3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J.

Size: px

Start display at page:

Download "3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J."

Winfred Miles
5 years ago
Views:

1 Drug Adherence Assessment Report CleanAssure TM (DRIED BLOOD SPOT): Detection Range see NOTES. Prescribed Medications: ACETAMINOPHEN (TYLENOL, MAPAP), AMLODIPINE (NORVASC), ASPIRIN, ATENOLOL (TENORMIN), BACLOFEN (LIORESAL, GABLOFEN), CELECOXIB (CELEBREX), DIPHENHYDRAMINE (BENADRYL), FLUOXETINE (PROZAC, SARAFEM), FUROSEMIDE (LASIX), GABAPENTIN (NEURONTIN), HYDROCHLOROTHIAZIDE (MICROZIDE), HYDROCODONE, LEVOTHYROXINE (SYNTHROID, TIROSINT), METFORMIN (FORTAMET, GLUMETZA, GLUCOPHAGE, RIOMET, JANUMET), MULTIVITAMINS, OMEPRAZOLE (PRILOSEC, ZEGERID), POTASSIUM, PREDNISONE, SIMVASTATIN (ZOCOR), TRAMADOL (ULTRAM, CONZIP) CONSISTENT RESULTS - REPORTED MEDICATION DETECTED (PARENT DRUG AND/OR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED POSITIVE(S) TEST OUTCOME DETECTION WINDOW ACETAMINOPHEN (TYLENOL, MAPAP) Acetaminophen Positive Plasma Half-Life: 2-3 hours TRAMADOL (ULTRAM, CONZIP) Tramadol Positive Plasma Half-Life: 4-8 hours TRAMADOL (ULTRAM, CONZIP) N-Desmethyl-Tramadol Negative Plasma Half-Life: 4-10 hours TRAMADOL (ULTRAM, CONZIP) O-Desmethyl-Tramadol Negative Plasma Half-Life: 4-10 hours FLUOXETINE (PROZAC, SARAFEM) Fluoxetine Negative Plasma Half-Life: 4 days FLUOXETINE (PROZAC, SARAFEM) Norfluoxetine Positive Plasma Half-Life: 4-16 days GABAPENTIN (NEURONTIN) Gabapentin Positive Plasma Half-Life: 5-7 hours BACLOFEN (LIORESAL, GABLOFEN) Baclofen Positive Plasma Half-Life: 3-4 hrs CELECOXIB (CELEBREX) Celecoxib Positive Plasma Half-Life: 8-12 hours DIPHENHYDRAMINE (BENADRYL) Diphenhydramine Positive Plasma Half-Life: 8-10 hours AMLODIPINE (NORVASC) Amlodipine Positive Plasma Half-Life: hours ATENOLOL (TENORMIN) Atenolol Positive Plasma Half-Life: 6-7 hours HYDROCHLOROTHIAZIDE (MICROZIDE) Hydrochlorothiazide Positive Plasma Half-Life: 6-15 hours OMEPRAZOLE (PRILOSEC, ZEGERID) Omeprazole Positive Plasma Half-Life: 1 hour METFORMIN (FORTAMET, GLUMETZA, GLUCOPHAGE, Metformin Positive Plasma Half-Life: 6-7 hours RIOMET, JANUMET) LEVOTHYROXINE (SYNTHROID, TIROSINT) Levothyroxine Positive Plasma Half-Life: 6-7 Days OMEPRAZOLE (PRILOSEC, ZEGERID) Omeprazole Acid Negative Plasma Half-Life: 1 hour INCONSISTENT RESULTS - REPORTED MEDICATION NOT DETECTED (NEITHER PARENT DRUG NOR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED POSITIVE(S) TEST OUTCOME DETECTION WINDOW HYDROCODONE Hydrocodone Negative Plasma Half-Life: hours HYDROCODONE Norhydrocodone Negative Plasma Half-Life: hours HYDROCODONE Hydromorphone Negative Plasma Half-Life: hours Page: 1 of 17

