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Nicotine Test - Cotinine
Test - Smoker's Nicotine Testing
_____________________
Nicotine,
which is the main drug in tobacco products, is the number one
used drug in the U.S. Many people do not consider nicotine to be
a drug, however it is. Nicotine is highly addictive and has the
properties of both a stimulant and a sedative. Nicotine, in the
form of tobacco, is so widely used for one main reason, it is
legal as long as you are 18 years of age or older. Tobacco is a
leading cause of cancer and cardiovascular problems in the U.S.
WHAT IS COTININE?
Cotinine is the first-stage
metabolite of nicotine, a toxic alkaloid that produces
stimulation of the autonomic ganglia and central nervous system
when in humans. Nicotine is a drug to which virtually
every member of a tobacco-smoking society is exposed whether
through direct contact or second-hand inhalation. In
addition to tobacco, nicotine is also commercially available as
the active ingredient in smoking replacement therapies such as
nicotine gum, transdermal patches and nasal sprays. In a
24-hour urine, approximately 5% of a nicotine dose is excreted
as unchanged drug with 10% as cotinine and 35% as
hydroxycotinine; the concentrations of other metabolites are
believed to account for less than 5%.1 While
cotinine is thought to be an inactive metabolite, it’s
elimination profile is more stable than that of nicotine which
is largely urine pH dependent. As a result, cotinine is
considered a good biological marker for determining nicotine
use. The plasma half-life of nicotine is approximately 60
minutes following inhalation or parenteral administration.2
Nicotine and cotinine are rapidly eliminated by the kidney; the
window of detection for cotinine in urine at a cutoff level of
200 ng/mL is expected to be up to 2-3 days after nicotine use.
For more information on the nicotine test -
cotinine test, see our
Nicotine Test
FAQs - Cotinine Test Q&A
Cotinine Test - Smoker's Nicotine Test Device |
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Description
The COT One Step
Cotinine Test Device (Urine) is a rapid urine screening test
that can be performed without the use of an instrument. The test
utilizes a monoclonal antibody to selectively detect elevated
levels of Cotinine (metabolized nicotine) in urine. The COT One Step Cotinine
Test Device (Urine) yields a positive result when the Cotinine
in urine exceeds 200 ng/mL.
#CAS-COT
- Cotinine
Nicotine Test
Instructions - How To Use Cotinine Test
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For complete specifications on the Cotinine Test Device
(click here).
The COT One Step Cotinine Test
Device (Urine) is an immunoassay based on the principle of competitive binding.
Drugs which may be present in the urine specimen compete against the drug
conjugate for binding sites on the antibody.
During testing, a urine specimen
migrates upward by capillary action. Cotinine, if present in the urine specimen
below 200 ng/mL, will not saturate the binding sites of antibody coated
particles in the test device. The antibody coated particles will then be
captured by immobilized Cotinine conjugate and a visible colored line will show
up in the test line region. The colored line will not form in the test line
region if the Cotinine level exceeds 200 ng/mL because it will saturate all the
binding sites of anti-Cotinine antibodies.
A
drug-positive urine specimen will not
generate a colored line in the test line region because of drug competition,
while a drug-negative urine specimen or a specimen containing a drug
concentration less than the cut-off will generate a line in the test line
region. To serve as a procedural control, a colored line will always appear at
the control line region indicating that that proper volume of specimen has been
added and membrane wicking has occurred.
The COT One Step Cotinine Test Device (Urine) is
a lateral flow chromatographic immunoassay for the detection of Cotinine in
human urine at a cut-off concentration of 200 ng/mL. This test will detect other
related compounds, please refer to the Analytical Specificity table in the
package insert.
This assay provides only a preliminary
analytical test result. A more specific alternate chemical method must be used
in order to obtain a confirmed analytical result.
Gas chromatography and mass spectrometry (GC/MS) is the
preferred confirmatory method. Clinical consideration and
professional judgment should be applied to any drug of abuse test result,
particularly when preliminary positive results are used.
