Cosyntropin Dosage

Medically reviewed by Drugs.com. Last updated on Jul 17, 2023.

Applies to the following strengths: 0.25 mg; 0.25 mg/mL

Usual Adult Dose for Adrenocortical Insufficiency

Rapid Screening Test for Adrenal Function: 0.25 mg IV or IM once

Dose range of 0.25 to 0.75 mg has been used in clinical studies; maximal response occurred with 0.25 mg dose
At 30 minutes post-dose, a rise of at least 7 mcg/100 mL is expected; stimulated plasma cortisol levels less than 18 to 20 mcg/dL at 30 to 60 minutes post dose are suggestive of adrenocortical insufficiency.

Comments:

Patients should omit pre-test doses of cortisone, hydrocortisone, or spironolactone to avoid diagnostic inaccuracies.
An IV infusion has also been used to provide a greater stimulus to the adrenal glands; same dose infused over 4 to 8 hours with adrenal response measured by urinary steroid excretion before and after treatment or measuring plasma cortisol levels before and at the end of the infusion (preferred).
Test results can be affected by concomitant medications and certain medical conditions.

Use: As a diagnostic drug in screening patients presumed to have adrenocortical insufficiency.

Usual Pediatric Dose for Adrenocortical Insufficiency

Rapid Screening Test for Adrenal Function:

0 to 2 years: 0.125 mg IV or IM once

3 years or older: 0.25 mg IV or IM once

Dose range of 0.25 to 0.75 mg has been used in clinical studies; maximal response occurred with 0.25 mg dose

At 30 minutes post-dose, a rise of at least 7 mcg/100 mL is expected; stimulated plasma cortisol levels less than 18 to 20 mcg/dL at 30 to 60 minutes post dose are suggestive of adrenocortical insufficiency.

Comments:

Patients should omit pre-test doses of cortisone, hydrocortisone, or spironolactone to avoid diagnostic inaccuracies.
An IV infusion has also been used to provide a greater stimulus to the adrenal glands; same dose infused over 4 to 8 hours with adrenal response measured by urinary steroid excretion before and after treatment or measuring plasma cortisol levels before and at the end of the infusion (preferred).
Test results can be affected by concomitant medications and certain medical conditions.

Use: As a diagnostic drug in screening patients presumed to have adrenocortical insufficiency.

Renal Dose Adjustments

Use caution in patients with nephrotic syndrome

Cortisol binding globulin levels can be low in patients with nephrotic syndrome; for these patients, cortisol binding globulin levels should be measured

Liver Dose Adjustments

Use caution in patients with cirrhosis

Cortisol binding globulin levels can be low in patients with cirrhosis; for these patients, cortisol binding globulin levels should be measured

Precautions

CONTRAINDICATIONS:

Hypersensitivity to active substance, synthetic ACTH, or any product excipients

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
May be administered IM or IV; however, some products for IV administration only

IV administration:

IV injection: Add dose to 2 to 5 mL of 0.9% sodium chloride injection; administer over 2-minutes
IV infusion: Add dose to glucose or saline solution and give at approximately 40 mcg/hour for 6 hours

IM administration:

Reconstitute 0.25 mg with 1 mL of 0.9% sodium chloride injection; inject IM

ACTH Stimulation Test:

Collect blood sample (6 to 7 mL) prior to injection
Administer dose
Collect second blood sample 30 and/or 60 minutes postdose

Storage requirements:

Protect from light
Store refrigerated 36F to 46F (2C to 8C); protect from freezing

General:

Plasma cortisol levels less than 18 to 20 mcg/dL at 30 or 60 minutes post injection are suggestive of adrenocortical insufficiency.
Test results may be affected by concomitant medications (e.g. cortisone, hydrocortisone, synthetic glucocorticoids [oral, inhaled, or injectable], spironolactone, and estrogens) or certain medical conditions (e.g., cirrhosis, nephrotic syndrome).
Concurrent measurement of cortisol binding globulin levels is recommended; if cortisol binding globulin levels are elevated, plasma total cortisol levels should be considered inaccurate.

Monitoring: