Cosyntropin
( Synthetic Corticotropin )Pronunciation: KOE-sin-TROE-pin
Class: Adrenalcortical steroid
Trade Names
Cortrosyn
- Injection, lyophilized powder for reconstitution 0.25 mg
Cosyntropin
- Injection, solution 0.25 mg/mL
Pharmacology
Exhibits full corticosteroidogenic activity of natural corticotropin, stimulating the adrenal cortex to produce and secrete adrenocortical hormones.
Indications and Usage
Diagnostic testing of adrenal function.
Contraindications
Standard considerations.
Dosage and Administration
Adults and Children older than 2 yr of ageIM/IV (direct injection) 0.25 to 0.75 mg. IV infusion 0.25 mg in dextrose 5% in water or saline 0.9% administered at 0.04 mg/h over 6 h.
NoteCortrosyn may be administered IM or IV; cosyntropin must be administered by IV only.
Children 2 yr of age and youngerIM/IV 0.125 mg often will be sufficient.
General Advice
- Do not allow cosyntropin to mix with blood or plasma infusions.
- Reconstituted preparations should not be retained.
- For IM administration, reconstitute 0.25 mg of Cortrosyn in solvent (1 mL ampule of sodium chloride 0.9% injection) and inject intramuscularly.
- For IV administration, reconstitute cosyntropin with 2 to 5 mL of sodium chloride 0.9% injection. For administration as an IV infusion, cosyntropin 0.25 mg may be added to glucose or saline solutions.
- Cosyntropin: Do not administer by IM; may be administered as a direct IV injection or as an IV infusion.
- Cortrosyn may be administered IM, as a direct IV injection, or as an IV infusion.
- Cosyntropin can be injected IV over a 2-min period. When given as an IV infusion, give at a rate of approximately 40 mcg/h over a 6-h period.
Storage/Stability
CortrosynStore at 59° to 86°F.
CosyntropinStore refrigerated at 36° to 46°F; protect from light and freezing.
Drug Interactions
AnticholinesterasesMay antagonize anticholinesterase effects in myasthenia gravis.
BarbituratesMay decrease pharmacologic effect of cosyntropin.
CarbamazepineMay decrease pharmacological effect of cosyntropin.
DiureticsCorticotropin may accentuate the electrolyte loss associated with diuretic therapy.
HydantoinsMay increase clearance and decrease therapeutic efficacy of cosyntropin.
Interleukin-2Pharmacologic effects may be decreased by cosyntropin; avoid coadministration.
MifepristoneCoadministration is contraindicated.
RitodrinePotential for increased risk of maternal pulmonary edema when coadministered with cosyntropin.
WarfarinMay require reduced dosage of warfarin; monitor INR closely and adjust dose as needed.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Miscellaneous
Rare hypersensitivity (eg, slight whealing with splotchy erythema at injection site).
Precautions
MonitorPlasma cortisol concentrationsMeasure plasma cortisol concentrations prior to and 30 min after administration. Collect blood sample of 6 to 7 mL in heparinized tube. Urinary steroidsAlternatively, measure urinary steroids before and after IV infusion. |
Pregnancy
Category C .
Lactation
Undetermined.
Hypersensitivity
Exhibits slight immunologic activity but is less likely to cause reactions than natural ACTH.
Concomitant therapy
Patients taking cortisone or hydrocortisone on the test day and patients taking spironolactone may exhibit abnormally high basal plasma cortisol levels. A decrease in plasma cortisol values following a stimulating dose of cosyntropin in patients taking cortisone or hydrocortisone may be seen, while a normal response is expected in patients taking spironolactone.
Patient Information
- Explain purpose of the test.
- Emphasize importance of lab tests.
- Instruct patients taking corticosteroids or aldosterone to omit doses on day of test.
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