Tetracosactrin

Tetracosactrin is a synthetic polypeptide. Tetracosactrin is used as a test of adrenal function and for the treatment of inflammatory or degenerative disorders.

Tetracosactrin is primarily indicated in conditions like Crohn's disease, Investigation of adrenocortical function, