COSYNTROPIN
| COSYNTROPIN (koe-sin-troe'pin) Cortrosyn Classifications: diagnostic agent; Therapeutic: diagnostic agent Prototype: Prednisone Pregnancy Category: C |
Availability
0.25 mg injection
Action
Synthetic polypeptide resembling corticotropin (ACTH) in relation to the first 24 of the 39 amino acids in naturally occurring ACTH. Has less immunologic activity and is associated with less risk of sensitivity than corticotropin.
Therapeutic Effect
In patient with normal adrenocortical function, stimulates adrenal cortex to secrete corticosterone, cortisol (hydrocortisone), several weak androgenic substances, and limited amounts of aldosterone.
Uses
Diagnostic tool to differentiate primary adrenal from secondary (pituitary) adrenocortical insufficiency.
Unlabeled Uses
In patients with normal adrenocortical function for the long-term treatment of chronic inflammatory or degenerative disorders responsive to glucocorticoids.
Contraindications
History of allergic disorders; scleroderma, osteoporosis; systemic fungal infections, ocular herpes simplex; recent surgery; history of or presence of peptic ulcer; CHF; hypertension; adrenocortical insufficiency and adrenocortical hyperfunction; immunizations, tuberculosis, infections; pregnancy (category C), lactation.
Cautious Use
Multiple sclerosis, acute gouty arthritis, mental disturbances, diabetes, abscess, pyrogenic infections, diverticulitis, renal insufficiency, myasthenia gravis, children.
Route & Dosage
| Rapid Screening Test Adult/Child (>2 y): IM/IV 0.25 mg |
Administration
Intramuscular- Reconstitute cosyntropin powder by adding 1.1 mL NS (diluent provided by manufacturer) to vial labeled 0.25 mg to provide solution containing 0.25 mg/mL.
- Inject deep IM into a large muscle.
Intravenous
PREPARE: Direct: Reconstitute as for IM. IV Infusion: Further dilute in 250–500 mL of D5W or NS. ADMINISTER: Direct: Give over 2 min. IV Infusion: Give at an approximate rate of 40 mcg/h over 4–6 h. |
- Reconstituted solutions remain stable 24 h at room temperature or 21 d at 2°–8° C.
- Cosyntropin should not be added to blood or to plasma infusions.
Adverse Effects (≥1%)
Body as a Whole: Mild fever. GI: Chronic pancreatitis. Skin: Pruritus.Diagnostic Test Interference
Cortisone, hydrocortisone, estrogen, spironolactone elevated bilirubin, and presence of free Hgb in plasma may interfere with plasma cortisol determinations.
Interactions
Drug: Cortisone, hydrocortisone can exhibit abnormally high baseline values of cortisol and a decreased response to cosyntropin test.Pharmacokinetics
Absorption: Plasma cortisol levels double in 15–30 min. Peak: 1 h. Duration: 2–4 h. Distribution: Unknown; does not cross placenta. Metabolism: Unknown.Nursing Implications
Assessment & Drug Effects
- Normal 17-KS levels in men are 10–25 mg/24 h; in women <50 y, 5–15 mg/24 h; and in women >50 y, 4–8 mg/24 h.
- Normal 17-OHCS levels in men are 5–12 mg/24 h; in women, 3–10 mg/24 h; in children 8–12 y, <4.5 mg/24 h; in younger children, 1.5 mg/24 h. Levels may be slightly higher in obese or muscular individuals.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug