At a Glance
Why Get Tested?
To detect the presence of and/or measure the quantity of nicotine or cotinine in blood, urine, saliva, or sometimes hair; to determine whether someone uses tobacco or has been exposed to secondhand smoke; sometimes performed to evaluate for acute nicotine poisoning
When to Get Tested?
Whenever someone requires confirmation of tobacco usage or exposure to secondhand smoke; occasionally when nicotine overdose is suspected
A blood sample collected from a vein in your arm or a random urine sample; sometimes a saliva sample or, rarely, a hair sample
Test Preparation Needed?
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 and subsequently absorbed into the blood. This testing detects and/or measures nicotine and its primary breakdown product (metabolite) cotinine in the blood, urine, saliva, or hair.
Nicotine is metabolized by the liver into more than 20 compounds, which are eliminated from the body in the urine. Both tobacco use and exposure to tobacco smoke can increase nicotine and cotinine concentrations in the body. Levels also rise with use of nicotine replacement products such as nicotine patches and gums. In large amounts, nicotine can be poisonous.
Cotinine is usually the test of choice to evaluate tobacco use or exposure to tobacco smoke because it is stable and is only produced when nicotine is metabolized. 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 may be ordered along with nicotine tests. In some cases, other nicotine metabolites, such as nicotine-1'-N-oxide, trans-3'-hydroxycotinine, or nornicotine, or other tobacco chemicals, such as anabasine in urine, may also be tested. The presence of anabasine in someone's urine indicates that the person is actively using a tobacco product, as it is not found in commercial nicotine replacement products, such as a patch.
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 ordered in cases of suspected nicotine poisoning. Acute overdoses of nicotine, such as might happen if a child ingests nicotine lozenges or gum, are relatively rare but generally require immediate medical attention. Symptoms can include a burning mouth, nausea, abdominal pain, salivating (drooling), diarrhea, sweating, confusion, dizziness, agitation, increased heart rate, rapid or difficult breathing, convulsions, coma, and even death.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm and/or a random urine sample is collected. 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.
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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.
Sources Used in Current Review
ARUP Consult. The Physician's Guide to Test Selection and Interpretation. Nicotine and Metabolites. Available online at http://www.arupconsult.com/Topics/NicotineMetabolites.html through http://www.arupconsult.com. Accessed December 2, 2013.
MedlinePlus Medical Encyclopedia. Nicotine Poisoning. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/002510.htm. Last updated January 30, 2013. Accessed December 2, 2013.
Medical Health Tests. Can you beat a cotinine urine test by drinking a lot of water? Available online at http://www.medicalhealthtests.com/askquestion/166/can-you-beat-a-cotinine-urine-test-by-drinking-a-l.html through http://www.medicalhealthtests.com. Published April 1, 2010. Accessed December 2, 2013.
Jen Wieczner. 10 Things E-Cigarettes Won't Tell You. The Wall Street Journal. Available online at http://online.wsj.com/news/articles/SB10001424052702304448204579184052293918312 through http://online.wsj.com. Published November 10, 2013. Accessed December 2, 2013.
(June 2011) American Lung Association. General Smoking Facts. Available online at http://www.lung.org/stop-smoking/about-smoking/facts-figures/general-smoking-facts.html through http://www.lung.org. Accessed December 2013.
(July 2012) National Institute on Drug Abuse. Tobacco/Nicotine Addiction. Available online at http://www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine through http://www.drugabuse.gov. Accessed December 2013.
Ralph Magnotti, PhD, DABCC. Lab Tests Online adjunct board member.
Sources Used in Previous Reviews
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1326-1327, 1422-1425.
Perez, E. (2007 January 19, Updated). Nicotine. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/002510.htm. Accessed on 9/9/07.
Wilson, S. et. al. (2007 April 10). The Role of Air Nicotine in Explaining Racial Differences in Cotinine Among Tobacco-Exposed Children. Medscape from CHEST 2007;131(3):856-862 [On-line information]. Available online at http://www.medscape.com/viewarticle/554042 through http://www.medscape.com. Accessed on 9/9/07.
Barclay, L. (2007 July 20). Comprehensive Smoking Bans May Decrease Secondhand Smoke Exposure. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/560150 through http://www.medscape.com. Accessed on 9/9/07.
(2007 February). Nicotine and Related Compounds in Urine and Serum/Plasma. ARUP Technical Bulletin [On-line information]. PDF available for download through http://www.aruplab.com. Accessed on 9/9/07.
(1999-2000). Cotinine. CDC Laboratory Procedure Manual [On-line information]. PDF available for download at http://www.cdc.gov/nchs/data/nhanes/frequency/lab06_met_cotinine.pdf through http://www.cdc.gov. Accessed on 9/9/07.
(2006 July). Nicotine Replacement Therapy. American Lung Association, Nicotine Replacement Therapy [On-line information]. Available online at http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=66696 through http://www.lungusa.org. Accessed on 10/6/07.
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp. 1299-1300.
Boulton, M., et. al. Reported (2003 May 9). Nicotine Poisoning After Ingestion of Contaminated Ground Beef --- Michigan, 2003. CDC MMWR [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5218a3.htm through http://www.cdc.gov. Accessed on 10/6/07.
Michigan Department of Community Health. Nicotine Factsheet [On-line information] PDF available for download at http://michigan.gov/documents/Nicotine_Factsheet_82361_7.pdf through http://michigan.gov. Accessed November 2007.
Arup Consult. Nicotine & Metabolites. Available online at http://www.arupconsult.com/Topics/NicotineMetabolites.html#tabs=0 through http://www.arupconsult.com. Accessed Nov 2010.
Medicinenet.com. MedTerms: Nicotine. Available online at http://www.medterms.com/script/main/art.asp?articlekey=22807 through http://www.medterms.com. Accessed Nov 2010.