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ACTH. Cosyntropin is less allergenic than natural ACTH. Because it is unavailable in a
repository form, it is not used therapeutically, only diagnostically.
Pharmacokinetics - ACTH injection has a rapid onset. Plasma half-life is about 15
minutes. After IM or rapid IV administration of 25 units, peak plasma concentrations are
usually achieved within 1 hour and begin to decrease after 2 to 4 hours. Repository
corticotropin contains ACTH incorporated in a gelatin menstruum designed to delay the
absorption rate and increase the period of effectiveness. Repository corticotropin has a
slower onset but may sustain effects for up to 3 days.
Contraindications:
Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent
surgery; history of or presence of peptic ulcer; congestive heart failure (CHF);
hypertension; sensitivity to porcine proteins. IV administration (except in the treatment of
idiopathic thrombocytopenic purpura). IV administration may be used for diagnostic
testing of adrenocortical function. Treatment of conditions accompanied by primary
adrenocortical insufficiency or adrenocortical hyperfunction.
Warnings:
Do not administer: Do not administer until adrenal responsiveness has been verified
with the route of administration (IM or SC) which will be used during treatment. A rise in
urinary and plasma corticosteroid values provides direct evidence of a stimulatory effect.
 Chronic administration: Chronic administration may lead to irreversible
adverse effects. ACTH may suppress signs and symptoms of chronic disease
without altering the natural course of the disease. Since complications with
corticotropin use are dependent on the dose and duration of treatment, a risk to
benefit decision must be made in each case.
 Prolonged use: Prolonged use increases the risk of hypersensitivity reactions and
may produce posterior subcapsular cataracts and glaucoma with possible damage
to the optic nerve.
 Stress: Although the action of ACTH is similar to that of exogenous
adrenocortical steroids, the quantity of adrenocorticoid secreted may be variable.
In patients who receive prolonged corticotropin therapy, use additional rapidly
acting corticosteroids before, during and after an unusually stressful situation.
 Infection: ACTH may mask signs of infection including fungal or viral eye
infections that may appear during its use. There may be decreased resistance and
inability to localize infection. When infection is present, administer appropriate
anti-infective therapy.
 Tuberculosis - Observe patients with latent tuberculosis or tuberculin reactivity
that receives ACTH, as reactivation of the disease may occur. During prolonged
ACTH therapy, administer chemoprophylaxis.
 Immunosuppression: Perform immunization procedures with caution, especially
when high doses are administered, because of the possible hazards of neurological
complications and lack of antibody response. Immunization with live vaccines is
usually contraindicated in patients on ACTH or corticosteroid therapy.
 Electrolytes: Corticotropin can elevate blood pressure, cause salt and water
retention and increase potassium and calcium excretion. Dietary salt restriction
and potassium supplementation may be necessary.