Cotinine Test -
Smoker's Nicotine Test
Nicotine Testing -or- Urine Cotinine Test
Nicotine Test Instructions - Directions for How To Use Cotinine Test Device
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This is the perfect test to check for
tobacco use. Our tests are used by clinics, tobacco free programs,
schools, parents and individuals. To see if your own system is free of nicotine, use this
simple cotinine test kit. Cotinine will typically remain in the body 2 to 4 days
after the last cigarette.
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Nicotine Test FAQs - Cotinine Test Questions & Answers
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Question |
Answer |
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What is cotinine? |
Cotinine
[COAT-e-neen] is a chemical that is made by the body from nicotine,
which is found in cigarette smoke. Since cotinine can be made only from
nicotine, and since nicotine enters the body with cigarette smoke,
cotinine measurements can show how much cigarette smoke enters your
body. |
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Is cotinine
harmful? |
As far as we
know, cotinine itself is not harmful. Cotinine is used simply to measure
how much tobacco smoke has entered your body. However, many studies show
that some of the 4,000 other chemicals found in tobacco smoke are
harmful. |
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Why should I
have a cotinine test? |
If you are
serious about stopping or reducing your smoking, or if you are
interested in the amount of smoke that has entered your body, this test
can be very useful. By knowing what your starting level of cotinine is,
you can see how successful your efforts to stop smoking are. |
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How is
cotinine measured? |
Our Cotinine
test is a simple
at home test that can measure cotinine in human urine. |
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Why don't
you just ask how much I smoke? Or just keep track? |
Smoking
behavior varies. For example, two people could each smoke a pack of
cigarettes a day. One may smoke unfiltered cigarettes, inhaling deeply
with each puff, while the other may smoke a low tar, filtered cigarette,
puffing lightly and smoking only half of each cigarette. The cotinine
test would be able to show a difference in the amount of cigarette smoke
entering the bodies of these two smokers. |
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How much
cotinine is normal? |
People who do
not smoke or who are not exposed to other peoples' smoke should not have
measurable cotinine. People who do smoke will have a cotinine level of
10 or higher in their blood, and a typical smoker has levels of 150 to
450 units. Levels in urine are ten times higher. |
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How can I
reduce my cotinine? |
The only way
to reduce your cotinine level is to stop or reduce your exposure to
cigarette smoke. |
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How long
should it take for me to see a drop in my cotinine level if I stop
smoking today? |
Depending on
how high your level is to begin with, your level could drop to that of a
nonsmoker in 7 to 10 days. |
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If I stop
smoking, then start again, how soon will cotinine show up in my body? |
Our Cotinine
test can detect cotinine as soon as one day after you've had a cigarette. |
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If I switch
to a low nicotine cigarette, will my cotinine level drop? |
It might, but
it depends on how you smoke low nicotine cigarettes. To satisfy a
craving for nicotine, some people smoke more low nicotine cigarettes
than they would regular cigarettes, and their cotinine level may
actually increase. |
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Do nicotine
patches, gum, or aerosols have an effect on cotinine levels? |
Because they
all use nicotine, these devices can increase cotinine levels. If you are
having a cotinine test, make sure that you mention on the lab slip that
you are using nicotine replacement products. |
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What about
other people's smoke? Won't my cotinine level increase if I breathe
other people's smoke? |
If you breathe
a lot of cigarette smoke even though you yourself don't smoke, your
cotinine level may be higher than that of a non-smoker. If so, you
should try to avoid places where there is a lot of smoke. |
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How can I
stop smoking? |
There are many
different ways to stop smoking, but there is no one way that's best for
everybody. The cotinine test will help you to measure the success of
whatever way you try. Ask your doctor for advice, or contact
organizations that are experienced in helping people give up cigarettes. |
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Where can I buy a Cotinine test? |
Right here! We are one of the largest
distributor of
Cotinine Tests on the internet. |
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Why buy tests from Transmetron? |
-
We sell only the best test kits on the
market!
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Excellent customer service. Our
customer service is surpassed by none!
