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SSRIs, bupropion, and urine drug screens

From: LLETTON@aol.com
Date: Mon, 7 Aug 1995 18:33:51 -0400
Subject: Sertraline and urine drug screens

In a message dated 95-08-07 05:44:56 EDT, Cdbojrab@aol.com writes:

I have been hearing rumors that patients taking sertraline (Zoloft) will sometimes show positive for benzos and narcotics on urine drug screens.
I had this happen with a client about a year ago -- he showed positive for benzos and swore up and down he hadn't had any. I tended to believe this client and checked with the lab's toxicology department, which confirmed that this can indeed happen. Scary. Up to that point, I had put great weight in drug testing. Now I'm not so sure...

From: "Robert A. Katz, M.D." <trp.fish@ix.netcom.com>
Date: Tue, 8 Aug 1995 23:59:28 -0400
Subject: Sertraline and urine drug screens

I also had an experience of this nature approximately 4 months back. To make matters worse, the 15 year old youngster was on probation. He was on 100 mg Zoloft qAM and scored a high positive for benzodiazepines. For other reasons, I switched him to imipramine and he's never had another positive urine test. Also of note is the fact that the youngster had never had a positive drug history of note.

From: snagymd@mem.po.com (Stephen Nagy, M.D.)
Date: Sun, 25 Feb 1996 15:58:54 -0500
Subject: Sertraline and urine drug screens

I checked with the toxicology department of the Oregon Medical Laboratory, and they had not heard of this. However, drug *screening* can be done by a variety of different kits utilizing different immunoassays, and some of them could have a false positive result.

One needs always to follow-up positive *screening* with *confirmatory* testing by gas chromatography-mass spectroscopy, or GCMS, which gives a molecular fingerprint for the substance present.

Any company that relies on a positive *screening* test to make hiring or firing decisions is hanging out legally in terms of its own liability, since false positive results can occur with any screening test.

From: snagymd@MEM.po.com (Stephen Nagy, M.D.)
Date: Tue, 23 Apr 1996 15:25:43 -0400
Subject: Bupropion and urine drug screens

Bupropion has a structure similar to stimulants, such as pseudoephedrine and phenylpropanolamine, that can lead to a positive immunoassay screening test for amphetamines.

Date: Tue, 23 Apr 1996 02:33:54 -0400
From: Robert G Ruegg <ruegg@med.unc.edu>
Subject: Fluoxetine and urine drug screens

Have had a few false positives for amphetamines on fluoxetine. Was immunoassay. Gas chromatography-mass spectroscopy gives the correct answer.

From: MWKR59A@prodigy.com (Dr Frederick C Goggans)
Date: Wed, 24 Apr 1996 03:24:43, -0500
Subject: Urine drug screens

I think that the forensic (DOT) standard and what we use in our clinical units and for hospital employment drug screening is an immunoassay screen and a GC/MS confirmation. Urines are not confirmed positive for methamphetamine unless amphetamine is also present above a certain amount because it was once noted that methamphetamine (but not amphetamine) could be actually produced by GC/MS if high doses of OTC stimulants were present in the specimen. GC/MS may not, however, distinguish between the d and l isomers of methamphetamine/amphetamine and this distinction may be necessary for further testing. Examples of substances that contain l-methamphetamine/amphetamine include Vick's inhaler and selegiline (an MAOI used in parkinson's disease). TLC (thin layer chromotography) does not meet forensic standards as I understand it.

Date: Wed, 24 Apr 1996 07:11:07 -0500
From: Stephen R Saklad <Saklad@uthscsa.edu>
Subject: Urine drug screens

GC/MS is the gold standard assay method. However, the possibility of a false positive on ELISA and on thin layer chromotography is very small. It seems to me that the key to the pairing of assays is that the properties of the compound being detected by them be as different as possible.

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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

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