2 INCONSISTENT RESULTS - REPORTED MEDICATION NOT DETECTED (NEITHER PARENT DRUG NOR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED POSITIVE(S) TEST OUTCOME DETECTION WINDOW SIMVASTATIN (ZOCOR) Simvastatin Negative Plasma Half-Life: 2 hours FUROSEMIDE (LASIX) Furosemide Negative Plasma Half-Life: 4-10 hours PREDNISONE Prednisolone Negative Plasma Half-Life: 3-4 hours INCONSISTENT RESULTS - ANALYTE DETECTED BUT NO CORESPONDING PRESCRIPTION REPORTED REPORTED PRESCRIPTION FLAG ILLICIT MEASURED RESULT CUTOFF TEST OUTCOME DETECTION WINDOW Diclofenac No Positive Plasma Half-Life: 1-2 hours Caffeine No Positive Plasma Half-Life: 5-6 hours SPECIMEN VALIDITY TESTING REPORTED PRESCRIPTION N/A TEST OUTCOME MEASURED RESULT UNITS REFERENCE RANGE N/A N/A N/A N/A ADDITIONAL MEDICATIONS REPORTED BUT NOT TESTED FOR IN THIS REPORT ASPIRIN, MULTIVITAMINS, POTASSIUM Page: 2 of 17

3 ADDITIONAL DETECTED ANALYTES CAFFEINE (CAFCIT, ALERT), DICLOFENAC (CATAFLAM, SOLARAZE, VOLTAREN), ESOMEPRAZOLE (NEXIUM) AMLODIPINE (NORVASC) & SIMVASTATIN (ZOCOR) Drug-Drug Interactions SERIOUS Coadministration with amlodipine may significantly increase the plasma concentrations of simvastatin and its active metabolite, simvastatin acid, and potentiate the risk of statin-induced myopathy. The proposed mechanism is amlodipine inhibition of simvastatin metabolism via intestinal and hepatic CYP450 3A4. When a single 80 mg dose of simvastatin was administered on day 10 of amlodipine given at a dosage of 10 mg once daily, simvastatin peak plasma concentration (Cmax) and systemic exposure (AUC) increased by an average of 1.5- and 1.8-fold, respectively, while simvastatin acid Cmax and AUC increased by an average of 1.6-fold each. High levels of statin or HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. (1) 1.) "Product Information. Zocor (simvastatin)." Merck & Co, Inc, West Point, PA. ASPIRIN & CELECOXIB (CELEBREX) The antiplatelet and cardioprotective effect of aspirin may be decreased with the concurrent use of some NSAIDs. ASPIRIN & PREDNISONE Decreased serum salicylate levels with reduced therapeutic response. Salicylate intoxication may occur when corticosteroid dosage is decreased in patients taking large doses of salicylates. Gastrointestinal ulceration may be increased as well. DICLOFENAC (CATAFLAM, SOLARAZE, VOLTAREN) & FLUOXETINE (PROZAC, SARAFEM) Concurrent use of a selective serotonin reuptake inhibitor(1-7,13) or a serotonin-norepinephrine reuptake inhibitor(8-10) and a NSAID may result in bleeding. DICLOFENAC (CATAFLAM, SOLARAZE, VOLTAREN) & FUROSEMIDE (LASIX) The pharmacological effects of loop diuretics may be decreased reducing their antihypertensive and diuretic actions. DICLOFENAC (CATAFLAM, SOLARAZE, VOLTAREN) & PREDNISONE Concurrent use of NSAIDs and corticosteroids may increase the incidence and/or severity of GI irritation or ulceration. FLUOXETINE (PROZAC, SARAFEM) & ASPIRIN Concurrent use of a selective serotonin reuptake inhibitor(1-7,13) or a serotonin-norepinephrine reuptake inhibitor(8-10) and a NSAID may result in bleeding. FLUOXETINE (PROZAC, SARAFEM) & CELECOXIB (CELEBREX) Concurrent use of a selective serotonin reuptake inhibitor(1-7,13) or a serotonin-norepinephrine reuptake inhibitor(8-10) and a NSAID may result in bleeding. Page: 3 of 17

