Nicotine/Cotinine

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Formal name: Nicotine or Cotinine

At a Glance

Why Get Tested?

To detect the presence or measure the quantity of nicotine or cotinine in blood, urine, saliva, or sometimes hair. To find out whether someone uses tobacco or has been exposed to second-hand smoke. Rarely it can be used to check for acute nicotine poisoning.

When to Get Tested?

Whenever someone requires confirmation of tobacco usage or exposure to second-hand smoke. Rarely when nicotine overdose is suspected.

Sample Required?

Usually a urine sample is collected, but sometimes a blood sample (from a vein in your arm) or a saliva sample is collected. Rarely a hair sample is collected.

Test Preparation Needed?

None

The Test Sample

What is being tested?

Nicotine is an addictive chemical found in the tobacco plant and concentrated in its leaves.  It is inhaled with each puff on a cigarette and ingested with chewing tobacco.  Nicotine is metabolised by the liver into more than 20 compounds, which are removed by the kidneys into the urine. Tobacco use and exposure to tobacco smoke can increase nicotine concentrations in the body.  Cotinine is the body's main breakdown product (metabolite) of nicotine. Cotinine and nicotine levels also rise with use of nicotine replacement products such as nicotine patches and gums.  In large amounts, nicotineis poisonous.

Cotinine is usually the best test to check for tobacco use or exposure to tobacco smoke because it lasts longer in the body and is only produced when nicotine is metabolised.  Cotinine has a half-life in the body of between 7 and 40 hours, while nicotine has a half-life of 1 to 4 hours.  Blood and/or urine cotinine tests are usually requested instead of nicotine tests. 

The presence of nicotine and/or cotinine in an individual’s sample may indicate the use of tobacco products or exposure to environmental tobacco smoke.  Testing may be used in a number of situations to evaluate the possible use of tobacco products such as in smoking cessation programs, prospective employment assessments and evaluations of applicants for health or life insurance.

Nicotine and cotinine testing may also be requested in cases of suspected nicotine poisoning. Acute overdoses of nicotine, such as may happen if a child ingests nicotine lozenges or gum, are relatively rare but generally require immediate medical attention.  Symptoms can include a burning mouth, feeling sick, abdominal pain, salivating (drooling), diarrhoea, sweating, confusion, dizziness, agitation, increased heart rate, rapid or difficult breathing, convulsions, coma, and even death.

How is the sample collected for testing?

A random urine sample is collected, or a blood sample is obtained by inserting a needle into a vein in the arm.  Occasionally a saliva sample may be obtained directly or by soaking a collecting cloth or swab with saliva. Rarely a hair sample may be collected.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.