Parenteral Manual


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Alternate Name(s): 
Synthetic Adrenocorticotropic hormone
Original Date: 
August 2005
Revised Date: 
October 2015
  • 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)

- Solutions Compatible: D5W, 0.9% NaCl

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: blood, plasma


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

Usual dilution: 0.25 mg/mL
IV Direct

Usual dilution: in 2-5 mL of NS
Infusion time: over 2 minutes

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

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 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


  • 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
  • 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

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