Clinical Pharmacology Laboratory Online Submission Form

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  1. Please complete this form.
  2. After clicking "Submit" you will see a confirmation page with a barcode.
  3. Print the barcode and include it in the package with your sample.
*Clinic Information
*Clinic Name
*Address
*City
*State *Zip code
*Country


Veterinarian Information
*Phone: Fax:
*Email (your confirmation will be sent to this address):
  Notify me by email when this sample is received?

*Report Method:


*Recommendations Needed? (No Additional Charge)

If recommendations are requested, dosing information is required.




Patient Information
Your Case/Ref Number (optional):
*Patient (First) Name: *Owner (Last) Name:
*Species: Breed:
Sex: Weight: kg
lb 		Age (years):


Presentation Date of Most Recent Relapse:
*

Pertinent History (Include secondary diagnoses): characters remaining.


Other Drugs in Use (Excluding any drugs being tested; please include dosages if available):
characters remaining.

*Abnormal Lab Results?
If Yes, Please List:

Monitoring Purpose:
*Clinical Signs Sufficiently Controlled?
Other control comments:

Please choose desired tests and then click 'Continue' for relevant submission information and questions.
Please provide as much information as you can.
*For detailed monitoring recommendations, click on a test name.*
For information regarding peak and trough sampling, click here.
Tests Requested
Test Name Single Sample Peak & Trough (2 samples)
Bromide (Potassium/Sodium)
Cyclosporine
Digoxin
Gabapentin
Leflunomide (Teriflunomide)
Levetiracetam (Keppra®)
Mycophenolate (MPA, MMF)
Phenobarbital
Theophylline
Zonisamide

Bromide

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Due to the long half-life, sample can be drawn at any time.
  • Fasting recommended but not required.
  • No ice needed.
  • Run Tuesday and Thursday mornings. Sample must be received by day before to be included in run.
  • Method: Gold Chloride.
  • Price: $55
Preparation
*
Dose:

*
Every
Other Dosing:

How Many Months at Current Dose?

Was a loading dose given? Yes No
How many days elapsed between last loading dose and sample collection?

Cyclosporine

  • Recommend Peak and Trough first time to establish half-life.
  • Recommend single 2-hour peak sample for subsequent submissions.
  • Minimum Sample Required: 0.5ml EDTA Whole Blood (purple top tube).
  • No ice needed.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing). If greater than 12 hour dosing interval, a 12hr trough may still be needed or concentrations may be non-detectable.
  • Run Wednesday and Friday Mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
  • Price: Single - $65, Peak & Trough - $105
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample (2 hours post-dose recommended) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Dilute if above assay range? Yes No

Digoxin

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Do not store in rubber topped tube as some types of rubber may affect digoxin results.
  • Fasting recommended but not required.
  • Ship on ice.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: 12hrs post dose or prior to next dose.
  • Run as received (1-2 day turnaround time).
  • Method: Immunoassay
  • Price: Single - $55, Peak & Trough - $85
Preparation
*
Dose:


*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Gabapentin

  • Recommend Peak and Trough first time to establish half-life.
  • Recommend single trough sample for subsequent submissions.
  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (8hrs post on 8hr dosing).
  • Run as received (1-2 day turnaround time).
  • Method: Immunoassay
  • Price: Single - $80, Peak & Trough - $115
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Leflunomide (Teriflunomide)

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Run in batches as received (2-3 week turnaround time).
  • Method: HPLC
  • Price: Single - $100, Peak & Trough - $115
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Levetiracetam (Keppra®)

  • Recommend Peak and Trough first time to establish half-life.
  • Recommend single trough sample for subsequent submissions.
  • Minimum Sample Required: 0.5ml Serum (no serum separator tubes, NO PLASMA - plasma contains enzymes that degrade the drug in vitro).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (8hrs post on 8hr dosing).
  • Run Tuesday and Thursday mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
  • Price: Single - $80, Peak & Trough - $115
Preparation *Extended Release: Yes No Unknown
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Mycophenolate (MMF/MPA)

  • Recommend Peak and Trough first time to establish half-life.
  • Minimum Sample Required: 0.5ml EDTA Plasma (purple top tube).
  • Ship on ice.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Run Wednesday and Friday Mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
  • Price: Single - $75, Peak & Trough - $120
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Phenobarbital

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Single sample: Trough recommended.
  • Run Tuesday, Wednesday, Thursday, and Friday mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
  • Price: Single - $35, Peak & Trough - $50
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Theophylline

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • Ship on ice.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Run as received (1-2 day turnaround time).
  • Method: Immunoassay
  • Price: Single - $55, Peak & Trough - $85
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Zonisamide

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Single sample: Trough recommended.
  • Run Tuesday, Wednesday, Thursday, and Friday mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
  • Price: Single - $80, Peak & Trough - $115
Preparation
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Other

  • Please call us at (334) 844-7187 for sample collection and shipping requirements and to confirm that we can run the test you request.
  • Some basic information can be found in our full TDM assay list.
Preparation Manufacturer/Pharmacy
*
Dose:

*
Every

Other Dosing:

*
How Long at Current Dose?

Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:


Additional Comments:
characters remaining.


A FedEx shipping label for this sample can be created once your sample information has been submitted.

If you received an invoice, you can pay it online at https://aub.ie/clinpharmpay.


Need help? Let us know!

Phone: 334/844-7187
Fax: 334/844-7188
Email: clinpharm@vetmed.auburn.edu

Mailing Address:
Clinical Pharmacology Laboratory
212 Greene Hall
College of Veterinary Medicine
Auburn, AL 36849-5518

Shipping Address:
Clinical Pharmacology Laboratory
1500 Wire Road
Auburn University, AL 36849

GPS Address:
1220 Wire Rd.
Auburn, AL 36832