-
Wide selection of other
urine and saliva tests. We have
one of the largest
selections of Drug Tests on the internet, including
Saliva Drug Test
Kits. We also offer other tests such as
Urine Menopause Test,
Urine Ovulation Test - Fertility Test,
and
Pregnancy Tests. We
offer a wide range of
drug testing supplies such as gloves and cups.
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What does cotinine have to do with my
pregnancy? |
Studies show that babies born to women with
high cotinine levels are more likely to be growth retarded. These
smaller, weaker babies may need to spend more time in the hospital and
may require special medical care. Women who smoke during pregnancy may
also be at higher risk for miscarriage and other pregnancy problems.
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If I reduce my cotinine level, will my
baby be all right? |
No one can guarantee any pregnant woman
that her baby will be all right, but by stopping smoking, you will be
removing a cause of many pregnancy problems. |
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Are
there any forms of tobacco that do not contain nicotine? |
No, they all contain nicotine. This
includes pipe tobacco, cigars, snuff, chewing tobacco, etc. If you use
any of these, nicotine may be detected in your system. |
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Can I be required to be tested for
tobacco use? |
Since tobacco use is legal for adults,
this would generally only apply to people who are court-ordered to be
tested, such as for child-custody reasons. However, since smokers tend
to have higher health costs and are at an increased risk for developing
a variety of diseases, some health and life insurance companies may
require their applicants to be tested for tobacco use prior to accepting
them as clients. |
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Where can I find information about
quitting smoking? |
There are many national organization and
government resources available. |
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What kinds of nicotine replacement
products are available? |
There are a variety
of over-the-counter (OTC) products and a few that are available by
prescription. OTC products include nicotine gum, patches, and lozenges.
Those available by prescription include nicotine patches, inhalers, and
nasal sprays. It is important to follow directions for their use and to
keep them away from children. The products are intended to be used in
conjunction with a smoking cessation program. Talk to your doctor about
the best options for you. |
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What do various levels of Cotinine mean? |
<10 ng/mL - considered to be consistent with no active
smoking
10 ng/mL to 100 ng/mL - associated with light smoking
or moderate passive exposure
300+ ng/mL - heavy smokers - more than 20 cigarettes a day |
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What are the signs or symptoms of nicotine overdose? |
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. |
Cotinine Test Information
Cotinine levels <10 ng/mL are considered to be consistent
with no active smoking. Values of 10 ng/mL to 100 ng/mL are associated with
light smoking or moderate passive exposure, and levels above 300 ng/mL are seen
in heavy smokers - more than 20 cigarettes a day. In urine, values between 11
ng/mL and 30 ng/mL may be associated with light smoking
or passive exposure, and levels in active smokers typically reach 500 ng/mL or
more.
Nicotine is rapidly metabolized and has a short half-life,
but cotinine is metabolized and eliminated at a much lower rate. Because of the
resulting increase with time in the cotinine to nicotine ratio in the body,
including in the brain, it
is of interest to examine the effect of cotinine on nicotine-induced changes.
Nicotine test - cotinine assays provide an objective quantitative measure that is more
reliable than smoking histories or counting the number of cigarettes smoked per
day. Cotinine also permits the measurement of exposure to second-hand smoke
(passive smoking).
Both
major
depression
and depressive symptoms are associated with a high rate of nicotine dependence,
and a history of major depression has an adverse impact on smoking cessation.
The main objective of this study was to investigate whether continuous ingestion
of nicotine affects indices of depressive behavior in the rat. The test compared
cholinergic- and serotonergic-hypersensitive Flinders Sensitive Line rats (FSL),
a genetic animal model of depression, with their control counterparts, Flinders
Resistant Line rats (FRL). Female rats of both lines were allowed access to a
solution of nicotine bitartrate (100 microg/mL) in tap
water
for 14 days. Subsequent behavioral testing revealed striking effects of
continuous ingestion of nicotine on depressive-like behavior of both lines. FSL
and FRL rats that ingested nicotine for 14 days displayed less immobility in the
10-min forced-swim test (an index of depressive-like behavior) relative to the
animals of both lines that were not exposed to nicotine or exposed to nicotine
for shorter periods of time. This finding indicates that ingested nicotine has
antidepressant properties that are independent of the genetic difference between
FSL and FRL female rats. Animal studies on nicotine ingestion and
withdrawal may become an important source of
insights into the comorbidity of depression and nicotine self-administration.