4 FLUOXETINE (PROZAC, SARAFEM) & HYDROCODONE The concurrent administration of benzhydrocodone, hydrocodone or oxycodone and a strong inhibitor of CYP2D6 may result in decreased efficacy of hydrocodone or oxycodone. Parent and metabolite concentrations of hydrocodone or oxycodone may be altered.(2) FLUOXETINE (PROZAC, SARAFEM) & TRAMADOL (ULTRAM, CONZIP) Tramadol analgesic efficacy may be decreased due to lower mu-opioid receptor mediated analgesia.(1,9,10). Higher concentrations of tramadol may be associated with increased inhibition of norepinephrine and serotonin reuptake, increasing risk for seizures and serotonin syndrome.(1) Symptoms of serotonin syndrome may include tremor, agitation, diaphoresis, hyperreflexia, clonus, tachycardia, hyperthermia, and muscle rigidity.(7) FUROSEMIDE (LASIX) & CELECOXIB (CELEBREX) The pharmacological effects of loop diuretics may be decreased reducing their antihypertensive and diuretic actions. GABAPENTIN (NEURONTIN) & HYDROCODONE Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. PREDNISONE & CELECOXIB (CELEBREX) Concurrent use of NSAIDs and corticosteroids may increase the incidence and/or severity of GI irritation or ulceration. SYMBOL LEGEND Highly elevated risk for indicated condition or adverse drug reaction. Medication can be prescribed with monitoring; alternative therapy may be needed. Moderately elevated risk for indicated condition or adverse drug reaction. Medication can be prescribed with monitoring; therapy ajustment may be needed. Typical risk for indicated condition or adverse drug reaction. Medication can be prescribed according to standard dosing guidelines. Drug interactions of moderate severity. The clinician should assess the patient`s characteristics and take action as needed. SERIOUS Severe drug interaction or contraindicated drug combination which may produces serious consequences in most patients. This drug combination generally should not be dispensed or administered to the same patient. Action is required to reduce risk of severe adverse interaction. 1. ANALGESICS / OPIATES Acetaminophen Positive ng/ml No Buprenorphine Negative ng/ml No Page: 4 of 17

5 Butorphanol Negative ng/ml No Codeine Negative ng/ml No Dihydrocodeine Negative ng/ml No EDDP Negative ng/ml No Fentanyl Negative ng/ml No Hydrocodone Negative ng/ml No Inconsistent Result Hydromorphone Negative ng/ml No Inconsistent Result Ketamine Negative ng/ml No Levorphanol Negative ng/ml No Meperidine Negative ng/ml No Methadone Negative ng/ml No Morphine Negative ng/ml No N-Desmethyl-Tramadol Negative ng/ml No Norbuprenorphine Negative ng/ml No Norcodeine Negative ng/ml No Norfentanyl Negative ng/ml No Norhydrocodone Negative ng/ml No Inconsistent Result Norketamine Negative ng/ml No Noroxycodone Negative ng/ml No Norpropoxyphene Negative ng/ml No O-Desmethyl-Tramadol Negative ng/ml No Oxycodone Negative ng/ml No Oxymorphone Negative ng/ml No Propoxyphene Negative ng/ml No Tapentadol Negative ng/ml No Tramadol Positive ng/ml No Page: 5 of 17

6 2. BENZODIAZEPINES 6-Hydroxybuspirone Negative ng/ml No 7-Aminoclonazepam Negative ng/ml No Alpha-hydroxyalprazolam Negative ng/ml No Alpha-Hydroxymidazolam Negative ng/ml No Alpha-Hydroxytriazolam Negative ng/ml No Alprazolam Negative ng/ml No Buspirone Negative ng/ml No Chlordiazepoxide Negative ng/ml No Clobazam Negative ng/ml No Clonazepam Negative ng/ml No Desalkylflurazepam Negative ng/ml No Diazepam Negative ng/ml No Estazolam Negative ng/ml No Flunitrazepam Negative ng/ml No Flurazepam Negative ng/ml No Lorazepam Negative ng/ml No Midazolam Negative ng/ml No N-Desmethyl-Flunitrazepam Negative ng/ml No Norchlordiazepoxide Negative ng/ml No Nordiazepam Negative ng/ml No Oxazepam Negative ng/ml No Prazepam Negative ng/ml No Temazepam Negative ng/ml No Triazolam Negative ng/ml No Page: 6 of 17

