Cosyntropin (Synthetic Corticotropin, Synthetic ACTH)
| (koe-sin-TROE-pin) |
| Cortrosyn |
| Class: Adrenal cortical steroid |
Action Exhibits full corticosteroidogenic activity of natural ACTH, stimulating adrenal cortex to produce and secrete adrenocortical hormones.
Indications Diagnostic testing of adrenal function.
Contraindications Standard considerations.
Route/DosageADULTS: IM/IV (direct injection) 0.25–0.75 mg. IV infusion 0.25 mg in D5W or 0.9% saline administered at 0.04 mg/hr over 6 hr. CHILDREN £ 2 YR: IM/IV 0.125 mg often will be sufficient.
InteractionsAnticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Barbiturates: May decrease pharmacologic effect of cosyntropin. Hydantoins: May increase clearance and decrease therapeutic efficacy of cosyntropin.
Lab Test Interferences None well documented.
Adverse ReactionsOTHER: Rare hypersensitivity.
PrecautionsPregnancy: Category C. Lactation: Undetermined. Hypersensitivity: Exhibits slight immunologic activity but is less likely to cause reactions than natural ACTH.
| PATIENT CARE CONSIDERATIONS |
|
Administration/Storage- Before administration, be prepared to treat possible acute hypersensitivity reaction.
- Administer by IM route, direct IV injection or IV infusion.
- Reconstitute 0.25 mg vial with 1 ml of 0.9% Sodium Chloride for Injection.
- Administer reconstituted drug via IM route or by direct IV injection over 2 min or further dilute in D5W or normal saline and infuse over 4–8 hr.
- Do not allow cosyntropin to mix with blood or plasma infusions.
- Reconstituted preparations should not be retained.
Assessment/Interventions- Obtain patient history, including drug history and any known allergies. Note hypersensitivity to natural corticotropin.
- Measure plasma cortisol concentrations prior to and 30–60 min after administration. Collect blood sample of 6–7 ml in heparinized tube.
- Alternatively, measure urinary steroids before and after IV infusion.
Patient/Family Education- 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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