_______________________________________
One Step Cotinine Test Device
A rapid, one step test for the qualitative detection of Cotinine
(nicotine metabolite) in human urine.
Intended Use
The COT One Step Cotinine Test Device (Urine) is a lateral flow
chromatographic immunoassay for the detection of Cotinine in human urine at a
cut-off concentration of 200 ng/mL. This test will detect other related
compounds, please refer to the Analytical Specificity table in this package
insert.
This assay provides only a preliminary
analytical test result. A more specific alternate chemical method must be used
in order to obtain a confirmed analytical result. Gas chromatography and mass
spectrometry (GC/MS) is the preferred confirmatory method. Clinical
consideration and professional judgment should be applied to any drug of abuse
test result, particularly when preliminary positive results are used.
Summary
Cotinine is the first-stage metabolite of nicotine, a toxic
alkaloid that produces stimulation of the autonomic ganglia and central nervous
system when in humans. Nicotine is a drug to which virtually every member of a
tobacco-smoking society is exposed whether through direct contact or second-hand
inhalation. In addition to tobacco, nicotine is also commercially
available as the active ingredient in smoking replacement therapies such as
nicotine gum, transdermal patches and nasal sprays. In a 24-hour urine,
approximately 5% of a nicotine dose is excreted as unchanged drug with 10% as
cotinine and 35% as hydroxycotinine; the concentrations of other metabolites are
believed to account for less than 5%.1 While
cotinine is thought to be an inactive metabolite, it’s elimination profile is
more stable than that of nicotine which is largely urine pH dependent. As a
result, cotinine is considered a good biological marker for determining nicotine
use. The plasma half-life of nicotine is approximately 60 minutes
following inhalation or parenteral administration.2
Nicotine and cotinine are rapidly eliminated by the kidney; the
window of detection for cotinine in urine at a cutoff level of 200 ng/mL is
expected to be up to 2-3 days after nicotine use. The COT One Step Cotinine Test
Device (Urine) is a rapid urine screening test that can be performed without the
use of an instrument. The test utilizes a monoclonal antibody to selectively
detect elevated levels of Cotinine in urine. The COT One Step Cotinine Test
Device (Urine) yields a positive result when the Cotinine in urine exceeds 200
ng/mL.
Principle
The COT One Step
Cotinine Test Device (Urine) is an immunoassay based on the principle of
competitive binding. Drugs which may be present in the urine specimen compete
against the drug conjugate for binding sites on the antibody. During
testing, a urine specimen migrates upward by capillary action. Cotinine, if
present in the urine specimen below 200 ng/mL, will not saturate the binding
sites of antibody coated particles in the test device. The antibody coated
particles will then be captured by immobilized Cotinine conjugate and a visible
colored line will show up in the test line region. The colored line will not
form in the test line region if the
Cotinine level exceeds 200 ng/mL
because it will saturate all the binding sites of anti-Cotinine antibodies. A
drug-positive urine specimen will not generate a colored line in the test line
region because of drug competition, while a drug-negative urine specimen or a
specimen containing a drug concentration less than the cut-off will generate a
line in the test line region. To serve as a procedural control, a colored line
will always appear at the control line region indicating that that proper volume
of specimen has been added and membrane wicking has occurred.
Reagents
The test device contains mouse
monoclonal anti-Cotinine antibody-coupled particles and Cotinine-protein
conjugate. A goat antibody is employed in the control line system.
Precautions
• Do not use after the expiration date.
• The test device should remain in the sealed
pouch until use.
• All specimens should be considered potentially
hazardous and handled in the same manner as an infectious agent.
