Cotinine effects on nicotine metabolism.

BACKGROUND: Nicotine clearance and half-life are known to be significantly reduced in smokers compared to nonsmokers. Cotinine is the major primary metabolite of nicotine, and it accumulates in the body with regular smoking. Nicotine and cotinine appear to be metabolized by the same liver enzyme. Therefore we hypothesized that cotinine inhibits nicotine metabolism, resulting in slower nicotine clearance in smokers compared with nonsmokers.
METHODS: This was a crossover, randomized, double-blind, and placebo-controlled study. The subjects were 12 healthy nonsmoking volunteers. They received two intravenous infusions of deuterium-labeled nicotine-d2 and cotinine-d4 (0.5 micrograms/kg/min), once with oral cotinine treatment of 0.25 mg/kg twice a day and once with placebo. Nicotine and cotinine pharmacokinetic parameters were determined for each infusion.
RESULTS: During oral cotinine treatment, average plasma levels of cotinine ware 900 ng/ml, comparable to levels observed in some very heavy smokers. Cotinine had no effect on the disposition kinetics of nicotine-d2. The half-life of cotinine after low-dose cotinine-d4 infusion was comparable to that after high-dose cotinine described in previous studies. The half-life of labeled cotinine derived from nicotine was significantly longer than the half-life of cotinine administered as cotinine.
CONCLUSIONS: Cotinine is not responsible for the lower nicotine clearance observed in smokers. Our data suggest that the pharmacokinetics of low-dose cotinine in nonsmokers do not differ from those of high-dose in smokers, and therefore cotinine levels can be used quantitatively in environmental tobacco exposure. The longer half-life of cotinine derived from nicotine suggests that slow release of nicotine from tissues is responsible for the apparent long half-life of cotinine in nonsmokers exposed to environmental tobacco smoke.

RCT Entities:   Population Interventions Outcomes