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Nicotine (or Cotinine) Blood Test

Last updated Jan. 14, 2019


The Nicotine (or Cotinine) Blood Test measures the levels of cotinine in blood. It is used to assess whether an individual consumes tobacco and to detect nicotine toxicity.

What are the other Names for this Test? (Equivalent Terms)

  • Nicotine and Metabolites Blood Test 

What is Nicotine (or Cotinine) Blood Test? (Background Information)

  • Nicotine is a compound abundant in tobacco leaves. It is also present in plants belonging to the nightshade family, which includes tomato and eggplant (brinjal). Nicotine is addictive and acts as a stimulant when consumed
  • Common methods of consuming nicotine include smoking cigarettes and chewing tobacco. The dose of nicotine consumed varies with the mode of consumption
  • The liver breaks down nicotine into various products, including cotinine. Whereas nicotine levels decline rapidly (half-life of 2 hours), cotinine levels linger (half-life of 20 hours). Cotinine may even intercalate (get inserted) into hair
  • Cotinine serves as a better indicator for nicotine levels than measuring nicotine directly due to its longer half-life and greater stability. Furthermore, the only source of cotinine is the degradation of nicotine; thus, further validating cotinine testing
  • The Nicotine (or Cotinine) Blood Test measures the levels of cotinine in blood. It is used to assess whether an individual consumes tobacco and to detect nicotine toxicity

What are the Clinical Indications for performing the Nicotine (or Cotinine) Blood Test?

Following are the clinical indications for performing a Nicotine (or Cotinine) Blood Test:

  • Screening for tobacco consumption for pre-employment, child custody, or health insurance enrollment purposes
  • Detecting nicotine toxicity, which is marked by:
    • Nausea and vomiting
    • Dizziness
    • Numbness of the mouth and drooling
    • Muscle twitching
    • Abdominal pain

How is the Specimen Collected for Nicotine (or Cotinine) Blood Test?

Following is the specimen collection process for Nicotine (or Cotinine) Blood Test:

Sample required: Blood

Process of obtaining blood sample in adults:

  • A band is wrapped around the arm, 3-4 inches above the collection site (superficial vein that lies within the elbow pit)
  • The site is cleaned with 70% alcohol in an outward spiral, away from the zone of needle insertion
  • The needle cap is removed and is held in line with the vein, pulling the skin tight
  • With a small and quick thrust, the vein is penetrated using the needle
  • The required amount of blood sample is collected by pulling the plunger of the syringe out slowly
  • The wrap band is removed, gauze is placed on the collection site, and the needle is removed
  • The blood is immediately transferred into the blood container, which has the appropriate preservative/clot activator/anti-coagulant
  • The syringe and the needle are disposed into the appropriate “sharp container” for safe and hygienic disposal

Preparation required: No special preparation is needed prior to the test. 

What is the Significance of the Nicotine (or Cotinine) Blood Test Result?

  • A positive Nicotine (or Cotinine) Blood Test may indicate tobacco consumption or consumption from a secondary source such as secondhand smoke
  • Excessive nicotine/cotinine levels may indicate nicotine toxicity

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results based on the overall clinical scenario. 

Additional and Relevant Useful Information:

  • In general, the Nicotine (or Cotinine) Test measures the levels of cotinine in blood, saliva, urine, or rarely, in hair
  • Nicotine acts as a defense mechanism for plants that produce it. It helps to ward-off herbivores and other such plant-eaters
  • In fact, nicotine is still used as an herbicide in agriculture in some parts of the world; even though, in many countries, it is no longer used

Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

References and Information Sources used for the Article:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Nov. 12, 2014
Last updated: Jan. 14, 2019