• The used test device should be discarded
according to local regulations.
Storage And Stability
Store as packaged in the sealed pouch either at room temperature or
refrigerated (2-30°C). The test device is stable through the expiration date
printed on the sealed pouch. The test device must remain in the sealed pouch
until use. DO NOT FREEZE. Do not use beyond the expiration date.
The urine specimen must be
collected in a clean and dry container. Urine collected at any time of the day
may be used. Urine specimens exhibiting visible precipitates should be
centrifuged, filtered, or allowed settle to obtain a clear supernatant for
testing.
Storage
Urine specimens may be stored at 2-8°C for up to 48 hours prior to
assay. For prolonged storage, specimens may be frozen and stored below -20°C.
Frozen specimens should be thawed and mixed before testing
Each Test Kit Includes
Test device • Dropper • Package insert
Materials Required But Not Included
Specimen collection container • Timer
Directions For Use
How To Use
Cotinine Test Devices
Allow test device, urine specimen to reach room temperature
(15-30°C) prior to testing.
1.Bring the pouch to room temperature
before opening it. Remove the test device from the sealed pouch and use it as
soon as possible.
2.Place the test device on a clean and
level surface. Hold the dropper vertically and transfer 3 full drops of urine
(approx. 100 µL) to the specimen well (S) of the test device, and then start the
timer. Avoid trapping air bubbles in the specimen well (S). See the illustration
below.
3.Wait for the colored line(s) to
appear. The result should be read at 5 minutes. It is important that the
background is clear before the result is read. Do not interpret the result after
10 minutes.
Interpretation of Results
(Please refer to the illustration above)
NEGATIVE:* Two lines appear. One
colored line should be in the control line region (C), and another apparent
colored line should be in the test line region (T). This negative result
indicates that the Cotinine concentration is below the detectable level (200
ng/mL).
*NOTE: The shade of color in the test line region (T) may vary, but it
should be considered negative whenever there is even a faint line.
POSITIVE: One colored line appears in the control line region (C). No
line appears in the test line region (T). This positive result indicates that
the Cotinine concentration exceeds the detectable level (200 ng/mL).
INVALID: Control line fails to appear. Insufficient specimen volume or
incorrect procedural techniques are the most likely reasons for control line
failure. Review the procedure and repeat the test using a new test device. If
the problem persists, discontinue using the lot immediately and contact your
local distributor.
Quality Control
A procedural control is included in the test. A
colored line appearing in the control line region (C) is considered an internal
procedural control. It confirms sufficient specimen volume, adequate membrane
wicking and correct procedural technique.
Limitation
1.The COT One Step Cotinine Test
Device (Urine) provides only a qualitative, preliminary analytical result. A
secondary analytical method must be used to obtain a confirmed result. Gas
chromatography/mass spectrometry (GC/MS) is the preferred confirmatory method..1,2
2.It is possible that technical or
procedural errors, as well as other interfering substances in the urine specimen may cause
erroneous results.
3.Adulterants, such as bleach and/or
alum, in urine specimens may produce erroneous results regardless of the
analytical method used. If adulteration is suspected, the test should be
repeated with another urine specimen.
4.A positive result indicates only
that the presence of Cotinine is above the cut-off concentration. It does
not indicate or measure level of consumption.
Other Information about nicotine test, nicotine testing,
cotinine test, cotinine testing:
How is the
nicotine test – cotinine test used?
Nicotine or its
primary
metabolite,
cotinine are most often tested to evaluate tobacco use. Long term use of tobacco
products can increase the risk of developing many diseases including
lung cancer,
COPD,
stroke,
heart disease,
and respiratory infections, or exacerbate
asthma, and
blood clot formation. In pregnant women, smoking can retard fetal growth and
lead to low birth weight babies.
Because use of
tobacco products can greatly affect the health of individuals, companies may use
nicotine/cotinine testing to evaluate prospective employees for tobacco use.
Many health and life insurance companies test applicants for nicotine or
cotinine as well.
