cosyntropin

Action and Spectrum

Actions and spectrum: 

cosyntropin is a synthetic form of adrenocorticotropic hormone produced by the pituitary gland. It acts on the adrenal cortex to stimulate the production and release of cortisol.

This steroid hormone regulates various physiological processes, including metabolism, immune function, and stress response. cosyntropin is a diagnostic tool to assess adrenal function, particularly in patients with suspected adrenal insufficiency or Addison’s disease. 

cosyntropin also has some anti-inflammatory and immunomodulatory effects, which may benefit its therapeutic benefits in certain conditions like multiple sclerosis and rheumatoid arthritis. However, its primary action is stimulating cortisol production in the adrenal glands. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Flushing 

Pruritus 

Hypersensitivity 

Peripheral edema 

Bradycardia 

Mild fever 

Chronic pancreatitis 

Rash 

Tachycardia 

Adrenal hemorrhage  

Post marketing Reports 

Anaphylactic reaction 

Black Box Warning

Black Box Warning:  

There is no black box warning associated with the use of cosyntropin. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

cosyntropin is contraindicated in individuals with known hypersensitivity to synthetic adrenocorticotropic hormone (ACTH) or any inactive ingredients in the formulation. Additionally, cosyntropin is contraindicated in patients with systemic fungal infections since the medication may stimulate the growth of fungi.

It must be used cautiously in patients with peptic ulcers, ulcerative colitis, and diverticulitis, as the medication may exacerbate these conditions. Finally, cosyntropin should be used cautiously in individuals with hypertension, congestive heart failure, or renal disease, as the medication may cause fluid retention and worsen these conditions.  

Caution: 

• Cardiovascular disease: cosyntropin can cause an increase in blood pressure and heart rate, which can be dangerous for patients with cardiovascular disease. 
• Diabetes: cosyntropin can cause an increase in blood glucose levels, which can be problematic for patients with diabetes. 
• Hypothyroidism: cosyntropin can cause a decrease in thyroid hormone levels, which can be problematic for patients with hypothyroidism. 
• Peptic ulcer disease: cosyntropin can increase stomach acid production, exacerbating peptic ulcer disease. 
• Seizure disorders: cosyntropin can lower the seizure threshold, making it more likely for patients with seizure disorders to experience seizures. 
• Myasthenia gravis: cosyntropin can exacerbate muscle weakness in patients with myasthenia gravis. 
• Renal impairment: cosyntropin is primarily eliminated by the kidneys, and patients with renal impairment may be at increased risk of adverse effects. 
• Hepatic impairment: cosyntropin is metabolized in the liver, and patients with hepatic impairment may be at increased risk of adverse effects. 

Pregnancy / Lactation

Pregnancy consideration: pregnancy category C 

Lactation: Safety and efficacy not established  

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women. 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits These category drugs should be prohibited for pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

cosyntropin, also known as ACTH (adrenocorticotropic hormone), is a synthetic polypeptide that acts as a hormone. It is a medication structurally like naturally occurring ACTH and has similar biological activity. 

cosyntropin binds to melanocortin receptors found on the adrenal cortex and stimulates the release of cortisol and other corticosteroids.

Cortisol regulates various physiological functions, including glucose metabolism, immune response, and stress response. cosyntropin also has immunomodulatory effects, which may contribute to its therapeutic efficacy in certain conditions.  

Pharmacodynamics: 

cosyntropin, or adrenocorticotropic hormone (ACTH), is a synthetic analog of natural ACTH. It stimulates the adrenal gland to produce and release cortisol, a steroid hormone crucial in regulating the body’s stress response, immune system, and metabolism. 

ACTH binds to the melanocortin receptor in the adrenal cortex, activating the adenylate cyclase-cAMP-protein kinase A (PKA) pathway, which leads to the synthesis and release of cortisol. ACTH also increases the production of other adrenal steroids, including androgens and aldosterone, but to a lesser extent than cortisol. 

The pharmacodynamic effects of cosyntropin are like those of natural ACTH. Cortisol release increases blood glucose levels, enhances protein catabolism, and increases lipolysis. It also has potent anti-inflammatory effects, making it helpful in treating inflammatory and autoimmune conditions such as rheumatoid arthritis and multiple sclerosis.  

Pharmacokinetics: 

Absorption 

cosyntropin is administered by injection, typically intramuscular or intravenous. It is rapidly absorbed into the bloodstream after injection 

Distribution 

cosyntropin is distributed throughout the body, including to the adrenal gland, which stimulates the release of cortisol. 

Metabolism 

cosyntropin is broken down by proteolytic enzymes, primarily in the liver and kidneys. 

Elimination and excretion 

The breakdown products of cosyntropin are excreted in the urine. 

The half-life of cosyntropin is short, typically minutes to hours. Its pharmacologic effects are short-lived, with a rapid onset and short duration of action. 

Adminstartion

Administration: 

cosyntropin is usually administered intravenously or intramuscularly. The dosage and route of administration may vary depending on the specific condition being treated and the individual patient factors.

The injection site should be cleaned before administration, and the needle should be inserted at a 90-degree angle into the muscle or vein. The injection should be given slowly, and the patient should be monitored for adverse reactions. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: cosyntropin 

Pronounced: [ KOE-sin-TROE-pin]  

Why do we use cosyntropin? 

• Diagnostic testing: cosyntropin is used to diagnose conditions related to the adrenal gland, such as adrenal insufficiency, Addison’s disease, and Cushing’s syndrome. 
• Treatment of infantile spasms: cosyntropin is sometimes used off-label to treat infantile spasms, a type of seizure disorder typically affecting infants between 4-8 months of age. 
• Other uses: cosyntropin may treat other conditions, such as multiple sclerosis, rheumatoid arthritis, and lupus.