7 3. ANTI-PSYCHOTICS 9-Hydroxyrisperidone Negative ng/ml No Aripiprazole Negative ng/ml No Asenapine Negative ng/ml No Brexpiprazole Negative ng/ml No Chlorpromazine Negative ng/ml No Clozapine Negative ng/ml No Clozapine_N_oxide Negative ng/ml No Dehydro-Aripiprazole Negative ng/ml No Fluphenazine Negative ng/ml No Haloperidol Negative ng/ml No Iloperidone Negative ng/ml No Lurasidone Negative ng/ml No Norquetiapine Negative ng/ml No Olanzapine Negative ng/ml No Perphenazine Negative ng/ml No Quetiapine Negative ng/ml No Risperidone Negative ng/ml No Thioridazine Negative ng/ml No Thiothixene Negative ng/ml No Ziprasidone Negative ng/ml No Page: 7 of 17

8 4. ANTI-DEPRESSANTS / SSRI / SNRI / TCA Amitriptyline Negative ng/ml No Amoxapine Negative ng/ml No Bupropion Negative ng/ml No Citalopram Negative ng/ml No Clomipramine Negative ng/ml No D-L-Kavain Negative ng/ml No Desipramine Negative ng/ml No Desmethoxyyangonin Negative ng/ml No Dihydrokavain Negative ng/ml No Dihydromethysticin Negative ng/ml No Doxepin Negative ng/ml No Duloxetine Negative ng/ml No Fluoxetine Negative ng/ml No Fluvoxamine Negative ng/ml No Hydroxybupropion Negative ng/ml No Imipramine Negative ng/ml No Methysticin Negative ng/ml No Milnacipran Negative ng/ml No Mirtazapine Negative ng/ml No N-Desmethyl-Clomipramine Negative ng/ml No Nordoxepin Negative ng/ml No Norfluoxetine Positive ng/ml No Normirtazapine Negative ng/ml No Nortriptyline Negative ng/ml No O-Desmethyl-Venlafaxine Negative ng/ml No Paroxetine Negative ng/ml No Sertraline Negative ng/ml No Trazodone Negative ng/ml No Venlafaxine Negative ng/ml No Vilazodone Negative ng/ml No Vortioxetine Negative ng/ml No Yangonin Negative ng/ml No 5. DEPRESSANTS Eszopiclone Negative ng/ml No Zaleplon Negative ng/ml No Zolpidem Negative ng/ml No Zopiclone-N-Oxide Negative ng/ml No Page: 8 of 17

9 6. ANTI-CONVULSANTS Dihydro-10- Hydroxycarbamazepine Negative ng/ml No Carbamazepine Negative ng/ml No Gabapentin Positive > ng/ml No Lamotrigine Negative ng/ml No Levetiracetam Negative ng/ml No Licarbazepine Negative ng/ml No Oxcarbazepine Negative ng/ml No Phenytoin Negative ng/ml No Pregabalin Negative ng/ml No Primidone Negative ng/ml No Tiagabine Negative ng/ml No Topiramate Negative ng/ml No Valproic Acid Negative ng/ml No Zonisamide Negative ng/ml No 7. MUSCLE RELAXANTS Baclofen Positive ng/ml No Carisoprodol Negative ng/ml No Cyclobenzaprine Negative ng/ml No Meprobamate Negative ng/ml No Metaxalone Negative ng/ml No Methocarbamol Negative ng/ml No 8. STIMULANTS / ADHD Amphetamine Negative ng/ml No Atomoxetine Negative ng/ml No Caffeine Positive ng/ml No Inconsistent Result Ephedrine Negative ng/ml No Guanfacine Negative ng/ml No Lisdexamfetamine Negative ng/ml No Methylphenidate Negative ng/ml No Ritalinic Acid Negative ng/ml No 9. DECONGESTANTS Dextromethorphan Negative ng/ml No Pseudoephedrine Negative ng/ml No 10. APPETITE STIMULANTS Marinol Negative ng/ml No Phentermine Negative ng/ml No Page: 9 of 17

