Dosing and uses of Acthrel (corticorelin)
Adult dosage forms and strengths
powder for injection
- 100mcg
Cushing Syndrome Differential Diagnosis
Indicated to differentiate between pituitary and ectopic ACTH production in patients with ACTH-dependent Cushing syndrome
1 mcg/kg IV infused over 30-60 seconds is the lowest dose that may produce maximal cortisol response and significant (perhaps sub-maximal) ACTH responses
Doses >1 mcg/kg not recommended
Draw ACTH baseline 15 minutes before dose (ie, average of 2 venous blood samples)
Draw postdose blood samples at 15, 30, and 60 minutes
Pediatric dosage forms and strengths
powder for injection
- 100mcg
Cushing Syndrome Differential Diagnosis
Indicated to differentiate between pituitary and ectopic ACTH production in patients with ACTH-dependent Cushing syndrome
1 mcg/kg IV infused over 30-60 seconds is lowest dose that may produce maximal cortisol response and significant (perhaps sub-maximal) ACTH responses
Doses >1 mcg/kg not recommended
Draw ACTH baseline 15 minutes before dose (ie, average of 2 venous blood samples)
Draw postdose blood samples at 15, 30, and 60 minutes
Acthrel (corticorelin) adverse (side) effects
>10%
Flushing of face, neck, and upper chest
1-10%
Dyspnea
<1%
Dizziness
Asystole
Seizure
Tachycardia
Xerostomia
Vomiting
Warnings
Contraindications
None listed in the manufacturer's labeL
Cautions
>1 mcg/kg not recommended, more adverse events but no benefit
Plasma ACTH response to corticorelin injection is inhibited or blunted in normal subjects pretreated with dexamethasone; use of heparin solution to maintain IV. cannula patency during corticorelin test not recommended; possible interaction between corticorelin and heparin associated with major hypotensive reaction reported after corticorelin administration
Carcinogenic potential of corticorelin not studied
Use caution in patients with hypersensitivity to sheep products
False negative reported to occur in up to 5-10% of Cushing's disease patients
Pregnancy and lactation
Pregnancy category: C
Lactation: Excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Acthrel (corticorelin)
Mechanism of action
Synthetic ovine corticotropin-releasing hormone; aids the clinician in differentiating between the causes of ACTH-dependent hypercortisolism (pituitary Vs ectopic) by measuring plasma ACTH and cortisol response to corticotropin-releasing hormone
Pharmacokinetics
Onset of ACTH Release: 2 min
ACTH Release Peak Plasma Time: 15-60 min
Onset of Cortisol Release: 10 min
Cortisol Release Peak Plasma Time: 60-120 min
Administration
IV Preparation
Reconstituted aseptically with 2 mL of NS by injecting it into lyophilized drug (conc=50 mcg/mL)
Roll vial to dissolve, do not shake
IV Administration
Give as bolus; however, some adverse events can be reduced by giving it as 30-sec infusion
