A synthetic form of corticotropin (ACTH); stimulates the adrenal gland to primarily produce corticosteroids (hydrocortisone) and a small amount of mineralocorticoids (aldosterone). Action requires intact adrenal responsiveness.
Therapeutic effects:
Production of adrenal steroids after administration.
IM IV (Adults and Children >2 yr): 0.25 mg as a single dose.
IM IV (Children <2 yr): 0.125 mg as a single dose.
Availability⬆⬇
(Generic available)
Powder for injection: 0.25 mg/vial
Assessment⬆⬇
In patients with a history of allergic reactions, monitor for hypersensitivity response (wheezing, rash or hives, and erythema) Cosyntropin is less likely than ACTH to cause such a response.
Lab Test Considerations:
Plasma cortisol concentrations will be measured before and 30 or 60 min after administration of cosyntropin. Therapeutic response is a rise in the plasma cortisol of at least 7 mcg/dL above baseline or a final concentration of at least 18 mcg/dL. In patients with septic shock, a therapeutic response is defined as a rise in the plasma cortisol of at least 9 mcg/dL. Administration of corticosteroids, estrogens, or spironolactone on day of test will interfere with test results by causing elevated baseline plasma cortisol concentrations.
Implementation⬆⬇
Do not confuse Cortrosyn with colchicine.
Discontinue spironolactone and glucocorticoids on the day that cosyntropin testing is performed. Long-acting glucocorticoids may need to be discontinued for a longer period before administration of cosyntropin. Discontinue estrogen-containing medications 4–6 wk before cosyntropin testing.
May be administered IM, IV push, and by IV infusion.
Discard unused reconstituted cosyntropin.
IV Administration:
Reconstitute 0.25 mg vial with 1 mL of 0.9% NaCl for injection.
Intermittent Infusion: Diluent: May be further diluted in 50 mL of D5W or 0.9% NaCl. Stable for 12 hr at room temperature or 21 days if refrigerated.
Rate: Infuse at a rate of 40 mcg/hr over 6 hr.
Y-Site Incompatibility: Do not administer other drugs through same IV line.
Patient/Family Teaching⬆⬇
Explain purpose of cosyntropin and need for lab tests.
Evaluation/Desired Outcomes⬆⬇
Differentiation of primary from secondary adrenocortical insufficiency.
