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HelpTest Code NICOS Nicotine and Metabolites, Serum
Additional Codes
Cotinine
Reporting Name
Nicotine and Metabolites, SUseful For
Monitoring tobacco use in a clinical setting
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Serum RedSpecimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Red top (serum gel/SST are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 0.8 mL
Collection Instructions: Within 2 hours of collection, centrifuge and aliquot serum into a plastic vial.
Specimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Reference Values
NICOTINE
<3.0 ng/mL
COTININE
<3.0 ng/mL
Day(s) Performed
Monday through Sunday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80323
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| NICOS | Nicotine and Metabolites, S | 90226-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 21313 | Nicotine | 3853-9 |
| 21314 | Cotinine | 10365-5 |
Interpretation
Serum nicotine concentration in the range of 30 to 50 ng/mL with cotinine in the range of 200 to 800 ng/mL indicates the subject is either actively using a tobacco product or on nicotine replacement therapy.
To discriminate if a patient on nicotine replacement therapy is also actively using a tobacco product, see NICOU / Nicotine and Metabolites, Random, Urine analysis; the presence of anabasine in urine, a tobacco alkaloid not present in nicotine replacement products, indicates recent tobacco use.
Typical findings are as follows:
While using a tobacco product:
-Peak nicotine concentration: 30 to 50 ng/mL
-Peak cotinine concentration: 200 to 800 ng/mL*
*Higher values may be seen in subjects with high cytochrome P450 2D6 activity
Tobacco user after 2 weeks complete abstinence:
-Nicotine concentration: <3.0 ng/mL
-Cotinine concentration: <3.0 ng/mL
Nontobacco user with passive exposure:
-Nicotine concentration: <3.0 ng/mL
-Cotinine concentration: <8.0 ng/mL
Nontobacco user with no passive exposure:
-Nicotine concentration: <3.0 ng/mL
-Cotinine concentration: <3.0 ng/mL
Clinical Reference
1. Dale LC, Hurt RD, Hays JT. Drug therapy to aid in smoking cessation. Tips on maximizing patients' chances for success. Postgrad Med. 1998;104(6):75-78, 83-84
2. Moyer TP, Charlson JR, Enger RJ, et al. Simultaneous analysis of nicotine, nicotine metabolites, and tobacco alkaloids in serum or urine by tandem mass spectrometry, with clinically relevant metabolic profiles. Clin Chem. 2002;48(9):1460-1471
3. Nicotine and cotinine. Testing.com; Updated February 2, 2023. Accessed February 16, 2024. Available at www.testing.com/tests/nicotine-and-cotinine/
4. McGrath-Morrow SA, Gorzkowski J, Groner JA, et al. The effects of nicotine on development. Pediatrics. 2020;145(3):e20191346. doi:10.1542/peds.2019-1346
Report Available
2 to 4 daysMethod Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.