Commutability of proficiency testing material containing amitriptyline and nortriptyline: A study within the framework of the Dutch Calibration 2.000 project

Clin Chim Acta. 2019 Nov:498:6-10. doi: 10.1016/j.cca.2019.07.036. Epub 2019 Jul 30.


Background: External quality assessment schemes (EQAS) can provide important information regarding accuracy and comparability of different measurement methods if the sample matrices are composed of commutable material. The aim of this study was to assess the commutability of different matrices for the material used in an EQAS for amitriptyline and nortriptyline.

Methods: Proficiency testing material (PTM) and patient samples containing amitriptyline and nortriptyline were prepared, collected, pooled, and distributed to participating laboratories for analysis. Low, medium and high concentrations of both drugs in liquid pooled human, lyophilized human and lyophilized bovine serum were tested in this study. The measurement deviation of the PTM results to the patient serum regression line were normalized by dividing trough the average within-laboratory SD (SDwl) derived from the results reported in the official EQAS, resulting in a relative residual. The commutability decision limit was set at 3 SDwl.

Results: With 10 laboratories participating in this study, 45 laboratory couples were formed. All matrix types delivered several relative residuals outside the commutability decision limit. The number and the magnitude of relative residuals for both drugs were lower for liquid human sera as compared to lyophilized human and bovine sera.

Conclusions: The PTM used for amitriptyline and nortriptyline is preferably prepared with human serum, although not all relative residuals are within the commutability decision limit.

Keywords: Commutability; External quality assessment scheme; Proficiency testing.

MeSH terms

  • Adrenergic Uptake Inhibitors / blood
  • Amitriptyline / blood*
  • Animals
  • Antidepressive Agents, Tricyclic / blood
  • Cattle
  • Freeze Drying
  • Humans
  • Laboratories / standards
  • Laboratory Proficiency Testing / methods*
  • Linear Models
  • Nortriptyline / blood*
  • Quality Control


  • Adrenergic Uptake Inhibitors
  • Antidepressive Agents, Tricyclic
  • Amitriptyline
  • Nortriptyline