10 11. ANTIDOTES Naloxone Negative ng/ml No Naltrexone Negative ng/ml No Page: 10 of 17

11 12. ILLICITS 5-Fluoro-NPB-22 Negative ng/ml Yes 5-MeO-DMT Negative ng/ml Yes 6-MAM (heroin metabolite) Negative ng/ml Yes 7-HydroxyMitragynine (Kratom) Negative ng/ml Yes AB-FUBINACA Negative ng/ml Yes Acetyl-Fentanyl Negative ng/ml Yes Alpha-PVP Negative ng/ml Yes AM2201 (Spice Cannabinoid) Negative ng/ml Yes Benzoylecgonine Negative ng/ml Yes Carfentanil Negative ng/ml Yes Cocaine Negative ng/ml Yes Didesmethyl-U Negative ng/ml Yes DMT Negative ng/ml Yes FDU-PB-22 Negative ng/ml Yes HU-210 (Spice Cannabinoid) Negative ng/ml Yes JWH-019 (Spice Cannabinoid) Negative ng/ml Yes JWH Hydroxybutyl (Spice Cannabinoid) Negative ng/ml Yes JWH-081 (Spice Cannabinoid) Negative ng/ml Yes JWH-122 (Spice Cannabinoid) Negative ng/ml Yes JWH-18-5-pentanoic acid (Spice Cannabinoid) JWH-18-5-pentanyl (Spice Cannabinoid) JWH-250-5OH-pentanyl (Spice Cannabinoid) Negative ng/ml Yes Negative ng/ml Yes Negative ng/ml Yes MDA Negative ng/ml Yes MDEA Negative ng/ml Yes MDMA Negative ng/ml Yes MDPV Negative ng/ml Yes Mephedrone Negative ng/ml Yes Methamphetamine Negative ng/ml Yes Methylone Negative ng/ml Yes Mitragynine (Kratom) Negative ng/ml Yes MMB-CHMICA Negative ng/ml Yes N-Desmethyl-U Negative ng/ml Yes Normephedrone Negative ng/ml Yes PCP Negative ng/ml Yes THC (Marijuana metabolite) Negative ng/ml Yes Page: 11 of 17

12 13. BARBITURATES Amobarbital Negative ng/ml No Butabarbital Negative ng/ml No Butalbital Negative ng/ml No Pentobarbital Negative ng/ml No Secobarbital Negative ng/ml No 14. DIRECT BIOMARKERS (-)-Cotinine Negative ng/ml No Ethyl Glucuronide (Ethanol) Negative ng/ml No Ethyl Sulfate (Ethanol) Negative ng/ml No 15. ANTI-INFLAMMATORY / NSAIDs Celecoxib Positive ng/ml No Chlorpheniramine Negative ng/ml No Colchicine Negative ng/ml No Diclofenac Positive ng/ml No Inconsistent Result Etodolac Negative ng/ml No Febuxostat Negative ng/ml No Hydroxychloroquine Negative ng/ml No Ibuprofen Negative ng/ml No Indomethacin Negative ng/ml No Meloxicam Negative ng/ml No Naproxen Negative ng/ml No Olopatadine Negative ng/ml No Oxipurinol Negative ng/ml No Piroxicam Negative ng/ml No Sumatriptan Negative ng/ml No Tofacitinib Negative ng/ml No 16. ANTI-HISTAMINES Cetirizine Negative ng/ml No Desloratadine Negative ng/ml No Diphenhydramine Positive ng/ml No Fexofenadine Negative ng/ml No Hydroxyzine Negative ng/ml No Loratadine Negative ng/ml No Montelukast Negative ng/ml No Page: 12 of 17

