Citation symbol Cite this page
 
x

Cite this page

Nicotine Exposure and Metabolites. ARUP Consult®. Retrieved December 23, 2025, https://arupconsult.com/content/nicotine-metabolites

Close

Nicotine Exposure and Metabolites

Last Literature Review: June 2025 Last Update:

Medical Experts

Contributor
Contributor

Nicotine is an addictive substance found in tobacco products and is one of the most heavily used addictive drugs in the United States. Use of tobacco products, particularly smoking, is the main preventable cause of disease and death in the U.S. Active smoking is also recognized as a risk factor for poor wound healing in postoperative outcome studies.  The main metabolites of nicotine are cotinine, trans-3'-hydroxycotinine, and nornicotine; of these, cotinine is the most widely used marker for detecting nicotine exposure.  Laboratory testing of urine for nicotine and its metabolites can help differentiate between active and passive nicotine exposure based on the concentrations detected ; however, these results are not definitive. Nicotine replacement therapy and tobacco use can be distinguished by the detection of a tobacco-specific alkaloid, such as anabasine.  Testing of plasma or serum, when necessary, is useful for identifying recent exposure and verifying abstinence from nicotine-containing products when qualifying patients for surgery or organ transplantation.

Quick Answers for Clinicians

What is the window of detection for nicotine and its metabolites?

The window of detection for nicotine is brief; therefore, nicotine concentration may not be a good indicator of smoking status. However, cotinine, a major metabolite of nicotine, may be detected up to 7 days after exposure. Tobacco users who abstain from tobacco for 2 weeks have cotinine concentrations comparable to those of unexposed nontobacco users. ,  However, due to potential secondary or tertiary exposure, one can present with persistently low concentrations of cotinine in urine even after smoking cessation.

How is anabasine testing used to determine smoking status?

Anabasine is a minor tobacco alkaloid that can be used as a biomarker to evaluate smoking abstinence and can help differentiate between individuals using tobacco and those using various nicotine replacement therapies. However, anabasine testing has a relatively low clinical sensitivity, and anabasine may be present in supplements and electronic cigarettes.  Anabasine levels should be interpreted in the context of other nicotine biomarkers.

Does laboratory testing for exposure differ based on the nicotine delivery source?

Clinical laboratory testing for nicotine exposure is the same, regardless of the delivery source. Although the uptake of nicotine differs depending on the delivery source—and traditional cigarettes deliver more nicotine than electronic cigarettes, nicotine gum, and nicotine patches , —nicotine metabolite values to determine active nicotine exposure remain the same across all types of delivery sources.

Can consuming certain foods lead to a positive test for nicotine or its metabolites?

Dietary intake of nicotine may be an important factor to consider in the interpretation of nicotine test results in nonsmokers. Foods that contain nicotine include cauliflower, eggplant, potatoes, and tomatoes. It is possible for an individual to consume enough of these foods to accumulate an amount of nicotine comparable to the amount inhaled by a passive smoker.  The level of nicotine is lower when nicotine-containing foods are cooked.

Indications for Testing

Testing is appropriate to evaluate individuals for recent use of nicotine-containing products or passive exposure to nicotine. Testing can also document use of tobacco versus use of purified nicotine products to assess compliance with smoking-cessation programs or to verify abstinence from nicotine-containing products when qualifying patients for surgery or organ transplantation.

Laboratory Testing

Quantitative Testing

Quantitative testing is typically performed by mass spectrometry, which provides greater sensitivity and a lower limit of detection compared with qualitative immunoassays. Assay cutoffs are dependent on specimen type and analytic method.

Urine

Urine testing is recommended to detect acute and chronic use of nicotine because analytes are detectable for a longer period of time in urine than in serum or plasma. The trans-3'-hydroxycotinine metabolite may persist in urine for weeks after cessation of long-term or heavy use of nicotine products.  Urine metabolite testing is also recommended to distinguish between nicotine exposure from tobacco products and purified nicotine products.

Anabasine, a tobacco alkaloid, can also be detected in urine and may distinguish the active use of tobacco products from use of nicotine replacement therapy ; individuals using purified nicotine products would not be expected to have anabasine in urine.

Serum or Plasma

Serum or plasma testing may be useful when a valid urine specimen cannot be obtained. Serum or plasma testing can detect recent use, typically within the past 7 days.  For more information, refer to the ARUP Consult Emergency Toxicology topic.

Qualitative Screening

Cotinine qualitative screening can be used to assess active use of nicotine and document abstinence from nicotine-containing products for compliance with smoking-cessation programs or for surgery prequalification.

ARUP Laboratory Tests

Quantitative Testing

Qualitative Screening

References