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Cosyntropin is a brand name for Cosyntropin (also known as Tetracosactide). The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: INDICATIONS AND USAGE Cosyntropin for Injection is intended for use as a diagnostic agent in the screening of patients presumed to have adrenocortical insufficiency. Because of its rapid effect on the adrenal cortex it may be utilized to perform a 30-minute test of adrenal function (plasma cortisol response) as an…
Verbatim from this product's FDA label. Tap a section to expand.
DOSAGE AND ADMINISTRATION
Cosyntropin for Injection may be administered intramuscularly or as a direct intravenous injection when used as a rapid screening test of adrenal function. It may also be given as an intravenous infusion over a 4 to 8 hour period to provide a greater stimulus to the adrenal glands.
75 mg have been used in clinical studies and a maximal response noted with the smallest dose. A suggested method for a rapid screening test of adrenal function has been described by Wood and Associates (1). A control blood sample of 6 to 7 mL is collected in a heparinized tube.
9% Sodium Chloride Injection, USP and inject intramuscularly. The reconstituted drug product should be inspected visually for particulate matter and discoloration prior to injection. Reconstituted Cosyntropin for Injection should not be retained.
125 mg will often suffice. A second blood sample is collected exactly 30 minutes later. Both blood samples should be refrigerated until sent to the laboratory for determination of the plasma cortisol response by some appropriate method.
If it is not possible to send them to the laboratory or perform the fluorimetric procedure within 12 hours, then the plasma should be separated and refrigerated or frozen according to need. Two alternative methods of administration are intravenous injection and infusion.
Cosyntropin for Injection can be injected intravenously in 2 to 5 mL of saline over a 2-minute period. 25 mg may be added to glucose or saline solutions and given at the rate of approximately 40 micrograms per hour over a 6-hour period.
It should not be added to blood or plasma as it is apt to be inactivated by enzymes. Adrenal response may be measured in the usual manner by determining urinary steroid excretion before and after treatment or by measuring plasma cortisol levels before and at the end of the infusion.
The latter is preferable because the urinary steroid excretion does not always accurately reflect the adrenal or plasma cortisol response to ACTH. The usual normal response in most cases is an approximate doubling of the basal level, provided that the basal level does not exceed the normal range.
Patients receiving cortisone, hydrocortisone or spironolactone should omit their pre-test doses on the day selected for testing. Patients taking inadvertent doses of cortisone or hydrocortisone on the test day and patients taking spironolactone or women taking drugs which contain estrogen may exhibit abnormally high basal plasma cortisol levels.
ADVERSE REACTIONS
Since Cosyntropin for Injection is intended for diagnostic and not therapeutic use, adverse reactions other than a rare hypersensitivity reaction are not anticipated. A rare hypersensitivity reaction usually associated with a pre-existing allergic disease and/or a previous reaction to natural ACTH is possible.
Symptoms may include slight whealing with splotchy erythema at the injection site. There have been rare reports of anaphylactic reaction. The following adverse reactions have been reported in patients after the administration of Cosyntropin for Injection and the association has been neither confirmed nor refuted: • bradycardia • tachycardia • hypertension • peripheral edema • rash
CONTRAINDICATION
The only contraindication to Cosyntropin for Injection is a history of a previous adverse reaction to it.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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A paradoxical response may be noted in the cortisone or hydrocortisone group as seen in a decrease in plasma cortisol values following a stimulating dose of Cosyntropin for Injection. In the spironolactone or estrogen group only a normal incremental response is to be expected.
Many patients with normal adrenal function, however, do not respond to the expected degree so that the following criteria have been established to denote a normal response: The control plasma cortisol level should exceed 5 micrograms/100 mL.
The 30-minute level should show an increment of at least 7 micrograms/100 mL above the basal level. The 30-minute level should exceed 18 micrograms/100 mL. Comparable figures have been reported by Greig and co-workers (2). Plasma cortisol levels usually peak about 45 to 60 minutes after an injection of Cosyntropin for Injection and some prefer the 60-minute interval for testing for this reason.
While it is true that the 60-minute values are usually higher than the 30-minute values, the difference may not be significant enough in most cases to outweigh the disadvantage of a longer testing period. If the 60-minute test period is used, the criterion for a normal response is an approximate doubling of the basal plasma cortisol value.
In patients with a raised plasma bilirubin or in patients where the plasma contains free hemoglobin, falsely high fluorescence measurements will result. The test may be performed at any time during the day but because of the physiological diurnal variation of plasma cortisol the criteria listed by Wood cannot apply.
It has been shown that basal plasma cortisol levels and the post Cosyntropin for Injection increment exhibit diurnal changes. However, the 30-minute plasma cortisol level remains unchanged throughout the day so that only this single criterion should be used (3).
Parenteral drug products should be inspected visually for particulate matter and discoloration whenever solution and container permit. Reconstituted Cosyntropin for Injection should not be retained.