Alternate Name(s):
CORTROSYN®, ACTH
Classification:
Synthetic Adrenocorticotropic hormone
Original Date:
August 2005
Revised Date:
October 2015
Indications:
- Diagnostic testing of adrenocortical function
Reconstitution and Stability:
- Stable at room temperature prior to reconstitution
- Reconstitute 0.25 mg vial with 1 mL normal saline to produce a 0.25 mg/mL solution
- Reconstituted vial stable 6 hours room temperature, do not store in fridge
- When further diluted in 0.9% Sodium Chloride or D5W, solution is stable for 12 hours at room temperature
- NOTE: 0.25 mg cosyntropin = 25 units corticotropin (ACTH)
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: no information
- Incompatible: blood, plasma
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES Usual dilution: 0.25 mg/mL |
| IV Direct |
YES |
| IV Intermittent Infusion | YES Usual dilution: dose may be added to dextrose or saline solutions Infusion time: over 4-8 hours Infusion rate: 40 mcg/hour |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- Diagnostic Test:
- Less than 2 years old: 15 mcg/kg up to max 250 mcg IV x 1 dose
- Greater than 2 years old: 0.25 mg IM/IV - Low Dose ACTH Stimulation test: 1 mcg IV
Adults:
- Diagnostic Test: 0.25 mg IV/IM of conventional cosyntropin
Potential hazards of parenteral administration:
- Patient should be supine during administration
- Bradycardia, tachycardia, hypertension, peripheral edema
- Pruritis, flushing, rash
Notes:
- 0.25 mg = 250 mcg
- Growth and development of infants and children on corticotropin therapy should be closely observed
- May mask signs of infection
- Contraindicated in patients with active fungal infection, peptic ulcer, osteoporosis, CHF, hypertension, scleroderma, ocular herpes simplex, sensitivity to porcine proteins
- Do not administer with live vaccines (MMR, varicella, yellow fever)
- Fewer hypersensitivity reactions than with ACTH
- Cosyntropin is approximately 100 times more potent than ACTH
- Avoid pre-test doses of cortisone, hydrocortisone and spironolactone on the day of the test
- Patients taking cortisone or hydrocortisone on the day of the test could have abnormally high plasma cortisol levels at baseline and a paradoxical decrease in plasma cortisol level after cosyntropin
- Prednisone, dexamethasone and betamethasone will not interfere with the test