No

Diagnostic Agent, Adrenocortical Insufficiency

Diagnostic test to differentiate primary adrenal from secondary (pituitary) adrenocortical insufficiency

C

Known hypersensitivity to cosyntropin

Use with caution in patients with pre-existing allergic disease or a history of allergic reactions to corticotropin

1% to 10%:

Cardiovascular: Flushing

Central nervous system: Mild fever

Dermatologic: Pruritus

Gastrointestinal: Chronic pancreatitis

<1%: Hypersensitivity reactions

Decreased effect: May decrease effect of anticholinesterases in patients with myasthenia gravis, nondepolarizing neuromuscular blockers, phenytoin and barbiturates may decrease effect of cosyntropin No data reported

Reconstitute with NS

Stability of parenteral admixture at refrigeration temperature (4°C): 21 days

I.V. infusion in NS or D₅W is stable 12 hours at room temperature

Stimulates the adrenal cortex to secrete adrenal steroids (including hydrocortisone, cortisone), androgenic substances, and a small amount of aldosterone

Distribution: Crosses the placenta

Metabolism: Unknown

Time to peak serum concentration: Within 1 hour (plasma cortisol levels rise in healthy individuals within 5 minutes of administration I.M. or I.V. push)

Adrenocortical insufficiency: I.M., I.V. (over 2 minutes): Peak plasma cortisol concentrations usually occur 45-60 minutes after cosyntropin administration

Neonates: 0.015 mg/kg/dose

Children <2 years: 0.125 mg

Children >2 years and Adults: 0.25-0.75 mg

When greater cortisol stimulation is needed, an I.V. infusion may be used:

Children >2 years and Adults: 0.25 mg administered at 0.04 mg/hour over 6 hours

Congenital adrenal hyperplasia evaluation: 1 mg/m²/dose up to a maximum of 1 mg

Give I.V. doses over 2 minutes

Normal baseline cortisol; increase in serum cortisol after cosyntropin injection of >7 mg/dL or peak response >18 mg/dL; plasma cortisol concentrations should be measured immediately before and exactly 30 minutes after a dose

Decreased effect: Spironolactone, hydrocortisone, cortisone

None reported

Barbiturates may decrease the levels of cosyntropin

No information available to require special precautions

No effects or complications reported

Take oral medication with 8 oz of water on empty stomach (1 hour before or 2 hours after meals) for best absorption; report any skin rashes immediately

Patient should not receive corticosteroids or spironolactone the day prior and the day of the test

Powder for injection: 0.25 mg