. Author manuscript; available in PMC: 2013 May 5.

Published in final edited form as: Ther Drug Monit. 2009 Feb;31(1):14–30. doi: 10.1097/FTD.0b013e3181957a3b

TABLE 7.

Advantages and Limitations of Hair Cotinine as a Biomarker for Nicotine Exposure

Advantages

Information on long-term exposure due to presence of cotinine in hair indefinitely

Absence of drug metabolism in hair provides a historical account of exposure

Uniform hair growth allows segmental analysis reflecting a specified exposure period

Standard laboratory techniques are reliable, sensitive, and specific to quantify cotinine in hair

Less variability than measurement of cotinine in other matrices allows better discrimination among individuals by exposure status

Hair collection is noninvasive and easy in most children well suited in a pediatric setting

Careful sample handling and storage not required. Sample is stable for up to 5 years

Objective measure of exposure—no recall bias, underreporting, and lack of awareness

No time activity patterns data required

Cotinine as opposed to nicotine in hair reflects only systemic exposure

Highly specific to nicotine intake

Allows fetal exposure assessment by measuring newborn’s hair at birth

Disadvantages

Interindividual variation in uptake and metabolism of nicotine results in some variability in cotinine levels

Irregular hair growth in some

Hair color and hair treatments affect cotinine concentration