ACCU-TELL TCA URINE TEST (CE)
Declaration: As with all diagnostic tests, a definitive clinical diagnosis should not be based on the result of a single test, but should only be made by the physician after all clinical and laboratory findings have been evaluated.
BIBLIOGRAPHY OF SUGGESTED READINGS
Catalog No. Product Name Note
ABT-DOA-A54 TCA Urine Strip CE
ABT-DOA-B54 TCA Urine Cassette CE
Accu-Tell ® Rapid Tricyclic Antidepressants (TCA) Test is a lateral flow, rapid immunoassay for the qualitative detection of TCA in human urine at a cut-off of 1000 ng/mL. This product is used to obtain a visual, qualitative result and is intended for professional use. The assay should not be used without proper supervision and is not intended for over the counter sale to lay persons.
This assay provides only a preliminary analytical test result. A more specific alternative chemical method must be used in order to obtain a confirmed analytical result. Gas chromatogra-phy/mass spectrometry (GC/MS) has been established as the preferred confirmatory method by the National Institute on Drug Abuse (NIDA). Clinical consideration and professional judgment should be applied to any drug of abuse test result, particularly when preliminary positive results are indicated.
Tricyclic antidepressants, (commonly called TCAs) have been prescribed since the 1950s for depression. They are the oldest antidepressants we use today. Until recently TCAs were the clear first choice of physicians for the vast majority of people with major depressive disorder. Examples of TCAs are: imipramine (Tofranil), amitriptyline (Elavil) and nortriptyline (Pamelor). TCAs work by raising the levels of serotonin and norepinephrine in the brain by slowing the rate of reuptake, or reabsorption, by nerve cells. It may take several weeks to see the desired result. Tricyclic antidepressant (TCA) overdose remains the leading cause of death from intentional drug overdose. Cardiac arrhythmias and hypotension are the major contributors of death in TCA overdose. Much of the cardiotoxicity from TCAs results from quinidine-like actions on the cardiac action potential and a negative inotropic action. Glucagon has been shown to reverse the depression in cardiac contractility, blood pressure and heart rate in quinidine toxicity.
Accu-Tell ® Rapid Tricyclic Antidepressants (TCA) Test is based on the principle of the highly specific immunochemical reactions of antigens and antibodies which are used for the analysis of specific compounds in biological fluids. This test is a rapid, visual, competitive immunoassay that can be used for the qualitative detection of TCA´s in human urine.
Accu-Tell ® Rapid Tricyclic Antidepressants (TCA) Test is a Rapid immunoassay in which a chemically labeled drug (drug conjugate) competes with the drug which may be present in urine for limited antibody binding sites. The test device contains a membrane strip which was pre-coated with drug conjugate on the test band. A colored anti-TCA monoclonal antibody-colloidal gold conjugate pad is placed at the right end of the membrane. In the absence of drug in the urine, the solution of the colored anti-body-colloidal gold conjugate and urine moves upward, chromatographically by capillary action, across the membrane. This solution then migrates to the immobilized drug conjugate zone on the test band region. The colored antibody-colloidal gold conjugate then attaches to the drug conjugate to form a visible line as the antibody complexes with the drug conjugate. Therefore, the formation of a visible precipitant in the test zoneoccurs, when the test urine is negative for the drug. When the drug is present in the urine, the drug antigen competes with the drug conjugate on the test band region for limited antibody sites on the anti-TCA monoclonal antibody-colloidal gold conjugate. When a sufficient concentration of drug is present, it will fill the limited antibody binding sites. This will prevent attachment of the colored antibody-colloidal gold conjugate to the drug conjugate zone on the test band region. Therefore, absence of the color band on the test region indicates a positive result.
A control band with a different antigen/antibody reaction is also added to the immunochromatographic membrane strip at the control region (c) to indicate that the test has performed properly. This control line should always appear, regardless of the presence of drug. This means that negative urine will produce two colored bands, and positive urine will produce only one band. The presence of this colored band in the control region also serves as 1) verification that sufficient volume has been added, and 2) that proper flow was obtained.
The test kit is to be stored at refrigeration (2-8°C) or room temperature (up to 30°C) in the sealed pouch for the duration of the shelf life.
