Dosing and uses of Cortrosyn, Synthetic ACTH (cosyntropin)
Adult dosage forms and strengths
powder for injection
- 0.25mg/vial
Screening of Adrenocortical Insufficiency
0.25-0.75 mg direct IV/Im
May administer 0.25 mg as IV infusion at 40 mcg/hr over 6 hr to provide greater stimuluse to the adrenal gland
Pediatric dosage forms and strengths
powder for injection
- 0.25mg/vial
Screening of Adrenocortical Insufficiency
< 2 years
- 0.125 mg IV/IM
> 2 years
- 0.25-0.75 mg direct IV/IM
- May administer 0.25 mg as IV infusion at 40 mcg/hr over 6 hr to provide greater stimuluse to the adrenal gland
Cortrosyn, Synthetic ACTH (cosyntropin) adverse (side) effects
Frequency not defined
Flushing
Mild fever
Pruritus
Chronic pancreatitis
Hypersensitivity
Rash
Peripheral edema
Tachycardia
Bradycardia
Adrenal hemorrhage
Warnings
Contraindications
Hypersensitivity to cosyntropin
Cautions
Hx of hypersensitivity to natural ACTH
Use caution in patients with gastrointestinal disease, cardiovascular disease, hepatic disease, infections, myasthenia gravis, ocular disease, psychiatric disturbances, osteoporosis, renal disease, thyroid disease
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 Cortrosyn, Synthetic ACTH (cosyntropin)
Mechanism of action
Mimics natural ACTH; stimulates adrenal cortex to secrete adrenal steroids (cortisone and hydrocortisone), androgenic substances, and aldosterone
Pharmacokinetics
Duration: IM: <4 hr
Onset: IM: 1 hr
Time to peak plasma concentration: Within 1 hr (IM, IV push)
Bioavailability: Well absorbed from parenteral route
Vd: 43%
Half-life: 7 min
Metabolism: Unknown
Excretion: Urine
Absorption: Rapid (IM)
Administration
IV Incompatibilities
Compatibility of cosyntropin for injection with other drugs depends on several factors (eg, concentration of the drugs, specific diluents used, resulting pH, temperature)
IV/IM Administration
Administer by IM or IV injection or by IV infusion
