Drug information of Tetracosactid

Tetracosactid

Drug group:

Tetracosactideis α 1-24 corticotropin, a synthetic subunit of ACTH.

Mechanism of effect

Cosyntropin combines with a specific receptor in the adrenal cell plasma membrane and, in patients with normal adrenocortical function, stimulates the initial reaction involved in the synthesis of adrenal steroids (including cortisol, cortisone, weak androgenic substances, and a limited quantity of aldosterone) from cholesterol by increasing the quantity of the substrate within the mitochondria.
Cosyntropin does not significantly increase plasma cortisol concentration in patients with primary or secondary adrenocortical insufficiency.

Pharmacodynamic

Tetracosactide acts on the adrenal glands in the same way as natural ACTH. This means if the adrenal glands are healthy, a single injection of tetracosactide will cause the adrenal glands to produce its hormones, including cortisol, and this can be measured in the blood.
If there is a problem with the adrenal glands themselves, the level of cortisol in the blood will not rise, or will only rise a little. This test is known as the short Synacthen test or Synacthen stimulation test.

Pharmacokinetics

Onset of action : IM, IV : Within 5 minutes increases in plasma cortisol concentrations are observed in healthy individuals;
Maximum effect : IM, IV: 45-60 minutes peak plasma cortisol concentration. Excretion is by Urine.

Dosage

Usual Adult Dose for Adrenocortical Insufficiency
* Diagnostic test to differentiate primary adrenal from secondary (pituitary) adrenocortical insufficiency :
0.25 to 0.75 mg IM or IV over 2 minutes. If greater cortisol stimulation is needed, 0.25 mg may be administered by IV infusion at 0.04 mg/hour over 6 hours.
Usual Pediatric Dose for Adrenocortical Insufficiency
*Diagnostic test to differentiate primary adrenal from secondary (pituitary) adrenocortical insufficiency :
<1 month: 0.015 mg/kg/dose IM or IV
1 month to 2 years: 0.125 mg IM or IV over 2 minutes
>2 years: 0.25 to 0.75 mg IM or IV over 2 minutes. If greater cortisol stimulation is needed, 0.25 mg may be administered by IV infusion at 0.04 mg/hour over 6 hours.
Congenital adrenal hyperplasia evaluation: 1 mg/m2/dose up to a maximum of 1 mg.

Alerts

Hypersensitivity reactions : Hypersensitivity reactions (including severe reactions) may occur particularly in patients with asthma or other allergies and often within 30 minutes of administration; monitor for hypersensitivity for ~1 hour after administration. Prolonged use may increase the risk of allergic reactions.
Cardiovascular disease : Use caution in patients with hypertension or thromboembolic disease.
Gastrointestinal disease : Use caution in patients with nonspecific ulcerative colitis, diverticulitis, or recent intestinal anastomosis.
Hepatic disease : Enhanced effects may be observed in patients with cirrhosis of the liver.
Infections : Use caution in patients with acute or chronic infections (especially varicella or vaccinia) or exanthematous and fungal diseases. Use with caution in patients with latent tuberculosis; treatment may reactivate latent tuberculosis. Rule out amebiasis prior to initiating therapy; may activate latent amebiasis.
Myasthenia gravis : Use caution in patients with myasthenia gravis.
Ocular disease : Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Not recommended for the treatment of optic neuritis; may increase frequency of new episodes. Consider routine eye exams in chronic users.
Osteoporosis : Use caution in patients with osteoporosis.
Psychiatric disturbances : Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Preexisting psychiatric conditions may be exacerbated by corticosteroid use .
Renal disease : Use caution in patients with renal insufficiency.
Thyroid disease : Enhanced effects may be observed with hypothyroidism .

Points of recommendation

To make sure this medicine is safe for you, tell your doctor if you have :
• If you have an allergy to tetracosactide or any other part of drug.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
Have patient report immediately to prescriber tachycardia, bradycardia, swelling of arms or legs, passing out, severe dizziness, vision changes, or severe headache (HCAHPS).

Pregnancy level

C


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