13 17. CARDIOVASCULAR Acebutolol Negative ng/ml No Alpha-hydroxymetoprolol Negative ng/ml No Amiodarone Negative ng/ml No Amlodipine Positive ng/ml No Apixaban Negative ng/ml No Atenolol Positive ng/ml No Atorvastatin Negative ng/ml No Atorvastatin Lactone Negative ng/ml No Benazepril Negative ng/ml No Bisoprolol Negative ng/ml No Candesartan Negative ng/ml No Candesartan Cilexetil Negative ng/ml No Carvedilol Negative ng/ml No Cilostazol Negative ng/ml No Clopidogrel Negative ng/ml No Dabigatran Negative ng/ml No Diltiazem Negative ng/ml No Dipyridamole Negative ng/ml No Dronedarone Negative ng/ml No Eletriptan Negative ng/ml No Enalaprilat Negative ng/ml No Ezetimibe Negative ng/ml No Fenofibric Acid Negative ng/ml No Flecainide Negative ng/ml No Gemfibrozil Negative ng/ml No Hydrochlorothiazide Positive ng/ml No Irbesartan Negative ng/ml No Labetalol Negative ng/ml No Lisinopril Negative ng/ml No Losartan Negative ng/ml No Metoprolol Negative ng/ml No N-Desethylamiodarone Negative ng/ml No Nadolol Negative ng/ml No Nifedipine Negative ng/ml No Olmesartan Acid Negative ng/ml No Pentoxifylline Negative ng/ml No Propranolol Negative ng/ml No Ranolazine Negative ng/ml No Page: 13 of 17

14 Rivaroxaban Negative ng/ml No Simvastatin Negative ng/ml No Inconsistent Result Telmisartan Negative ng/ml No Ticagrelor Negative ng/ml No Valsartan Negative ng/ml No Verapamil Negative ng/ml No Warfarin Negative ng/ml No 18. ANTIMICROBIAL Itraconazole Negative ng/ml No Nitrofurantoin Negative ng/ml No 19. GASTROINTESTINAL / DIETARY Biotin Negative ng/ml No Famotidine Negative ng/ml No Hyoscyamine Negative ng/ml No Lansoprazole Negative ng/ml No Metoclopramide Negative ng/ml No Omeprazole Positive ng/ml No Omeprazole Acid Negative ng/ml No Pantoprazole Negative ng/ml No Ranitidine Negative ng/ml No 20. ANTI-EMETIC Ondansetron Negative ng/ml No Promethazine Negative ng/ml No 21. DIABETIC Glimepiride Negative ng/ml No Glipizide Negative ng/ml No Glyburide Negative ng/ml No Linagliptin Negative ng/ml No Metformin Positive ng/ml No Nateglinide Negative ng/ml No Pioglitazone Negative ng/ml No Repaglinide Negative ng/ml No Rosiglitazone Negative ng/ml No Saxagliptin Negative ng/ml No Sitagliptin Negative ng/ml No Page: 14 of 17

15 22. DIURETICS / INCONTINENCE Acetazolamide Negative ng/ml No Alfuzosin Negative ng/ml No Canrenone Negative ng/ml No Chlorothiazide Negative ng/ml No Darifenacin Negative ng/ml No Doxazosin Negative ng/ml No Furosemide Negative ng/ml No Inconsistent Result Indapamide Negative ng/ml No Solifenacin Negative ng/ml No Terazosin Negative ng/ml No Torsemide Negative ng/ml No Triamterene Negative ng/ml No 23. PDE (Phosphodiesterase Inhibitors) Sildenafil Negative ng/ml No Tadalafil Negative ng/ml No Vardenafil Negative ng/ml No 24. CORTICOSTEROIDS / HORMONE THERAPY Budesonide Negative ng/ml No Dexamethasone Negative ng/ml No Finasteride Negative ng/ml No Levothyroxine Positive ng/ml No Prednisolone Negative ng/ml No Inconsistent Result Raloxifene Negative ng/ml No 25. ANTI-NEOPLASTICS / CANCER THERAPY Methotrexate Negative ng/ml No 26. DEMENTIA (Parkinson's/Alzheimer's) Donepezil Negative ng/ml No Rivastigmine Negative ng/ml No Ropinirole Negative ng/ml No Page: 15 of 17

