Cotinine as a biomarker of systemic nicotine exposure in spit tobacco users

Unlike cigarette smokers, spit tobacco (ST) users absorb a significant amount of nicotine through the gastrointestinal tract while swallowing tobacco juice. The majority of the absorbed nicotine is rapidly converted to cotinine during first-pass hepatic metabolism. This process potentially compromis...

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Bibliographic Details
Published in:Addictive behaviors 2004-02, Vol.29 (2), p.349-355
Main Authors: Ebbert, Jon O., Dale, Lowell C., Nirelli, Liza M., Schroeder, Darrell R., Moyer, Thomas P., Hurt, Richard D.
Format: Article
Language:English
Subjects:
Addictions
Adult
Aged
Biomarker
Biomarkers - blood
Chewing tobacco
Cotinine
Cotinine - blood
Deglutition
Female
Humans
Male
Middle Aged
Nicotine
Nicotine - administration & dosage
Nicotine - blood
Prospective Studies
Smokeless tobacco
Tobacco
Tobacco Use Disorder - blood
Tobacco Use Disorder - diagnosis
Tobacco, Smokeless - pharmacokinetics
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Summary:Unlike cigarette smokers, spit tobacco (ST) users absorb a significant amount of nicotine through the gastrointestinal tract while swallowing tobacco juice. The majority of the absorbed nicotine is rapidly converted to cotinine during first-pass hepatic metabolism. This process potentially compromises the utility of cotinine as a biomarker for systemic nicotine exposure in ST users. To investigate this question, we correlated nicotine and cotinine concentrations with clinical measures of ST use in 68 daily ST users enrolled in a nonnicotine pharmacologic intervention trial. We found that a higher frequency of swallowing tobacco juice ( P=.007) was an independent predictor of higher serum cotinine concentrations. Serum nicotine concentrations, on the other hand, were not correlated with a higher frequency of swallowing. In the absence of a reliable way to measure frequency of swallowing, we conclude that cotinine should not be used for guiding clinical decisions that depend upon a precise quantification of systemic nicotine exposure, such as tailored nicotine replacement therapy.
ISSN:0306-4603
1873-6327
DOI:10.1016/j.addbeh.2003.08.046