Nicotine and
cotinine can both be measured qualitatively or
quantitatively.
Quantitative testing can help distinguish between active smokers, tobacco users
who have recently quit, non-tobacco-users who have been exposed to significant
environmental tobacco smoke, and non-users who have not been exposed.
Cotinine may
also be measured in saliva and in hair, although hair testing is primarily used
in a research setting, such as a study of non-smokers exposure to tobacco smoke.
Blood or urine
nicotine may be ordered by itself or along with cotinine if a doctor suspects
that someone is experiencing a nicotine overdose.
When a patient
has reported that they are using nicotine replacement products but are no longer
smoking, nicotine, cotinine, and urine anabasine measurements may sometimes be
ordered. Anabasine is present in tobacco but not in commercial nicotine
replacement products. If a sample tests positive for anabasine, then the person
is still using tobacco products.
When is the
nicotine test – cotinine test ordered?
Cotinine and/or
nicotine may be ordered whenever an evaluation of tobacco use status or tobacco
smoke exposure is required. When a person enters a smoking cessation program,
blood or urine cotinine tests may be ordered to evaluate compliance. Urine,
blood, or saliva testing may be performed as a screen for tobacco use when
someone is applying for life or health insurance, or applying for work with an
employer that prohibits smoking. Testing may also be ordered by a court for
child custody purposes. Since smoking can increase the risks of medical
complications, testing may be performed prior to the start of some drug
therapies or surgical procedures.
Nicotine and
cotinine are sometimes measured when a patient has symptoms that the doctor
suspects may be due to a nicotine overdose. Symptoms of mild nicotine poisoning
may include:
-
Nausea, vomiting
-
Dizziness
-
Drooling
-
Weakness
More serious
nicotine poisoning may result in:
Hair testing is
rarely performed in a clinical setting but may be ordered when an evaluation of
longer term tobacco use is desired.
What does the
test result mean?
In the blood,
nicotine levels can rise within a few seconds of a puff on a cigarette. The
quantity depends on the amount of nicotine in the cigarette and the manner in
which a person smokes, such as how deeply they inhale. Test results are not
interchangeable. Concentrations will be higher in urine than in blood or saliva.
There is also some variability from person to person and some genetic
differences in the rate that nicotine is metabolized and in the rate that
cotinine is cleared from the body. When someone stops using tobacco and nicotine
products, it can take more than two weeks for blood levels of cotinine to drop
to the level that a non-tobacco user would have and several weeks more for urine
levels to decrease to very low concentrations.
In general, high
levels of nicotine or cotinine indicate active tobacco or nicotine replacement
use. Moderate concentrations indicate a tobacco user who has not had tobacco or
nicotine for two to three weeks. Lower levels may be found in a non-tobacco user
who has been exposed to environmental smoke. Very low to non-detectible
concentrations are found in non-tobacco users who have not been exposed to
environmental smoke or a tobacco user who has refrained from tobacco and
nicotine for several weeks.
Patients whose
nicotine overdose is self-evident may not be tested for nicotine or cotinine.
Concentrations would typically be increased, but levels do not necessarily
correlate with the severity of a person’s symptoms.
Is there
anything else I should know?
Some pesticides
contain high concentrations of nicotine. This can be another source of nicotine
poisoning.
A person’s
genetic makeup may influence how they metabolize nicotine. Variations in the
genes that code for the CYP2A6 liver enzyme affect the rate of nicotine
metabolism.
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
What sample is required?
A
blood sample collected from a vein in your arm or a random urine sample;
sometimes a saliva sample or, rarely, a hair sample
What is being tested?
Nicotine is a addictive alkaline 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 metabolized by the liver into more
than 20 compounds, which are excreted by the kidneys into the urine. Both
tobacco use and exposure to tobacco smoke can increase nicotine and its primary
metabolite, cotinine, concentrations in the body. Levels also rise with nicotine
replacement products such as nicotine patches and gums. In large amounts,
nicotine can be poisonous.
