Cotinine in urine (24-hour collection)

Why This Test Is Done

Your healthcare provider may order this test to monitor nicotine use, especially if you're trying to quit smoking or using nicotine replacement therapies. It provides a more accurate picture than single-point urine or saliva tests, as it captures total exposure over time.

What to Expect Before the Test

You’ll collect all urine produced in a 24-hour period, typically starting after midnight and ending the same day the next morning. Use a clean container and keep it refrigerated until you return it to the lab. Follow any specific instructions your provider gives you, such as avoiding certain medications or foods that might affect results.

What the Test Results Mean

Higher levels of cotinine suggest recent nicotine exposure, while lower levels may indicate reduced or no exposure. However, results alone shouldn’t determine smoking status—your provider will consider them alongside other factors like symptoms and medical history.

Common Causes of Abnormal Results

Elevated cotinine levels can result from smoking, vaping, or using nicotine patches/gums. Very low levels might indicate strict avoidance of nicotine products, but false negatives can occur if collection isn’t complete or if nicotine was recently ingested.