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Cotinine, Urine

Measures cotinine, which your body makes from nicotine, in urine. It shows nicotine use over the last few days and can count the amount, not just yes or no.

AI-verified against cited sources. Awaiting expert reviewLOINC 10366-3

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What it is

When nicotine enters your body, the liver turns most of it into cotinine, and your kidneys pass it into the urine. Nicotine levels fall by half in about two hours, but cotinine lasts for days. Urine holds about 4 to 5 times more cotinine than blood on average, which is why urine cutoffs are higher. Any source counts: cigarettes, cigars, chewing tobacco, vapes, nicotine gum, patches or lozenges. This is the measured version. The yes-or-no version is a separate marker.

Why it matters

Tobacco smoke raises the risk of heart disease, lung disease and cancer. A urine cotinine level gives an objective measure of recent nicotine exposure, which can be more reliable than memory. It is sometimes used before surgery, for insurance paperwork, and in quit-smoking programs. A measured number can also show whether nicotine intake is going down over time.

If it’s high

A result above the cutoff means nicotine has entered your body in the last few days. It cannot show which product it came from. Urine runs about 4.6 times higher than blood on average, so urine cutoffs are higher than blood cutoffs. A result just above a low cutoff can also come from heavy secondhand smoke, so the cutoff your lab or program uses matters.

Common causes

  • Smoking cigarettes, cigars or a pipe
  • Vaping (cotinine levels in regular vapers are similar to those in cigarette smokers)
  • Smokeless tobacco
  • Nicotine gum, patches, lozenges or pouches
  • Heavy or long exposure to other people's smoke (usually a low level)
  • Smoking cannabis in blunts (hollowed-out cigars), which can give levels like active smoking

What can help

  • If you want to quit, ask your clinician about proven quit-smoking support; in the US, 1-800-QUIT-NOW connects you to a free state quitline
  • If a result surprises you, ask whether secondhand smoke, nicotine replacement or a vape could explain it
  • If the test is for surgery or insurance, ask the ordering office which cutoff it uses and how long to wait after your last nicotine

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

For adults: up to 15 ng/mL. Source: ARUP Laboratories, Nicotine & Tobacco Research (SRNT subcommittee on biochemical verification).

SRNT 2019 update: urine cotinine cutpoints for separating smokers from nonsmokers (research guidance)

  • Below the cutpoint rangebelow 30 ng/mL
  • 30 to 50 ng/mL: the range where cutpoints are set30 to under 50 ng/mL
  • Above the cutpoint range50 and above ng/mL

What can affect your result

  • Time since your last nicotine: cotinine falls by half about every 16 hours
  • How watery your urine is, and its acidity
  • The amount and type of nicotine you use
  • Genes that control how the liver processes nicotine, which vary across ethnic groups
  • Estrogen, pregnancy and heavy alcohol use, which change how the body handles nicotine and cotinine
  • Secondhand smoke exposure
  • Whether the lab reports free or total cotinine
  • Every nicotine source counts, including cigarettes, cigars, chewing tobacco, vapes, nicotine gum, patches and lozenges. This test cannot tell tobacco from nicotine replacement products on its own; anabasine, reported on some panels, is tobacco-specific.
  • Very dilute urine lowers the number, and ARUP notes that diluted or adulterated urine can hide use. Urine flow rate and acidity also change the cotinine level.
  • Labs may report free or total cotinine. Total cotinine is about 1.5 to 2 times higher than free.
  • Some labs divide by creatinine. That version cannot be converted to ng/mL without the creatinine value.
  • Immunoassays often read higher than LC-MS/MS because they are less specific.
  • How fast your body clears nicotine varies with genes, ethnic background, sex hormones and pregnancy.

A random (single) urine sample. ARUP does not ask for a particular time of day. Cotinine falls by half about every 16 hours (about 8 to 30 or more, depending on the person), so urine reflects nicotine use over roughly the last few days. For a daily user, it usually takes about 80 to 100 hours to drop to common cutoff levels after the last nicotine.

When to talk to a clinician

A cotinine result is never an emergency by itself. Talk with your clinician if you want help quitting, or if you are pregnant or have a child who lives with heavy smoke exposure.

Questions you could ask

  • Would a blood or saliva test suit my situation better than a urine test?
  • Which cutoff does this lab or program use, and what does my number mean against it?
  • If I use nicotine replacement or a vape, how will that show on this test?

Questions people ask

Why are urine numbers so much higher than blood numbers?

Cotinine is concentrated in urine, about 4 to 5 times higher than in blood on average. That is why urine cutoffs, such as 15 to 50 ng/mL, are higher than blood cutoffs, such as 3 to 10 ng/mL.

Will vaping, patches or gum show up?

Yes. Cotinine comes from nicotine itself, so any nicotine product raises it. A urine panel that includes anabasine can help show tobacco use, because anabasine comes from tobacco and not from nicotine replacement products. It is less helpful for vaping, because some e-liquids contain traces of it.

How long after I quit will the result be negative?

Cotinine halves about every 16 hours, and the time varies from person to person. For most daily users it reaches common cutoffs in about 3 to 4 days. Experts consider waiting 6 to 7 days after the last nicotine a safe way to avoid a false positive.

Show the science and sources

Units

  • 1 ng/mL = 1 ng/mL
  • 1 ng/mL = 1 µg/L
  • 1 ng/mL = 5.675 nmol/L

Open the Cotinine (Urine) unit converter

For clinicians and researchers

Urine cotinine is measured by LC-MS/MS (ARUP, 15 ng/mL cutoff, with nicotine at 15, 3-hydroxycotinine at 50 and anabasine at 5 ng/mL) or by immunoassay screens. Cotinine is formed mainly by CYP2A6 and has a mean half-life of about 16 hours. The average ratio of urine free cotinine to plasma cotinine is about 4.6 (range 4.0 to 5.3) and depends on urine flow and pH, which is why urine cutpoints are higher than blood. The 2019 SRNT update puts urine cutpoints at 30 to 50 ng/mL, predicts about 23 ng/mL from the serum cutpoint and the urine-to-plasma ratio, and notes that empirical studies found about 30 ng/mL. Total urinary cotinine (free plus glucuronide) is about 1.5 to 2 times free. Creatinine-corrected urine cotinine correlates slightly better with plasma, but most published cutpoints are uncorrected. ARUP notes that 100 ng/mL is often used for surgery clearance. Rapid lateral-flow strips are typically built around 200 ng/mL, are semi-quantitative, and are not suitable for secondhand smoke levels. In pregnancy, cutpoints of 25 to 50 ng/mL have been suggested. Cotinine cannot separate tobacco from nicotine replacement or e-cigarettes; anabasine and anatabine in urine (cutpoint about 2 ng/mL) come from tobacco, so they help separate tobacco from pharmaceutical nicotine, though some e-liquids contain them too. Total nicotine equivalents are the preferred quantitative marker of daily nicotine intake but have no established cutpoints.

LOINC 10366-3 (primary), 92643-6, 33796-4. Specimen: urine.

Sources

  1. Nicotine and Metabolites, Urine, Quantitative (ARUP test code 0092356), ARUP Laboratories
  2. Cotinine Screen, Urine (ARUP test code 2007081), ARUP Laboratories
  3. Biochemical Verification of Tobacco Use and Abstinence: 2019 Update, Nicotine & Tobacco Research (SRNT subcommittee on biochemical verification) (2020)
  4. Cotinine (PubChem compound 854019), PubChem, National Library of Medicine

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.

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