tetracosactide

Action and Spectrum

Actions and spectrum: 

• Stimulation of Adrenal Cortex: tetracosactide acts primarily on adrenal cortex to stimulate the release of corticosteroid hormones, particularly cortisol. This stimulation helps regulate various physiological processes, including metabolism and immune response. 
• Anti-inflammatory Effects: Through its action on the adrenal cortex, tetracosactide has anti-inflammatory properties. It can be used in conditions where the body needs increased cortisol levels to suppress inflammation and immune responses, such as in autoimmune disorders or allergic reactions. 
• Diagnostic Tool: tetracosactide is also used diagnostically. It is administered as part of an ACTH stimulation test to assess the functioning of the adrenal glands. This test is particularly helpful in diagnosing conditions like Addison’s disease and assessing the pituitary gland’s ability to produce ACTH. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Hypersensitivity reactions 

psychological disturbances 

Vertigo 

Cushing’s syndrome 

Pancreatitis 

haemorrhage 

peptic ulcer 

abdominal distension 

Hyperglycaemia 

increased appetite 

Hypokalaemia 

peripheral oedema 

Osteoporosis 

Convulsion 

myopathy 

headache 

rash 

necrotising vasculitis 

Hypertension 

thromboembolism 

Black Box Warning

Black Box Warning: 

There are no black box warnings associated with the use of tetracosactide. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: tetracosactide should not be used in individuals who have a known hypersensitivity or allergy to this medication or any of its components. 
• Systemic Fungal Infections: tetracosactide may suppress the immune system. It is contraindicated in individuals with systemic fungal infections unless the infection is being effectively treated with antifungal medications. 
• Uncontrolled Hypertension: tetracosactide can cause an increase in blood pressure. It should be used cautiously or avoided in individuals with uncontrolled hypertension. 
• Myocardial Infarction: Individuals who have recently experienced a myocardial infarction should use tetracosactide with caution, as it can have cardiovascular effects. 
• Diabetes Mellitus: tetracosactide can affect blood glucose levels. It should be used cautiously in individuals with diabetes mellitus, and blood sugar levels should be closely monitored.

Caution: 

• Peptic Ulcer Disease: tetracosactide can stimulate gastric acid secretion, potentially aggravating peptic ulcer disease. It should be used with caution in individuals with a history of ulcers. 
• Cardiovascular Conditions: Individuals with pre-existing cardiovascular conditions, such as heart disease or heart rhythm disorders, should be closely monitored while using tetracosactide due to its potential to affect the cardiovascular system. 
• Osteoporosis: Long-term use of tetracosactide can lead to bone loss. Individuals with a history of osteoporosis or at risk of developing it should use this medication with caution. 
• Pregnancy and Lactation: The safety of tetracosactide during pregnancy and breastfeeding is not well-established. Its use during pregnancy should be carefully considered, and it is not recommended during breastfeeding.

Comorbidities: 

• Adrenal Insufficiency: tetracosactide is commonly used to diagnose and treat adrenal insufficiency, where the adrenal glands does not produce enough hormones, such as cortisol. Comorbidities associated with adrenal insufficiency include fatigue, weakness, low blood pressure, and electrolyte imbalances. 
• Autoimmune Disorders: In some cases, adrenal insufficiency can be caused by autoimmune diseases like Addison’s disease. These autoimmune conditions may have additional comorbidities and complications associated with them. 
• Pituitary Disorders: tetracosactide may be used to evaluate pituitary function, it stimulates the release of certain hormones from the adrenal glands. Pituitary disorders, such as pituitary tumors or dysfunction, can lead to hormonal imbalances. 
• Corticosteroid Replacement Therapy: In individuals with adrenal insufficiency, tetracosactide may be used to assess the adequacy of corticosteroid replacement therapy. Comorbidities in this context may involve issues related to long-term corticosteroid use, such as osteoporosis, weight gain, and increased susceptibility to infections. 

