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Benzodiazepine metabolism

Posted: Tue May 07, 2019 1:32 pm
by delzey
My name is Dean Elzey. I am an MRO in Ft. Wayne, in. I have a donor who is positive for lorazepam. She has a prescription for alprazolam. These drugs are of different classes. There is a metabolic roadmap for the Azepam class in the MRO Handbook, but none for the Azolam class (alprazolam). It is a reasonable suspicion test. It would appear that the donor is + for a different benzodiazepine class than for which she has a script. Is that true? I have always thought that on a drug test a benzodiazepine is a benzodiazepine. But I don't recall whether that fact crosses from class to class. It doesn't appear so on the roadmap.

Re: Benzodiazepine metabolism

Posted: Tue May 07, 2019 6:10 pm
by MaxwellEdison
benzo metab.jpg
benzo metab.jpg (26.93 KiB) Viewed 1756 times

Re: Benzodiazepine metabolism

Posted: Wed May 08, 2019 12:54 pm
by delzey

Thanks for your response. I think ,after looking at your diagram, that since all benzos are similar enough and interconvertable that a + for lorazepam could be obtained when the medication taken was alprazolam. I have always thought that, but my assistant showed me the diagram of the Azepam group and pointed out that there is no apparent metabolism from the Azolam group to get to that end point. Am I correct in thinking that a positive benzo and that the chemical name is unimportant on the lab result????

Dean Elzey

Re: Benzodiazepine metabolism

Posted: Wed May 08, 2019 1:02 pm
by Robert Swotinsky MD
The specific benzodiazepine(s) that are identified are important to the interpretation of the results.

The use of alprazolam does not account for the presence of lorazepam in the urine.