1. For in vitro use only.
2. For professional use only.
3. Urine specimens may be potentially infectious. Proper handling and disposal methods should be established.
4. Avoid cross-contamination of urine samples by using a new specimen collection container and specimen pipette for each urine sample.
Accu-Tell ® Rapid Tricyclic Antidepressants (TCA) Test is formulated for use with urine specimens. Fresh urine does not require any special handling or pretreatment. Urine samples should be collected such that testing can be performed as soon as possible after the specimen collection, preferably during the same day. The specimen may be refrigerated at 2-8°C for 2 days, or frozen at -20°C for a longer period of time. Specimens that have been refrigerated must be equilibrated to room temperature prior to testing. Specimens previously frozen must be thawed, equilibrated to room temperature, and mixed thoroughly prior to testing.
Note: Urine specimens and all materials coming in contact with them should be handled and disposed of as if capable of transmitting infection. Avoid contact with skin by wearing gloves and proper laboratory attire.
Review “Specimen Collection“ instructions. Test device, patients’ samples, and controls should be brought to room temperature (20-30°C) prior to testing. Do not open pouches until ready to perform the assay.
For Test Cassette:
1. Remove the test device from its protective pouch (bring the device to room temperature before opening the pouch to avoid condensation of moisture on the membrane). Label the device with patient or control identification.
2. Draw the urine sample to the line marked on the pipette. Dispense 3 drops (or 120 μl) into the sample well. Use a separate pipette and device for each sample or control.
3. Read result between 3 to 8 minutes after the addition of sample. Do not read result after 8 minutes.
For Test Strip:
1. Bring the pouch to room temperature before opening it. Remove the test strip from the sealed pouch and use it as soon as possible.
2. With arrows pointing toward the urine specimen, immerse the test strip vertically in the urine specimen for at least 5 seconds. Do not pass the maximum line on the test strip when immersing the strip.
Place the test strip on a non-absorbent flat surface, start the timer and wait for the red line(s) to appear. The result should be read between 3 to 8 minutes after the addition of sample. Do not interpret the result after 8 minutes.
Negative: Two coloured lines appear. The line in the test region (T) is the drug probe line; the line on the control region (C ) is the control line, which is used to indicate proper performance of the device. The colour intensity of the test line may be weaker or stronger than that of the control line.
Positive: Only one coloured line appears in the control region (C ). The absence of a test line indicates a positive result.
Invalid: No line appears in the control region. Under no circumstances should a positive sample be identified until the control line forms in the viewing area. If the control line does not form, the test result is inconclusive and should be repeated.
Note: A very faint line in the test region indicates that the TCA in the sample is near the cut-off level of the test. These samples should be re-tested or confirmed with a more specific method be-fore a positive determination is made.
1. The assay is designed for use with human urine only.
2. A positive result with any of the tests indicates the presence of a drug/metabolite only, and does not indicate or measure intoxication.
3. There is a possibility that technical or procedural errors as well as other substances and factors not listed may interfere with the test and cause false results.
4. If it is suspected that the samples have been mislabelled or tampered with, a new specimen should be collected and the test should be repeated.
Good laboratory practice recommends the use of control materials to ensure proper kit performance. Quality control specimens are available from commercial sources. When testing the positive and negative controls, use the same assay procedure as with a urine specimen.
Accu-Tell ® Rapid TCA Urine Test provides built-in process control with a different antigen/antibody reaction at the control region (C) in each strip. This control line should always appear regardless of the presence of drug or metabolite. If the control line does not appear, the test device should be discarded. The presence of this control band in the control region serves as 1) verification that sufficient volume is added, 2) that proper flow is obtained.
Accuracy: The accuracy of Accu-Tell ® Rapid TCA Urine Test was evaluated in comparison to a commercially available immu-noassay at a cut-off of 1000 ng/mL for TCA. 92 urine samples, collected from presumed non-user volunteers, have been tested by both procedures with 100% agreement.
In a separate study, 70 urine samples (obtained from a clinical laboratory where they were screened and confirmed as positives by the commercially available immunoassay and GC/MS) were tested by Rapid TCA Test Cassette. Of the 70 samples with TCA concentration > 1000 ng/mL, 69 were found to be positives by both methods (98% agreement).
Reproducibility: The reproducibility of Accu-Tell ® Rapid TCA Urine Test was evaluated at 4 different sites using blind controls. Of the 60 samples without TCA all were determined negatives. Of the 60 samples with a TCA concentration of 1500 ng/ml, all were determined positive.
