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HelpEPIC ORDER CODE LAB683 Ethosuximide, Serum
Additional Codes
SQ: ETHSXM
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Serum gel tubes should be centrifuged within 2 hours of collection.
2. Red-top tubes should be centrifuged and the serum aliquoted into a plastic vial within 2 hours of collection.
Useful For
Monitoring ethosuximide therapy
Determining compliance
Assessing ethosuximide toxicity
Method Name
Enzyme-Multiplied Immunoassay Technique (EMIT)
Reporting Name
Ethosuximide, SSpecimen Type
SerumSpecimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 28 days | ||
| Ambient | 14 days |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Ethosuximide (Zarontin) is used in the treatment of absence (petit mal) epilepsy in adults and children 3 years and older. Ethosuximide is almost completely absorbed from the gastrointestinal tract, reaching a peak plasma concentration in 1 to 4 hours following oral administration.
Approximately 10% to 20% of the drug is excreted unchanged in the urine; the remainder is metabolized by hepatic microsomal enzymes. The volume of distribution of ethosuximide is approximately 0.7 L/kg, and its half-life is 17 to 56 hours (adult) and 30 hours (pediatric). Minimal ethosuximide circulating in the blood is bound to protein (approximately 22%).
Ethosuximide produces a barbiturate-like toxicity, characterized by central nervous system and respiratory depression, nausea, and vomiting, when the blood level is greater than 120 mcg/mL.
Reference Values
Therapeutic: 40-100 mcg/mL
Critical value: >150 mcg/mL
Interpretation
Dosage is guided by blood levels; the therapeutic range for ethosuximide is 40 to 100 mcg/mL.
Toxic concentration: above 120 mcg/mL.
Clinical Reference
1. Milone MC, Shaw LM. Therapeutic drugs and their management. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:420-453.e9
2. Brunton LL, Knollmann BC, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics, 14th ed. McGraw-Hill Education, 2023
3. Hiemke C, Bergemann N, Clement HW, et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: Update 2017. Pharmacopsychiatry. 2018;51(1-02):9-62
Method Description
The enzyme-multiplied immunoassay technique assay is a homogeneous enzyme immunoassay technique used for the analysis of specific compounds in biological fluids. The assay is based on competition between drug in the sample and drug labeled with the enzyme glucose-6-phosphate dehydrogenase (G6PD) for antibody binding sites. Enzyme activity decreases upon binding to the antibody, so the drug concentration in the sample can be measured in terms of enzyme activity. Active enzyme converts oxidized nicotinamide adenine dinucleotide (NAD) to NADH, resulting in an absorbance change that is measured spectrophotometrically. Endogenous serum G6PD does not interfere, because the coenzyme functions only with the bacterial (Leuconostoc mesenteroides) enzyme employed in the assay.(Package insert: Ethosuximide reagent. Siemens Healthcare Diagnostics, Inc; 04/2015)
Day(s) Performed
Monday through Saturday
Report Available
Same day/1 daySpecimen Retention Time
2 weeksPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80168
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ETX | Ethosuximide, S | 3616-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 8769 | Ethosuximide, S | 3616-0 |
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-Therapeutics Test Request (T831)