The Direct Answer: No Marketed Drug Contains Cotinine
To directly address the central question, there are currently no commercially available and marketed medications that list cotinine as an active ingredient [1.7.1]. This is a common point of confusion, as cotinine is intrinsically linked to nicotine, a widely used substance. Instead of being an ingredient added to drugs, cotinine is a substance the human body produces after it has been exposed to nicotine [1.2.2]. The liver, and to a lesser extent the lungs and kidneys, metabolize nicotine, with the primary resulting compound being cotinine [1.8.1, 1.4.1]. Its presence in the body is therefore an indicator of nicotine exposure, not the result of taking a cotinine-based medication.
Interestingly, a drug version of cotinine was developed. Cotinine fumarate, under the proposed brand name Scotine, was studied as a potential antidepressant [1.7.1]. However, despite this development, the drug was never ultimately marketed to the public [1.4.2, 1.7.1].
Understanding Cotinine and Its Source
Cotinine is an alkaloid and the predominant metabolite of nicotine [1.2.3]. When a person uses any product containing nicotine, their body breaks it down. About 70-80% of this nicotine is converted into cotinine [1.2.3]. Because of this process, cotinine has become the standard biomarker for measuring nicotine exposure in a person [1.2.4, 1.3.4].
Sources that lead to the presence of cotinine in the body include:
- Tobacco Products: Cigarettes, cigars, chewing tobacco, and snuff all contain nicotine [1.6.2].
- Nicotine Replacement Therapy (NRT): Products designed to help people quit smoking, such as nicotine patches, gum, lozenges, inhalers, and nasal sprays, also contain nicotine and will lead to a positive cotinine test [1.5.1, 1.5.2].
- Electronic Cigarettes (E-cigarettes/Vapes): These devices vaporize a liquid that typically contains nicotine, which is then metabolized into cotinine [1.5.4].
- Secondhand Smoke: Even non-smokers can have detectable levels of cotinine in their system if they are exposed to environmental tobacco smoke (ETS) [1.2.1].
Why Test for Cotinine and Not Nicotine?
The primary reason cotinine is the preferred substance for testing is its half-life. The half-life of a substance is the time it takes for the concentration of that substance in the body to be reduced by half.
- Nicotine has a very short half-life of about two hours [1.8.1]. This means its levels in the body drop quickly, making it a less reliable indicator of tobacco use.
- Cotinine has a much longer half-life, averaging around 15 to 20 hours [1.8.1, 1.8.3]. This provides a much wider window for detection, making it possible to identify nicotine exposure for several days (up to a week) after last use [1.2.6].
This stability and longer detection window make cotinine an excellent and reliable marker for clinicians, insurance companies, and employers to assess a person's smoking status or nicotine exposure [1.6.1, 1.6.2].
Comparison Table: Cotinine vs. Nicotine
To clarify the differences between these two related compounds, a side-by-side comparison is helpful.
| Feature | Nicotine | Cotinine |
|---|---|---|
| Source | Naturally occurs in tobacco plants; active ingredient in NRTs [1.3.2, 1.6.2] | The primary metabolite of nicotine, formed in the body [1.2.2] |
| Primary Use | Recreational stimulant; active ingredient in smoking cessation aids [1.5.6] | Biomarker for detecting and quantifying nicotine exposure [1.3.3] |
| Half-Life | Short (approx. 2 hours) [1.8.1, 1.8.2] | Long (approx. 15-20 hours) [1.8.1, 1.8.3] |
| Pharmacological Potency | High-potency agonist of nicotinic acetylcholine receptors (nAChRs) [1.4.5] | Low-potency agonist of nAChRs (about 100 times lower than nicotine) [1.4.2] |
| Toxicity & Effects | Addictive; significant cardiovascular effects [1.4.5] | Not considered addictive; minimal cardiovascular effects at typical levels [1.4.5] |
The Therapeutic Potential of Cotinine
While not used as a medication, extensive research has explored cotinine's own pharmacological effects. Preclinical studies, mostly in animal models, suggest it has a favorable safety profile and potential therapeutic benefits without the negative addictive and cardiovascular effects of nicotine [1.4.5].
Nootropic and Neuroprotective Effects
Research has shown that cotinine can cross the blood-brain barrier and may have cognitive-enhancing (nootropic) properties [1.7.3, 1.7.6]. Studies in animal models of Alzheimer's disease, schizophrenia, and PTSD have found that cotinine may:
- Improve working memory and attention [1.4.5].
- Reduce anxiety and fear-related behaviors [1.7.1].
- Exhibit antipsychotic-like effects [1.7.1].
These findings suggest that cotinine, or derivatives of it, could one day become a therapeutic agent for various neuropsychiatric disorders [1.3.6]. It is believed to act as a modulator of nicotinic acetylcholine receptors, among other potential mechanisms, but more research is needed to fully understand its actions in humans [1.7.6].
Conclusion
The answer to "What drug has cotinine in it?" is simple: none that are currently marketed. Cotinine is the downstream product of nicotine metabolism, making it a reliable marker for tobacco and nicotine use, rather than a therapeutic agent itself. Its longer half-life compared to nicotine makes it the gold standard for testing, whether for clinical, insurance, or employment purposes. While the unmarketed antidepressant Scotine represents a past attempt to use it therapeutically, cotinine's future may lie in its potential as a treatment for complex neuropsychiatric conditions, a field where research is ongoing.
For more information on cotinine, you can visit the National Cancer Institute's definition page.