Precision: The precision of Accu-Tell ® Rapid TCA Urine Test was determined by conducting the test with blind spiked controls. The control at 500 ng/mL should give a negative result and the control at 2000 ng/mL should give a positive result.
|
Concentra-tion (ng/mL)
|
No Tested
|
Correct Result
|
% Correct Result
|
|
500
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50
|
50
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100
|
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2000
|
50
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50
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100
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Specificity: The specificity for Accu-Tell ® Rapid TCA Urine Test was tested by adding various drugs, drug metabolites, and other compounds that are likely to be present in urine. All compounds were prepared in drug-free normal human urine.
The following structurally related compounds produced positive results when tested at levels equal to or greater than the concentrations listed below.
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Compound
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Concentration (ng/ml)
|
|
Nortriptyline
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1,000
|
|
Amitriptyline
|
1,000
|
|
Desipramine
|
600
|
|
Imipramine
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600
|
|
Nordoxepin
|
1,000
|
|
Cyclobenzaprine
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1,500
|
|
Clomipramine
|
5,000
|
|
Doxepin
|
3,000
|
|
Protriptyline
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2,000
|
|
Perphenazine
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75,000
|
|
Promazine
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15,000
|
|
Trimipramine
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2,000
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The following compounds were found not to cross-react when tested at concentrations up to 100 μg/mL.
Acetaminophen, Acetone, Albumin, Amoxapine, Ampicillin, Aspartame, Aspirin, Atropine, Baclofen, Benzocaine, Bilirubin, (+)-Brompheniramine, Caffeine, Carbamate, Carbamazepine, Carisoprodol, Creatine, Creatinine, (+)-Chlorpheniramine, (+/-)-Chlorpheniramine, Chlorpromazine, Chlorprothixene, Chlorthalidone, Clofibrate, Cyclodextrin, Cyprohepadine, Dantrolene, Dexamethasone, Dexbrompheniramine, Dextromethorphan, 4-Dimethylaminoantipyrine, Diphen-hydramine, 5,5-Diphenylhydantoin, DL-Homatropine, Dopamine, Ecgonine, Ecgonine Methyl Ester, (-) Ephedrine, (+) Ephedrine, (+/-) Ephedrine, (+) Ephedrine, Erythromycin, Ethanol, Fenofibrate, Fentanyl, Fluoxetine, Furosemide, Gemfibrozil, Glucose, Guaicol-Glyceryl-Ether, Hemoglobin, DL-Homatropine, Hydrochlorothiazide, Hydroxytyramide, Ibuprofen, (+/-)-Isoproterenol, Lidocaine, Maprotiline, Methanol, Methapyrilene, Methaqualone, N-Methyl-Ephedrine, , Naltrexone, ß-Naphthalene Acetic Acid, (+) Naproxen, (-)-Nicotine, Nicotinic Acid, Norcodeine, (+/-)-Norephedrine, Noscapine-Hydrochloride, Orphenadrine, Oxalic Acid, Penicillin-G, Phenothiazine, Phenelzine, L-Phenylephrine, Primidone, Procaine, Promethazine, 2-Propylpentanoic Acid, Pseudoephedrine, d-Propoxyphene, Quinidine, Riboflavin, Salicylic Acid, Sodium Chloride, Sulindac, Theophyline, Thioridazine, cis-Thiothixene, D(+)-Trehalose, Trifluoperazine, Vitamin C
1. Baselt, R.C. Disposition of Toxic Drugs and Chemicals in Man, Biomedical Publications, 1982.
2. Urine Testing for Drugs of Abuse. National Institute on Drug Abuse (NIDA), Research Monograph 73, 1986.
3. Fed. Register, Department of Health and Human Services, Mandatory Guidelines for Federal Workplace Drug Testing Programs, 53, 69, 11970, 1988.
4. Gorodetzkym, C.W.: Detection of Drugs of Abuse in Biological Fluids. in Martin WR (ed): Drug Addiction I, New York, Springer Verlag.
5. Hofmann F.E.: A Handbook on Drug and Alcohol Abuse: The Biomedical Aspects, New York. Oxford University Press, 1983.
The above information is just for reference. The actual technical specifications are subject to the insert provided with the product.
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