Neonatal Drug Therapy Manual

Cosyntropin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ACTH (Cortrosyn)
Classification: 
Adrenal Corticosteroid
Original Date: 
January 2009
Revised Date: 
May 2020
Indications: 
  • To assess recovery of normal adrenal responsiveness after steroid hormone treatment
  • For diagnosis of congenital adrenal hyperplasia
Administration: 
  • IV direct: infuse IV over 2 minutes
    • To avoid potential loss during administration, do not administer via a T-connector.
    • For low ACTH Stimulation test, dilute 1 mL (1 mcg) cosyntropin syringe received from pharmacy with 2 mL normal saline for a total volume of 3 mL.  Administer IV direct over 2 minutes. Flush and saline lock after administration.
    • For regular ACTH Stimulation test, reconstitute 0.25 mg vial with 1 mL of normal saline for a final concentration of 0.25 mg/mL or 250 microgram/mL.  Withdraw dose (15 mcg/kg) and further dilute with normal saline for a total volume of 3 mL.  Administer IV direct over 2 minutes. Flush and saline lock.
Dosage: 
  • Low-Dose ACTH Stimulation Test (for suspected secondary adrenal insufficiency including suspected adrenal suppression from long-term glucocorticoid therapy):
    • 1 microgram/kg (Max 1 microgram) IV x 1 dose
  • ACTH Stimulation Test (for primary adrenal insufficiency including congenital adrenal hyperplasia): 
    • < 2 years: 15 mcg/kg IV
Side Effects: 
  • Unlikely with short-term use
  • Rarely, hypersensitivity reactions
Parameters to Monitor: 
  • Care Map for Low Dose ACTH Stimulation Test - Infant < 1 month CGA
Procedure 0 min 30 min 45 min 60 min
HR, BP x      
Baseline bloodwork if ordered1,2   x    
Serum Cortisol1   x x x
Cosyntropin x      

1 Refer to Table of Sample Requirements for Endocrine Tests for type of tube and minimum volume

2 Verify with physician if baseline bloodwork ordered if OK to be completed AFTER Cosyntropin

 

  • Care Map for Low Dose ACTH Stimulation Test - Infant > 1 month CGA
Procedure 0 min 15 min 30 min 45 min 60 min
HR, BP x        
Baseline bloodwork if ordered1 x        
Serum Cortisol1 x x x x x
Cosyntropin x        

1 Refer to Table of Sample Requirements for Endocrine  Tests for type of tube and minimum volume

 

  • Care Map for Regular ACTH Stimulation Test
Investigations/Medications 0 min* 30 min 60 min
Cosyntropin x    
Additional baseline bloodwork x    
Cortisol x x x
ACTH x    

* Ensure all 0 min investigations are all drawn prior to Cosyntropin administration

Reconstitution and Stability: 
  • Low Dose ACTH Stimulation Test
    • Cosyntropin 1 mcg/mL syringe dispensed by pharmacy

 

  • Regular ACTH Stimulation Test
    • Cosyntropin 0.25 mg vial
      • Add 1 mL normal saline
      • Final concentration: 0.25 mg/mL (equivalent to 250 micrograms/mL)
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: no information

- Incompatible: blood, plasma

Notes: 
  • 0.25 mg = 250 mcg
  • All glucocorticoids including inhaled corticosteroids should be held for at least 24 hours prior to ACTH stimulation test if possible.  If the patient has received glucocorticoids on the day of the scheduled test, contact the physician prior to proceeding.
References: 

1.    LeDrew R, Bariciak E, Webster R, Barrowman N, Ahmet A, Timing of Peak Serum Cortisol Levels Following Low-Dose ACTH Stimulation in Neonates. Poster presentation at the Pediatric Academic Societies Meeting, Toronto ON, May 6th, 2018. 

2.   Kristi et al. Effect of Dose on Response to Adrenocorticotropin in Extremely Low Birth Weight Infants. JCEM. 90:6380-6385, 2005
3.   Kazlauskaite Rasa et. Al. Corticotropin Tests for Hypothalamic-Pituitary-Adrenal Insufficency: A Metaanalysis. JCEM 93:4245-4253, 2008

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