Pregnancy / Lactation

Pregnancy consideration: Pregnancy Category: C 

Lactation: excreted into breast milk: unknown  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

tetracosactide, also known as cosyntropin, is a synthetic peptide that mimics the action of adrenocorticotropic hormone. It primarily acts on the adrenal cortex, stimulating the release of cortisol and other steroid hormones. This pharmacological action is essential for diagnosing and managing disorders related to adrenal gland function.

tetracosactide is commonly used in medical practice to assess adrenal responsiveness, particularly in cases of suspected adrenal insufficiency. By testing the adrenal glands’ ability to produce cortisol in response to tetracosactide, healthcare providers can diagnose conditions like Addison’s disease or assess the adequacy of corticosteroid replacement therapy.  

Pharmacodynamics: 

• Stimulation of Adrenal Cortex: tetracosactide primarily acts on the adrenal cortex, specifically the zona fasciculata and zona reticularis. It binds to melanocortin receptors (MC2R) on the surface of adrenal cells, stimulating the production and release of cortisol, a glucocorticoid hormone. This stimulation is essential for maintaining the body’s response to stress, regulating metabolism, and controlling inflammation. 
• Release of Other Steroid Hormones: Besides cortisol, tetracosactide also induces the production and secretion of other steroid hormones like aldosterone and androgens. These hormones play important roles in regulating fluid balance and secondary sexual characteristics. 
• Immunomodulatory Effects: tetracosactide’s activation of the adrenal cortex leads to anti-inflammatory and immunosuppressive effects, making it valuable in managing various inflammatory and autoimmune conditions. 
• Diagnostic Use: tetracosactide is commonly employed as a diagnostic tool to assess the responsiveness of the adrenal glands. In an ACTH stimulation test, it is administered to evaluate the adrenal glands’ ability to produce cortisol in response to ACTH. A lack of cortisol production can indicate adrenal insufficiency.

Pharmacokinetics: 

Absorption 

tetracosactide is typically administered by injection, either intravenously (IV) or intramuscularly (IM). When injected, it is rapidly absorbed into the bloodstream. 

Distribution 

Once in the bloodstream, tetracosactide circulates throughout the body. It has a short half-life, which means it does not remain in the bloodstream for an extended period. Its distribution is primarily within the adrenal cortex, where it acts on melanocortin receptors (MC2R) to stimulate the production of cortisol and other steroid hormones. 

Metabolism 

tetracosactide itself is a synthetic peptide and is not extensively metabolized in the body. Its primary role is to mimic the action of adrenocorticotropic hormone (ACTH) and stimulate the adrenal cortex to produce cortisol. As such, it does not undergo metabolic transformations like many drugs. 

Elimination and excretion 

tetracosactide and its metabolites are eliminated from the body primarily through renal excretion. The kidneys filter the peptide from the bloodstream, and it is then excreted in the urine. The exact details of its excretion, including any potential metabolites, may vary depending on individual factors and the specific formulation of the drug. 

Adminstartion

Administration: 

• Intravenous (IV) Injection: This is the most common route for tetracosactide administration. Insert a needle into the vein, usually in the arm, and inject the medication directly into the bloodstream. This route allows for rapid absorption and is often used for diagnostic testing to assess adrenal gland function. 
• Intramuscular (IM) Injection: In some cases, tetracosactide may be administered via IM injection. A healthcare provider will inject the medication into a large muscle, typically the buttocks or thigh. IM injections may be used for therapeutic purposes when a slower and more sustained release of the medication is desired. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: tetracosactide 

Pronounced: (teh-truh-koh-sak-tide)  

Why do we use tetracosactide? 

• Adrenal Function Testing: tetracosactide is frequently used in medical tests to assess the function of the adrenal glands. A healthcare provider administers tetracosactide to stimulate the release of cortisol from the adrenal glands. This test helps diagnose conditions such as Addison’s disease and assess the hypothalamic-pituitary-adrenal (HPA) axis function. 
• Diagnostic Testing for Cortisol Levels: tetracosactide can be used in combination with the blood tests to measure cortisol levels. This is valuable in diagnosing conditions like Cushing’s syndrome, where there is an excess of cortisol production. 
• Therapeutic Use in Some Adrenal Conditions: In certain adrenal conditions, like congenital adrenal hyperplasia (CAH), tetracosactide may be used as part of the treatment regimen. It can help stimulate cortisol production in individuals with adrenal insufficiency.