16 Historical Result Data Comments: This test was performed at Alcala Testing and Analysis Services (CLIA# 05D ). Dried Blood Spot specimens are analyzed using CleanAssure TM (patent pending) technology. In contrast to urine, in dried blood spot specimens (CleanAssure TM DBS) detection may be reduced (compound-specific). E.g. Morphine and Fentanyl exhibiting short plasma half-lives may require a follow up test with a urine specimen. In dried blood spot specimens parent drugs are often detected in higher concentrations than their metabolites commonly observed in urine specimens. Morphine is a commonly detected metabolite among patients taking Codeine. Hydromorphone is a commonly detected metabolite among patients taking Hydrocodone and Morphine. An active molecule of OPANA, Oxymorphone is a commonly detected metabolite among patients taking Oxycodone. OPANA (Oxymorphone) will not metabolize to Noroxycodone or Oxycodone. Oxazepam is a commonly detected metabolite among patients taking Diazepam, Nor-Diazepam or Temazepam. Temazepam and Nor- Diazepam are commonly detected metabolites among patients taking Diazepam. Alprazolam, Alpha-OH-Alprazolam, Clonazepam, and 7- amino-clonazepam are not detected in patients taking Diazepam, Nor-diazepam, Lorazepam, Oxazepam, and Temazepam. Meprobamate is a commonly detected metabolite among patients taking Carisoprodol and its presence is consistent with the use of Carisoprodol. Nortrimipramine, the metabolite of Trimipramine, may cause a false positive result for Imipramine in this assay. Trimipramine (brand name Surmontil) and its metabolite are not part of this assay. Trimipramine will be differentiated from other tricyclics, but its metabolite may cause interference with Imipramine. An active (drug) or metabolite may be listed as a Negative Outcome, however, if either the active or any metabolite(s) are present (Positive), then the result is listed as Consistent for that reported prescribed medication. In case of patients consuming HYDROCODONE-containing medications: Norhydrocodone is the major metabolite of Hydrocodone indicating presence of Hydrocodone in urine. While Hydrocodone can also be metabolized to Hydromorphone, identification of just Hydromorphone by itself is not a confirmation of Hydrocodone being present, since recent studies suggest that urine specimens of patients taking Hydrocodone always show presence of Hydrocodone or Norhydrocodone in combination with Hydromorphone. Page: 16 of 17

17 FOR PATIENT RESULTS INDICATING JUST THE PRESENCE OF HYDROMORPHONE: THIS MAY BE DERIVED FROM MORPHINE- CONTAINING PRESCRIPTION DRUGS OR HYDROMORPHONE-ONLY PRESCRIPTIONS (FOR EXAMPLE, DILAUDID). Further reading: Valtier,S. and Bebarta,V.S. (2012) Excretion profile of hydrocodone, hydromorphone and norhydrocodone in urine following single dose administration of hydrocodone to healthy volunteers. J. Anal. Toxicol., 36, and Barakat,N.H., Atayee,R.S., Best,B.M. and Ma,J.D. (2014) Observations of Urinary Hydrocodone and Metabolite Distributions in Pain Patients. J. Anal. Toxicol., 38, ) REFERENCES for DRUG-DRUG-INTERACTIONS are available upon request. Notes: Specimen collected by CleanAssure TM Dried Blood Spot Mitra TM Microsampling. This procedure is to determine the presence and concentration of prescription/non-prescription drugs from dried blood spots collected using Mitra TM Microsampling devices by finger pricks. This method and associated validation is intended for patient compliance testing only (i.e. determination of the presence or absence and concentrations of prescribed and illicit drugs in dried blood spots) and is not validated for therapeutic drug monitoring (TDM) of drug plasma levels. Detection ranges may be reduced (compound-specific) versus urine toxicology test results. Mitra TM Microsampling devices improve patient comfort and increase operational efficiencies. Reviewed By: 04/01/ :10 Date: Page: 17 of 17

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J.

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J. Drug Adherence Assessment Report Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - REPORTED MEDICATION DETECTED (PARENT DRUG AND/OR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED