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Blood Test Tracker

Cotinine, Urine (Screen)

A yes-or-no urine test for cotinine, a product of nicotine. Positive means nicotine exposure above the lab's cutoff in about the last few days.

AI-verified against cited sources. Awaiting expert reviewLOINC 12293-7

What it is

When nicotine enters your body, the liver turns most of it into cotinine, and your kidneys pass it into the urine. This screen checks whether cotinine is above a set cutoff and reports positive or negative, not a number. It picks up any nicotine source: cigarettes, cigars, chewing tobacco, vapes, nicotine gum, patches or lozenges. It is often used for surgery clearance, insurance paperwork and quit-smoking programs.

Why it matters

A urine screen gives a simple, objective check of recent nicotine exposure. It is quick and low-cost. Because it only says yes or no at one cutoff, a follow-up measured test is sometimes used to confirm a result or to see how much nicotine is present.

If it’s high

A positive screen means cotinine was above the lab's cutoff, so nicotine has entered your body in the last few days. It cannot show which product it came from. Heavy exposure to other people's smoke is usually below common screening cutoffs, but a lab-specific cutoff matters. A positive screen is often followed by a measured test.

Common causes

  • Smoking cigarettes, cigars or a pipe
  • Vaping
  • Smokeless tobacco
  • Nicotine gum, patches, lozenges or pouches
  • Smoking cannabis in blunts (hollowed-out cigars), which can contain tobacco
  • Very heavy exposure to other people's smoke (uncommon at these cutoffs)

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
  • Ask the ordering office which cutoff it uses and whether a measured follow-up test is needed

What can affect your result

  • Time since your last nicotine: cotinine falls by half about every 16 hours
  • The cutoff the test uses (for example about 200 versus 500 ng/mL)
  • How watery your urine is
  • The amount and type of nicotine you use
  • Genes, ethnic background, sex hormones and pregnancy, which change how the body clears nicotine
  • Every nicotine source counts, including cigarettes, cigars, chewing tobacco, vapes, nicotine gum, patches and lozenges. A screen cannot tell tobacco from nicotine replacement products.
  • The cutoff decides the answer. ARUP's screen turns positive at 500 ng/mL, while rapid test strips are typically built around 200 ng/mL, so lighter use can be negative on one test and positive on another.
  • Very dilute urine can lower the amount below the cutoff.
  • A screen is presumptive. ARUP recommends a quantitative LC-MS/MS test to follow up a presumptive result.

A random (single) urine sample. ARUP does not ask for a particular time of day. Reflects nicotine use over roughly the last few days. Cotinine falls by half about every 16 hours, and for a daily user it takes about 80 to 100 hours to drop to common cutoff levels.

When to talk to a clinician

A cotinine screen 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 screen?
  • Which cutoff did this test use?
  • Should this be confirmed with a measured test?

Questions people ask

What is the difference between this and the measured urine cotinine test?

The screen only says positive or negative at one cutoff. The measured test gives a number, so you can see how much nicotine is present and compare it with lower or higher cutoffs. They are separate markers in this catalog.

Will vaping, patches or gum make the screen positive?

They can. Cotinine comes from nicotine itself, so any nicotine product can raise it. Whether the screen turns positive depends on how much you used recently and on the cutoff the test uses.

Show the science and sources

For clinicians and researchers

ARUP's Cotinine Screen, Urine (test 2007081) is an enzyme immunoassay (ARUP lists its compliance category as FDA) with a 500 ng/mL positive cutoff, reported as Negative or Positive (LOINC 12293-7). ARUP recommends its quantitative LC-MS/MS test (0092356, cutoff 15 ng/mL for cotinine) to follow up a presumptive result, and for differentiating nicotine replacement from tobacco use (anabasine). The SRNT 2019 update puts urine cotinine cutpoints for separating smokers from nonsmokers at 30 to 50 ng/mL, so screens built around 200 to 500 ng/mL are less sensitive than quantitative cutpoints. Lateral-flow strips are nominally set at 200 ng/mL, are semi-quantitative, and have not proven reliable for quantifying exposure or detecting secondhand smoke. Immunoassays often read higher than chromatographic methods because of cross-reactivity. Cotinine has a mean half-life of about 16 hours.

LOINC 12293-7 (primary), 59646-0, 43218-7. Specimen: urine.

Sources

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

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

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