Test Catalog

Test Id : NICOS

Nicotine and Metabolites, Serum

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring tobacco use in a clinical setting

Method Name
A short description of the method used to perform the test

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.


Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Nicotine and Metabolites, S

Lists additional common names for a test, as an aid in searching


Tobacco Alkaloids

Specimen Type
Describes the specimen type validated for testing

Serum Red

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Collection Container/Tube: Red top (serum gel/SST are not acceptable)

Submission Container/Tube: Plastic vial


If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Red Refrigerated (preferred) 28 days
Ambient 28 days
Frozen 28 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring tobacco use in a clinical setting

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Fatalities related to tobacco use are a leading cause of death in United States. Nicotine, coadministered in tobacco products such as cigarettes, pipe tobacco, cigars, 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 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 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 approximately 2 hours. Cotinine exhibits an apparent elimination half-life of approximately 24 hours. Heavy tobacco users who abstain from tobacco for 2 weeks exhibit serum nicotine values less than 3.0 ng/mL and cotinine less than 3.0 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.


<3.0 ng/mL



<3.0 ng/mL

Provides information to assist in interpretation of the test results

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

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
Recommendations for 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 Dec;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 Sep;48(9):1460-1471

3. Nicotine and cotinine. Testing.com; Updated November 9, 2021 Accessed April 11, 2022. 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 Mar;145(3):e20191346. doi: 10.1542/peds.2019-1346

Method Description
Describes how the test is performed and provides a method-specific reference

Nicotine and metabolites are extracted from serum. The extract is quantified by high-performance liquid chromatography-tandem mass spectrometry.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information


Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test


Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

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 instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.


G0480 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
NICOS Nicotine and Metabolites, S 90226-2
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
21313 Nicotine 3853-9
21314 Cotinine 10365-5

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports