specimens are approved for testing in New York only when indicated in the Specimen Information field above.

The CPT codes provided are based on Viracor Eurofins' interpretation of the American Medical Association's Current Procedural Terminology (CPT) codes and are provided for general informational purposes only. CPT coding is the sole responsibility of the billing party. Questions regarding coding should be addressed to your local Medicare carrier. Viracor Eurofins assumes no responsibility for billing errors due to reliance on the CPT codes illustrated in this material.

References

Ashbee HR, Barnes RA, Johnson EM, et al. Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother 2014; 69: 1162-76.

Pascual A, Calandra T, Bolay S, et al. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes. Clin Infect Dis 2008; 46: 201-11.

Tan K, Brayshaw N, Tomaszewski K, et al. Investigation of the potential relationships between plasma voriconazole concentrations and visual adverse events or liver function test abnormalities. J Clin Pharmacol 2006; 46: 235-43.

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