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QMS® Lamotrigine (LTG)

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QMS® Lamotrigine (LTG) QMS® Lamotrigine (LTG) For In Vitro Diagnostic Use Only Rx Only 0373795 This Quantitative Microsphere System (QMS) package insert must be read carefully prior to Avoid breathing mist or vapor. Contaminated work clothing should not be allowed out of the use. Package insert instructions must be followed accordingly. Reliability of assay results workplace. Wear protective gloves/eye protection/face protection. In case of inadequate cannot be guaranteed if there are any deviations from the instructions in this package insert. ventilation wear respiratory protection. If on skin: Wash with plenty of soap and water. IF INHALED: If breathing is difficult, remove victim to fresh air and keep at rest in a position Intended Use comfortable for breathing. If skin irritation or rash occurs: Get medical advice/attention. The QMS® Lamotrigine assay is intended for the quantitative determination of lamotrigine in If experiencing respiratory symptoms: Call a POISON CENTER or doctor/physician. Wash human serum or plasma on automated clinical chemistry analyzers. contaminated clothing before reuse. Dispose of contents/container to location in accordance with local/regional/national/international regulations. Lamotrigine concentrations can be used as an aid in management of patients treated with lamotrigine. CAUTION: This product contains human sourced and/or potentially infectious components. Components sourced from human blood have been tested and found to be Summary and Explanation of the Test nonreactive for HBsAg, anti-HIV 1/2, and anti-HCV. No known test method can offer complete Lamotrigine [3,5-diamino-6-(2,3-dichlorophenyl)-1,2,4-triazine] is an anticonvulsant drug assurance that products derived from human sources or inactivated microorganisms will approved for use in the treatment of epilepsy and is often prescribed as monotherapy or as not transmit infection. Therefore, it is recommended that all human sourced materials one component of a multiple anti-epileptic drug therapy.1-3 be considered potentially infectious and handled with appropriate biosafety practices. Principles of the Procedure The QMS Lamotrigine assay is a homogeneous particle-enhanced turbidimetric immunoassay. Specimen Collection and Handling The assay is based on competition between drug in the sample and drug coated onto a The following specimen collection tubes may be used for the QMS Lamotrigine assay: microparticle for antibody binding sites of the lamotrigine antibody reagent. The lamotrigine- coated microparticle reagent is rapidly agglutinated in the presence of the anti-lamotrigine Glass Plastic antibody reagent and in the absence of any competing drug in the sample. The rate of Serum • No Additive • With Silicon absorbance change is measured photometrically. When a sample containing lamotrigine is • Serum Separator Tube (gel) added, the agglutination reaction is partially inhibited, slowing down the rate of absorbance change. A concentration-dependent classic agglutination inhibition curve can be obtained • Clot Activator with maximum rate of agglutination at the lowest lamotrigine concentration and the lowest Plasma • EDTA (K3) • EDTA (K2) agglutination rate at the highest lamotrigine concentration. • Lithium Heparin • Sodium Heparin Reagents • Plasma Separator Tube with Reagent Kit Lithium Heparin (gel) QMS Lamotrigine, 0373795, is supplied as a liquid, ready-to-use, two-reagent kit that Other specimen collection tubes have not been validated for use with the QMS Lamotrigine assay. Follow the contains: manufacturer’s processing instructions for serum or plasma tubes. Reagent 1 1 x 19 mL • Inadequate centrifugation of the specimen may cause an erroneous result. Reagent 2 1 x 19 mL • Ensure specimens are free of fibrin, red blood cells, and other particulate matter. • Remove the plasma or serum from the cells, clot, or gel as soon as possible after Reactive Ingredients collection. Some serum or plasma tubes may not be suitable for use with therapeutic Ingredient Concentration drug monitoring assays; refer to information provided by the tube manufacturer.4 Anti-lamotrigine Polyclonal Antibody (Sheep) <5.0% • Specimens removed from the cells, clot, or gel may be stored up to one week at 2 Sodium Azide ≤0.09% to 8°C. If testing will be delayed more than one week, specimens should be stored Lamotrigine-coated Microparticles <1.0% frozen (≤ -10°C) prior to being tested. Specimens stored at 2 to 8°C for up to one week Sodium Azide ≤0.09% or frozen up to four weeks showed no performance differences (±10% of lamotrigine concentration at time zero) from fresh samples. Care should be taken to limit the Reagent Handling and Storage number of freeze-thaw cycles. • It is recommended that samples for the QMS