Nicotine and Metabolites, Urine

CPT CODE:

USEFUL FOR:

Monitoring tobacco use
Monitoring replacement therapy to verify that it is adequate

SPECIMEN REQUIRED:

3 mL from a random urine collection. No preservative.Send specimen refrigerated in a plastic, 13-mL urine tube.

TRANSPORT TEMPERATURE:

Refrig\Ambient OK\Frozen OK

CLINICAL INFORMATION:

Tobacco use is the leading cause of death in the United States.Nicotine, coadministered in tobacco products such as cigarettes, pipe,cigar, or chew, is an addicting substance that causes individuals tocontinue use of tobacco despite concerted efforts to quit. Nicotinestimulates dopamine release and increases dopamine concentrationin the nucleus accumbens, a mechanism that is thought to be the basisfor addiction for drugs of abuse.
Nicotine is rapidly metabolized in the liver to cotinine, exhibiting anelimination half-life of 2 hours. Cotinine exhibits an apparent eliminationhalf-life of 15 hours. Patients using tobacco products excrete nicotinein urine in the concentration range of 1,000 ng/mL to 5,000 ng/mL.Cotinine accumulates in urine in proportion to dose and hepaticMetabolism (which is genetically determined); most tobacco usersexcrete cotinine in the range of 1,000 ng/mL to 8,000 ng/mL. Urineconcentrations of nicotine and metabolites in these ranges indicatethe subject is using tobacco or is receiving high-dose nicotine patchtherapy.
In addition to nicotine and metabolites, tobacco products also containother alkaloids that can serve as unique markers of tobacco use. Twosuch markers are anabasine and nornicotine. Anabasine is presentin tobacco products, but not nicotine replacement therapies.Nornicotine is present as an alkaloid in tobacco products and as ametabolite of nicotine. The presence of anabasine >10 ng/mL ornornicotine >30 ng/mL in urine indicates current tobacco use,irrespective of whether the subject is on nicotine replacement therapy.The presence of nornicotine without anabasine is consistent withuse of nicotine replacement products. Heavy tobacco users whoabstain from tobacco for 2 weeks exhibit urine nicotine values <30 ng/mL,cotinine <50 ng/mL, anabasine <2 ng/mL, and nornicotine <2 ng/mL.
Passive exposure to tobacco smoke can cause accumulation of nicotinemetabolites in nontobacco users. Urine cotinine has been observed toaccumulate up to 20 ng/mL from passive exposure. Neither anabasinenor nornicotine accumulates from passive exposure.
Tobacco users engaged in programs to abstain from tobacco requiresupport in the form of counseling, pharmacotherapy, and continuousencouragement. Occasionally, counselors may elect to monitorabstinence by biochemical measurement of nicotine and metabolites ina random urine specimen to verify abstinence. If results of biologictesting indicate the patient is actively using a tobacco produ

CLINICAL INTERPRETATION:

Urine nicotine in the range of 1,000 ng/mL to 5,000 ng/mL withcotinine in the range of 1,000 ng/mL to 8,000 ng/mL indicates thesubject is either actively using a tobacco product or on high-dosenicotine patch therapy.
The presence of anabasine and nornicotine indicates a subjecton patch therapy who is actively using a tobacco product.
Typical findings are as follows:
While using a tobacco product:Peak nicotine concentration:  1,000 ng/mL to 5,000 ng/mLPeak cotinine concentration:  1,000 ng/mL to 8,000 ng/mLAnabasine concentration:  10 ng/mL to 500 ng/mLNornicotine concentration:  30 ng/mL to 900 ng/mL
Tobacco user after 2 weeks complete abstinence:Nicotine concentration:  <30 ng/mLCotinine concentration:  <50 ng/mLAnabasine concentration:  <2.0 ng/mLNornicotine concentration:  <2.0 ng/mL
Nontobacco user with passive exposure:Nicotine concentration:  <20 ng/mLCotinine concentration:  <20 ng/mLAnabasine concentration:  <2.0 ng/mLNornicotine concentration:  <2.0 ng/mL
Nontobacco user with no passive exposure:Nicotine concentration:  <2.0 ng/mLCotinine concentration:  <5.0 ng/mLAnabasine concentration:  <2.0 ng/mLNornicotine concentration:  <2.0 ng/mL

REFERENCE VALUES:

Non-tobacco user with no passive exposure:

NICOTINE

      <2.0 ng/mL

COTININE

      <5.0 ng/mL

ANABASINE

      <2.0 ng/mL

NORNICOTINE

      <2.0 ng/mL