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.
Pharmacokinetics⬆⬇
Absorption: Rapidly absorbed.
Distribution: Removed from plasma to many tissues.
Metabolism/Excretion: Unknown.
Half-Life: Unknown.
Time/Action Profile⬆⬇
(effects on plasma cortisol levels)
ROUTE
ONSET
PEAK
DURATION
IM, IV
5 min
45–60 min
unknown
Contraind./Precautions⬆⬇
Contraindicated in:
Hypersensitivity.
Use Cautiously in:
OB: Pregnancy or lactation (safety not established).
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.
May be administered IM, IV push, and by IV infusion.
Reconstitute 250-mcg vial with 1 mL of 0.9% NaCl for IM injection.
Discard unused reconstituted cosyntropin.
IV Administration:
Reconstitute 250-mcg vial with 2–5 mL of 0.9% NaCl for IV push 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.
Patient/Family Teaching⬆⬇
Explain purpose of cosyntropin and need for lab tests.
Evaluation/Desired Outcomes⬆⬇
Differentiation of primary from secondary adrenocortical insufficiency.
US Brand Names⬆⬇
Cortrosyn
Code⬆
NDC Code
0548- Amphastar Pharmaceuticals, Inc.
0548-5900- Cortrosyn
0548-5900-00- 10 VIAL in 1 CARTON (0548-5900-00) > 1 mL in 1 VIAL
0781- Sandoz Inc
0781-3440- Cosyntropin
0781-3440-95- 10 VIAL in 1 CARTON (0781-3440-95) > 1 mL in 1 VIAL (0781-3440-71)