Lamotrigine assay be drawn just prior to • and Ready for Use. a dose (trough level). The trough concentration is most indicative of the therapeutic • Before use, invert several times, avoiding the formation of bubbles. level of lamotrigine.5,6 • Remove air bubbles, if present in the reagent cartridge, with a new applicator stick. Alternatively, allow the reagent to sit at the appropriate storage temperature to allow Procedure the bubbles to dissipate. To minimize volume depletion, do not use a transfer pipette to remove the bubbles. Materials Provided • When either the or the reagent cartridge becomes empty, replace both • QMS Lamotrigine Reagents, 0373795 cartridges and verify calibration with at least two levels of controls according to the established Quality Control requirements for your laboratory. If control results fall Materials Required but not Provided outside acceptable ranges, recalibration may be necessary. • QMS Lamotrigine Calibrators, 0373787 • In the case of accidental spill, clean and dispose of material according to your CAL A-F: A (1 x 2.0 mL); B-F (1 × 1.0 mL each) laboratory’s SOP, local, state, and country regulations, with consideration that the • QMS Lamotrigine Controls, 0374090 material contains potentially infectious materials. Level 1-3: 1 x 2.5 mL each • In the case of damaged packaging on arrival, contact your technical support representative (contact details listed at the end of this package insert). Assay Procedure For a detailed description of how to run and calibrate an assay, refer to the instrument specific CAUTION: Reagent bubbles may interfere with proper detection of reagent level in the operations manual. cartridge, causing insufficient reagent aspiration that could impact results. Specimen Dilution Procedures The unopened reagents are stable until the expiration date when stored at 2 to 8°C. Use QMS Lamotrigine CAL A (0.0 µg/mL) to manually dilute samples outside the reportable Do not freeze reagents or expose them to temperatures above 32°C. range of the assay. Warnings and Precautions Precautions for Users • For in vitro diagnostic use. • Do not mix materials from different kit lot numbers. DANGER: QMS Lamotrigine (LTG) assay contains ≤5.0% Drug-specific antibody and ≤2.0% Human Serum Albumin (HSA). H317 - May cause allergic skin reaction. H334 - May cause allergy or asthma symptoms or breathing difficulties if inhaled. Manual Dilution Protocol Lamotrigine drug concentrations should not be the only means of therapeutic drug A manual dilution can be performed on patient samples with lamotrigine concentrations management. The assay should be used in conjunction with information available from reported as greater than 40.0 µg/mL by making a dilution of the specimen with QMS clinical evaluations and other diagnostic procedures. Clinicians should carefully monitor Lamotrigine CAL A (0.0 µg/mL) before pipetting the sample into the sample cup. The dilution patients during therapy initiation and dosage adjustments. It may be necessary to obtain must be performed so the diluted test results read greater than the assay sensitivity of 2.0 µg/ multiple samples to determine expected variations of optimal (steady-state) concentrations mL. The concentration reported must be multiplied by the manual dilution factor to obtain the for individual patients. final sample concentration. Specific Performance Characteristics Final Sample Concentration = Reported Concentration x Manual Dilution Factor Representative performance results obtained on a commercially available automated clinical chemistry analyzer that employs turbidimetric quantitative analysis are shown below. Manual Dilution Factor = (Volume of Sample + Volume of CAL A) Volume of Sample Sensitivity Limit of Quantitation (LOQ) Calibration The LOQ of the QMS Lamotrigine assay is defined as the lowest concentration for which The QMS Lamotrigine assay must be calibrated using a full calibration (6-point) procedure. To acceptable inter-assay precision and recovery is observed (often considered <20% CV with perform a full calibration, test the QMS Lamotrigine Calibrators A, B, C, D, E, and F in duplicate. ±15% recovery). A pooled patient serum containing lamotrigine and lamotrigine-spiked plasma samples were diluted and assayed in duplicate twice a day for five days. The following Calibration is required with each new lot number. Verify the calibration curve with at least theoretical lamotrigine concentrations were analyzed: two levels of controls according to the established Quality Control requirements for your laboratory. If control results fall outside acceptable ranges, recalibration may be necessary. Pooled patient serum samples containing lamotrigine Note: Lamotrigine CAL A is the calibration blank for this assay. Tested Target (µg/mL) 1.74 2.75 3.78 4.88 Quality Control AVG
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