| U.S. Brand Names |
| Cortrosyn® Injection |
 |
| Generic Available |
|
No |
|
| Synonyms |
| Synacthen; Tetracosactide |
|
| Pharmacological Index |
|
Diagnostic Agent, Adrenocortical Insufficiency |
|
| Use |
|
Diagnostic test to differentiate primary adrenal from secondary (pituitary) adrenocortical insufficiency |
|
| Pregnancy Risk Factor |
|
C |
|
| Contraindications |
|
Known hypersensitivity to cosyntropin |
|
| Warnings/Precautions |
|
Use with caution in patients with pre-existing allergic disease or a history of allergic reactions to corticotropin |
|
| Adverse Reactions |
|
1% to 10%: Cardiovascular: Flushing Central nervous system: Mild fever Dermatologic: Pruritus Gastrointestinal: Chronic pancreatitis <1%: Hypersensitivity reactions |
|
| Drug Interactions |
|
Decreased effect: May decrease effect of anticholinesterases in patients with myasthenia gravis, nondepolarizing neuromuscular blockers, phenytoin and barbiturates may decrease effect of cosyntropin No data reported |
|
| Stability |
|
Reconstitute with NS Stability of parenteral admixture at refrigeration temperature (4°C): 21 days I.V. infusion in NS or D5W is stable 12 hours at room temperature |
|
| Mechanism of Action |
|
Stimulates the adrenal cortex to secrete adrenal steroids (including hydrocortisone, cortisone), androgenic substances, and a small amount of aldosterone |
|
| Pharmacodynamics/Kinetics |
|
Distribution: Crosses the placenta Metabolism: Unknown Time to peak serum concentration: Within 1 hour (plasma cortisol levels rise in healthy individuals within 5 minutes of administration I.M. or I.V. push) |
|
| Usual Dosage |
|
Adrenocortical insufficiency: I.M., I.V. (over 2 minutes): Peak plasma cortisol concentrations usually occur 45-60 minutes after cosyntropin administration Neonates: 0.015 mg/kg/dose Children <2 years: 0.125 mg Children >2 years and Adults: 0.25-0.75 mg When greater cortisol stimulation is needed, an I.V. infusion may be used: Children >2 years and Adults: 0.25 mg administered at 0.04 mg/hour over 6 hours Congenital adrenal hyperplasia evaluation: 1 mg/m2/dose up to a maximum of 1 mg |
|
| Administration |
|
Give I.V. doses over 2 minutes |
|
| Reference Range |
|
Normal baseline cortisol; increase in serum cortisol after cosyntropin injection of >7 mg/dL or peak response >18 mg/dL; plasma cortisol concentrations should be measured immediately before and exactly 30 minutes after a dose |
|
| Test Interactions |
|
Decreased effect: Spironolactone, hydrocortisone, cortisone |
|
| Mental Health: Effects on Mental Status |
|
None reported |
|
| Mental Health: Effects on Psychiatric Treatment |
|
Barbiturates may decrease the levels of cosyntropin |
|
| Dental Health: Local Anesthetic/Vasoconstrictor Precautions |
|
No information available to require special precautions |
|
| Dental Health: Effects on Dental Treatment |
|
No effects or complications reported |
|
| Patient Information |
|
Take oral medication with 8 oz of water on empty stomach (1 hour before or 2 hours after meals) for best absorption; report any skin rashes immediately |
|
| Nursing Implications |
|
Patient should not receive corticosteroids or spironolactone the day prior and the day of the test |
|
| Dosage Forms |
|
Powder for injection: 0.25 mg |
|
|
Copyright © 2007 Drugs Area |
