Explanation

Cotinine (urine): what is measured?

The analysis measures how much cotinine is excreted in the urine. Cotinine is formed in the liver from nicotine and leaves the body through the kidneys. Cotinine is present in urine in higher concentrations than in blood, so even small amounts of nicotine become visible. The source can be smoking, but also an e-cigarette, snus or a nicotine replacement product.

What can it detect?

Nicotine intake in the past few days, from any source
Low exposure, for example from secondhand smoke

Result

What does the result mean?

Cotinine (urine) too high

A high value fits daily nicotine use. The level depends not only on how much nicotine has been taken in, but also on how much you have drunk: diluted urine gives a lower result. That is why the value is often corrected for creatinine. Nicotine patches, gum, e-cigarettes and snus give the same increase as cigarettes.

Cotinine (urine) too low

A low or unmeasurable value fits someone who does not use nicotine. After quitting smoking, the value falls to unmeasurable over the course of a few days. Secondhand smoke gives a low but often still measurable value. Drinking a lot just before urinating can lower a result without less nicotine having been taken in.

After an abnormal result

There is no standard medical follow-up to an abnormal result. If you want to quit smoking, the GP or practice nurse offers support.

Reliability

How reliable is the test?

Cotinine in urine is a sensitive measure of nicotine intake in the past few days and also shows secondhand smoke exposure. For an individual, the result adds little to what someone already knows about their own smoking. A single urine sample varies greatly with fluid intake; correction for the creatinine level is usual so that results can be compared. The result says something about nicotine intake in the past few days and nothing about the harm from smoking in that person.

What can affect the result?

Fluid intake strongly determines how concentrated the urine is; without correction for creatinine, results are hard to compare.
Nicotine replacement products, e-cigarettes and snus give the same increase as cigarettes.
The rate at which nicotine is broken down differs between people and changes during pregnancy, among other situations.
There are no agreed cut-off values; the laboratory decides which cut-off it uses.

Who it is for

Who is the test useful for?

Useful for

The result is mainly meaningful when it is unclear whether someone uses nicotine. Sometimes the result matters for a medical question, for example around surgery or a treatment in which smoking strongly affects the outcome. For someone who wants to quit smoking, the measurement adds nothing to support.

How common is it?

About 17.8 percent of Dutch adults smoke. The percentage of smokers in the Netherlands is lower than the average in the European Union and is slowly falling.

VZinfo (RIVM)

Drawbacks and risks

A measurable value due to secondhand smoke or a nicotine replacement product can wrongly be interpreted as smoking.
A diluted urine sample can give a low result in someone who does smoke.

Get tested

Cotinine (urine): test panels

Cotinine (urine) is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Urine
Nicotine
Nicotine in urine; recent use.
€ 51,00

Evidence

Sources

This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.

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