Cotinine urine test: what to know

After the body processes nicotine, it produces cotinine, which can be measured in urine. The test may be requested for smoking assessment, a workplace or clinical programme, or to check whether nicotine exposure is present. A result needs context: cigarettes, shisha, vaping products, nicotine gum, patches, lozenges, and exposure to tobacco smoke may affect interpretation. The test does not by itself describe your overall health, prove when exposure happened, or measure every substance in urine.

Different laboratories use different methods and reporting categories. Tell the clinician or testing service about all nicotine-containing products, recent exposure, medicines, and supplements before the sample is collected.

Follow the collection instructions exactly. You may be asked for a clean-catch sample or to provide urine in a labelled container. Wash your hands, avoid touching the inside of the container, and tell staff if you cannot provide a sample. Do not stop a prescribed nicotine medicine simply to change a result; ask the requester how it should be documented. If the result seems unexpected, discuss repeat testing or confirmatory testing rather than guessing from the report.

The test itself is not usually an emergency. Seek prompt medical help for nicotine poisoning symptoms such as vomiting, severe dizziness, confusion, marked weakness, trouble breathing, or an abnormal heartbeat after nicotine exposure. A urine result that concerns you is a reason to speak with the requesting clinician, especially if it affects treatment or a monitored health plan.

Ask why the test is being ordered, which products can affect it, whether prescribed nicotine replacement should continue, how the laboratory reports the result, and what an unexpected finding means. Ask whether another urine test is needed for a separate concern, since cotinine testing does not replace routine urine assessment.