Test ID: NICOS
Nicotine and Metabolites, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring tobacco use
Method Name A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Tobacco Alkaloids
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Red top
Specimen Volume: 1.4 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days |
| Frozen | 365 days | |
| Ambient | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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 to continue use of tobacco despite concerted efforts to quit. Nicotine stimulates dopamine release and increases dopamine concentration in the nucleus accumbens, a mechanism that is thought to be the basis for addiction for drugs of abuse.
Nicotine-dependent patients use tobacco products to achieve a peak serum nicotine value of 30 ng/mL to 50 ng/mL, the concentration at which the nicotine high is maximized. Nicotine is metabolized in the liver to cotinine. Cotinine accumulates in serum in proportion to dose and hepatic metabolism (which is genetically determined); most tobacco users accumulate cotinine in the range of 200 ng/mL to 800 ng/mL. Serum concentrations of nicotine and metabolites in these ranges indicate the patient is using tobacco or is receiving high-dose nicotine patch therapy.
Nicotine is rapidly metabolized, exhibiting an elimination half-life of 2 hours. Cotinine exhibits an apparent elimination half-life of 15 hours. Heavy tobacco users who abstain from tobacco for 2 weeks exhibit serum nicotine values <2.0 ng/mL and cotinine <2.0 ng/mL.
Passive exposure to tobacco smoke can cause accumulation of nicotine metabolites in nontobacco users. Serum cotinine has been observed to accumulate up to 8 ng/mL from passive exposure.
Tobacco users engaged in programs to abstain from tobacco require support in the form of counseling, pharmacotherapy, and continuous encouragement. Occasionally, counselors may elect to monitor abstinence by biochemical measurement of nicotine and metabolites in serum to verify abstinence. If results of biologic testing indicate the patient is actively using a tobacco product during therapy, additional counseling or intervention may be appropriate.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
NICOTINE
<2.0 ng/mL
COTININE
<2.0 ng/mL
Interpretation Provides information to assist in interpretation of the test results
Serum nicotine concentration in the range of 30 ng/mL to 50 ng/mL with cotinine in the range of 200 ng/mL 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 actively using a tobacco product, see 82510 Nicotine and Metabolites, 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 ng/mL to 50 ng/mL
-Peak cotinine concentration: 200 ng/mL 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: <2.0 ng/mL
-Cotinine concentration: <2.0 ng/mL
Nontobacco user with passive exposure:
-Nicotine concentration: <2.0 ng/mL
-Cotinine concentration: <8.0 ng/mL
Nontobacco user with no passive exposure:
-Nicotine concentration: <2.0 ng/mL
-Cotinine concentration: <2.0 ng/mL
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Knowledge of time elapsed between last dose and specimen collection is important for interpretation of test results.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Dale LC, Hurt RD, Hays JT: Drug therapy to aid in smoking cessation. Tips on maximizing patients' chances for success. Postgrad Med 1998;104:75-78, 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;48:1460-1471
Method Description Describes how the test is performed and provides a method-specific reference
Nicotine and metabolites are extracted from serum by solid-phase extraction techniques. The extract eluate is quantified by high-performance liquid chromatography-tandem mass spectrometry.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83887
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 21313 | Nicotine | 3853-9 |
| 21314 | Cotinine | 10365-5 |
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