Cotinine is the major metabolite of nicotine and 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 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.
How is it used?
Nicotine or its primary metabolite, cotinine are most often tested to evaluate
tobacco use. Long term use of tobacco products can increase the risk of
developing many diseases including lung cancer, COPD, stroke, heart disease, and
respiratory infections, or exacerbate asthma, and blood clot formation. In
pregnant women, smoking can retard fetal growth and lead to low birth weight
babies.
Because use of tobacco products can greatly affect the health of individuals,
companies may use nicotine/cotinine testing to evaluate prospective employees
for tobacco use. Many health and life insurance companies test applicants for
nicotine or cotinine as well.
Nicotine and cotinine can both be measured qualitatively or quantitatively.
Quantitative testing can help distinguish between active smokers, tobacco users
who have recently quit, non-tobacco-users who have been exposed to significant
environmental tobacco smoke, and non-users who have not been exposed.
Cotinine may also be measured in saliva and in hair, although hair testing is
primarily used in a research setting, such as a study of non-smokers exposure to
tobacco smoke.
Blood or urine nicotine may be ordered by itself or along with cotinine if a
doctor suspects that someone is experiencing a nicotine overdose.
When
a patient has reported that they are using nicotine replacement products but are
no longer smoking, nicotine, cotinine, and urine anabasine measurements may
sometimes be ordered. Anabasine is present in tobacco but not in commercial
nicotine replacement products. If a sample tests positive for anabasine, then
the person is still using tobacco products.
When is it ordered?
Cotinine and/or nicotine may be ordered whenever an evaluation of tobacco use
status or tobacco smoke exposure is required. When a person enters a smoking
cessation program, blood or urine cotinine tests may be ordered to evaluate
compliance. Urine, blood, or saliva testing may be performed as a screen for
tobacco use when someone is applying for life or health insurance, or applying
for work with an employer that prohibits smoking. Testing may also be ordered by
a court for child custody purposes. Since smoking can increase the risks of
medical complications, testing may be performed prior to the start of some drug
therapies or surgical procedures.
Nicotine and cotinine are sometimes measured when a patient has symptoms that
the doctor suspects may be due to a nicotine overdose. Symptoms of mild nicotine
poisoning may include:
-
Nausea, vomiting
-
Dizziness
-
Drooling
-
Weakness
More
serious nicotine poisoning may result in:
Hair
testing is rarely performed in a clinical setting but may be ordered when an
evaluation of longer term tobacco use is desired.
What does the test result
mean?
In
the blood, nicotine levels can rise within a few seconds of a puff on a
cigarette. The quantity depends on the amount of nicotine in the cigarette and
the manner in which a person smokes, such as how deeply they inhale. Test
results are not interchangeable. Concentrations will be higher in urine than in
blood or saliva. There is also some variability from person to person and some
genetic differences in the rate that nicotine is metabolized and in the rate
that cotinine is cleared from the body. When someone stops using tobacco and
nicotine products, it can take more than two weeks for blood levels of cotinine
to drop to the level that a non-tobacco user would have and several weeks more
for urine levels to decrease to very low concentrations.
In
general, high levels of nicotine or cotinine indicate active tobacco or nicotine
replacement use. Moderate concentrations indicate a tobacco user who has not had
tobacco or nicotine for two to three weeks. Lower levels may be found in a
non-tobacco user who has been exposed to environmental smoke. Very low to
non-detectible concentrations are found in non-tobacco users who have not been
exposed to environmental smoke or a tobacco user who has refrained from tobacco
and nicotine for several weeks.
Patients whose nicotine overdose is self-evident may not be tested for nicotine
or cotinine. Concentrations would typically be increased, but levels do not
necessarily correlate with the severity of a person’s symptoms.
Is there anything else I
should know?
Some
pesticides contain high concentrations of nicotine. This can be another source
of nicotine poisoning.
A
person’s genetic makeup may influence how they metabolize nicotine. Variations
in the genes that code for the CYP2A6 liver enzyme affect the rate of nicotine
metabolism.
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