NAME OF DRUG
cosyntropin

CLASSIFICATION

Synthetic Adrenocorticotropic Hormone

ALTERNATE NAME

CORTROSYN

INDICATIONS

• diagnostic testing of adrenocortical function

RECONSTITUTION AND STABILITY

• stable at room temperature
• reconstitute 0.25 mg vial with 1 mL NS
• reconstituted solutions should not be stored longer than 24 hours in refrigerator

COMPATIBILITY

• compatible with dextrose and saline solutions
• incompatible with other drugs

ROUTES OF ADMINISTRATION

• IM
• IV direct - over a 2 minute period
• IV infusion - 0.04 mg/hour for 6 hours

 VH & HSC ADMINISTRATION POLICY

E - Direct IV route can be administered by nurses on general nursing units provided a venous access has been established, and according to policies and recommendations stated in this manual.

 DOSAGE

For rapid screening for adrenocortical insuffiency

Adult:

• 1mcg OR 250mcg IM or direct IV over 2 minutes
• the literature suggests that the 1mcg dose is a more sensitive screening test

Cosyntropin 0.25 mg is approximately equivalent to 25 units of corticotropin (ACTH) 

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• transient local induration and pain after IM injection
• serious allergic reactions

 IMPORTANT IMPLICATIONS

• measure baseline plasma cortisol levels immediately before and exactly 30 minutes after IM or IV injection
• normal adrenal function is indicated by an increase in plasma cortisol concentrations above 500nmol/L
• fewer hypersensitivity reactions than with ACTH, however patients should be monitored for at least 1 hour after administration
• patients should not receive pretest doses of cortisone, hydrocortisone, or spironolactone on the day of testing due to interaction with fluorometric analysis resulting in erroneously high plasma cortisol concentrations; therapy with prednisone, dexamethasone, and betamethasone may be maintained as these drugs are not detectable with the fluorometric method.
• short term administration of cosyntropin, even in large doses, is unlikely to produce harmful effects
• prolonged use may result in hypothalmic-pituitary insufficiency

References: Lancet 2000;355:542-5. J Clin Endocrinol Metab 1998;83:2726-9. J Clin Endocrinol Metab 1995;80:1301-5.

Rev. July 2000