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Krydsreaktioner på stoftest

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Filtrér på detektionsvindue (valgfrit)
Filteret sammenligner med litteraturens typiske detektionsvindue (≈ 5 × halveringstid). Reelt vindue varierer betydeligt med dosis, varighed, BMI, hydrering, urinens pH og assay-cutoff. værdierne er generelle og ikke patient-specifikke.
📚 Kilder & metode
  • Hovedreferencer (oversigtsartikler): Moeller KE, Kissack JC, Atayee RS, Lee KC. Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens. Mayo Clin Proc 2017;92(5):774-796 (PMID 28325505). Saitman A, Park HD, Fitzgerald RL. False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review. J Anal Toxicol 2014;38(7):387-396.. Brahm NC, Yeager LL, Fox MD, et al. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm 2010;67(16):1344-1350.
  • Bupropion → amfetamin: Reisfield GM, Goldberger BA, Bertholf RL. 'False-positive' and 'false-negative' test results in clinical urine drug testing. Bioanalysis 2009;1(5):937-952. Casey ER et al. Frequency of false positive amphetamine screens due to bupropion using the Syva EMIT II immunoassay. J Med Toxicol 2011;7(2):105-108. Nixon AL et al. Bupropion metabolites produce false-positive urine amphetamine results. Clin Chem 1995;41(6):955-956.
  • Sertralin → benzodiazepin: Nasky KM, Cowan GL, Knittel DR. False-Positive Urine Screening for Benzodiazepines: An Association with Sertraline? A Two-year Retrospective Chart Analysis. Psychiatry (Edgmont) 2009;6(7):36-39 (senere omdøbt til Innovations in Clinical Neuroscience).
  • Quetiapin → methadon: Widschwendter CG et al. Quetiapine cross reactivity with urine methadone immunoassays. Am J Psychiatry 2007;164(1):172. Cherwinski K et al. False methadone-positive urine drug screens in patients treated with quetiapine. J Am Acad Child Adolesc Psychiatry 2007;46(4):435-436. Lancelin F et al. False-positive results in the detection of methadone in urines of patients treated with psychotropic substances. Clin Chem 2005;51(11):2176-2177. Fischer M et al. False-positive methadone drug screens during quetiapine treatment. J Clin Psychiatry 2010;71(12):1696.
  • Quetiapin → TCA: Hendrickson RG, Morocco AP. Quetiapine cross-reactivity among three tricyclic antidepressant immunoassays. J Toxicol Clin Toxicol 2003;41(2):105-108. Caravati EM et al. Quetiapine cross-reactivity with plasma tricyclic antidepressant immunoassays. Ann Pharmacother 2005;39(9):1446-1449. Cerullo MA et al. Tricyclic antidepressant immunoassays may reflect quetiapine adherence. Am J Psychiatry 2008;165(7):919-920.
  • Aripiprazol → amfetamin: Kaplan J, Shah P, Faley B, Siegel ME. Case Reports of Aripiprazole Causing False-Positive Urine Amphetamine Drug Screens in Children. Pediatrics 2015;136(6):e1625-8. Caricasole V et al. Aripiprazole causing false positive urine amphetamine drug screen in an adult patient with bipolar disorder. Compr Psychiatry 2019;94:152126.
  • Trazodon → amfetamin/MDMA (m-CPP): Baron JM et al. The trazodone metabolite meta-chlorophenylpiperazine can cause false-positive urine amphetamine immunoassay results. J Anal Toxicol 2011;35(6):364-368. Logan BK, Costantino AG, Rieders EF, Sanders D. Trazodone, meta-chlorophenylpiperazine (an hallucinogenic drug and trazodone metabolite), and the hallucinogen trifluoromethylphenylpiperazine cross-react with the EMIT II Ecstasy immunoassay in urine. J Anal Toxicol 2010;34(9):587-589.
  • Venlafaxin/Dextromethorphan → PCP: Schier J, Diaz JE. Avoid unfavorable consequences: dextromethorphan can bring about a false-positive phencyclidine urine drug screen. J Emerg Med 2000;18(3):379-381 (dextromethorphan). Sena SF, Kazimi S, Wu AH. False-positive phencyclidine immunoassay results caused by venlafaxine and O-desmethylvenlafaxine. Clin Chem 2002;48(4):676-677. Bond GR, Steele PE, Uges DR. Massive venlafaxine overdose resulted in a false positive Abbott AxSYM urine immunoassay for phencyclidine. J Toxicol Clin Toxicol 2003;41(7):999-1002. Rengarajan A, Mullins ME. How often do false-positive phencyclidine urine screens occur with use of common medications? Clin Toxicol (Phila) 2013;51(6):493-496.
  • Oxaprozin → benzodiazepin: Fraser AD, Howell P. Oxaprozin cross-reactivity in three commercial benzodiazepine immunoassays. J Anal Toxicol 1998.
  • Efavirenz → benzodiazepin & THC: Rossi S et al. Cannabinoid screening tests give false-positive results in efavirenz-treated patients. Clin Chem 2006. Blank A et al. Efavirenz treatment and false-positive results in benzodiazepine screening tests. Clin Infect Dis 2009.
  • Carbamazepin → TCA: Matos ME et al. Carbamazepine produces false-positive results in tricyclic antidepressant immunoassay. Clin Chem 2000.
  • Diphenhydramin/Doxylamin/Verapamil → methadon: Rogers SC et al. Rapid urine drug screens: diphenhydramine and methadone cross-reactivity. Pediatr Emerg Care 2010. Lichtenwalner MR, Mencken T, Tully R, Petosa M. False-positive immunochemical screen for methadone attributable to metabolites of verapamil. Clin Chem 1998;44(5):1039-1041 (PMID 9590378). Også gennemgået i Moeller 2017 og Brahm 2010.
  • Tapentadol → methadon: Collins AA, Merritt AP, Bourland JA. Cross-reactivity of tapentadol specimens with DRI methadone enzyme immunoassay. J Anal Toxicol 2012;36(8):582-7. Tang S, Mullins ME, Braun BM et al. Can tapentadol cause a false-positive urine drug screen for amphetamine? J Anal Toxicol 2013 (svar: nej).
  • Selegilin → amfetamin/metamfetamin: Heinonen EH, Lammintausta R. A review of the pharmacology of selegiline. Acta Neurol Scand 1991. Selegilin metaboliseres in vivo til L-amfetamin og L-metamfetamin. Bekræftelse: Romberg RW et al. Methamphetamine and amphetamine derived from the metabolism of selegiline. J Forensic Sci 1995.
  • Rifampicin → opiater: Daher EF et al. Rifampicin interference in urine opiate immunoassay. J Clin Pharm Ther 2002. De Paula M et al. Rifampin causes false-positive immunoassay results. J Anal Toxicol 1998.
  • Fluoroquinoloner → opiater: Baden LR et al. Quinolones and false-positive urine screening for opiates by immunoassay technology. JAMA 2001;286(24):3115-3119.
  • Pantoprazol → THC: Felton D et al. Pantoprazole-induced false-positive urine screen for THC. J Pharm Pract 2014. variabel mellem assays.
  • Pseudoefedrin/efedrin → amfetamin: Stout PR, Klette KL, Horn CK. Evaluation of ephedrine, pseudoephedrine and phenylpropanolamine concentrations in human urine samples and a comparison of the specificity of DRI amphetamines and Abuscreen online (KIMS) amphetamines screening immunoassays. J Forensic Sci 2004;49(1):160-164. strukturel lighed med amfetamin-skelet.
  • Labetalol → amfetamin/MDMA: Yee LM, Wu D. False-positive amphetamine toxicology screen results in three pregnant women using labetalol. Obstet Gynecol 2011;117(2 Pt 2):503-506.
  • Tramadol → PCP/buprenorphin: Loughrey MB et al. Tramadol-induced false-positive urine drug screen for PCP. Clin Toxicol 2003. Ly BT et al. False-positive urine phencyclidine immunoassay screen result caused by interference by tramadol and its metabolites. Ann Emerg Med 2012;59(6):545-7.
  • Atomoxetin → amfetamin: Fenderson JL et al. Amphetamine positive urine toxicology screen secondary to atomoxetine. Case Rep Psychiatry 2013:381261.
  • Methylphenidat → amfetamin: Manzi S et al. Methylphenidate produces a false-positive urine amphetamine screen. Pediatr Emerg Care 2002;18(5):401. Klinisk sjælden i moderne assays.
  • SAMHSA cutoffs: Mandatory Guidelines for Federal Workplace Drug Testing Programs, 82 FR 7920 (23. januar 2017; gældende fra 1. oktober 2017). Aktuelle skæringsværdier: amfetamin 500/250, kokain (BE) 150/100, opiater (morfin) 2000/2000, THC 50/15, PCP 25/25, MDMA 500/250, 6-AM 10/10, oxykodon/oxymorphon/hydrokodon/hydromorphon 100/100 ng/mL.
  • Detektionstider: Verstraete AG. Detection times of drugs of abuse in blood, urine, and oral fluid. Ther Drug Monit 2004;26:200-205. Hadland SE, Levy S. Objective Testing: Urine and Other Drug Tests. Child Adolesc Psychiatr Clin N Am 2016.
  • Danske retningslinjer: Retsmedicinsk Institut (Aarhus & København). vejledning til urin-stoftest og bekræftelseskromatografi. Sundhedsstyrelsen. vejledning ved behandling af opioidafhængighed (krav om bekræftelse ved positive screening-resultater). pro.medicin.dk. halveringstider og farmakokinetik.
  • Halveringstider: Stahl SM. Prescriber's Guide: Stahl's Essential Psychopharmacology, 7. udg. (CUP 2021). Pro.medicin.dk produktresuméer. Maudsley Prescribing Guidelines, 14. udg.
  • Generelle principper for immunoassay-design: Melanson SE. The Utility of Immunoassays for Urine Drug Testing. Clin Lab Med 2012.
Ansvarsfraskrivelse: Krydsreaktivitet er assay-specifik. Forskellige fabrikanter (EMIT, CEDIA, KIMS, FPIA) bruger forskellige antistof-specifikationer, og samme medicin kan reagere positivt på én test og negativt på en anden. Detektionstider afhænger desuden af dosis, varighed, individuel metabolisme, hydrering og cutoff-værdi. Alle positive screening-resultater bør bekræftes med GC-MS eller LC-MS/MS, særligt ved forensisk eller juridisk anvendelse. Dette værktøj erstatter ikke laboratorie-konsultation eller individuel klinisk vurdering.

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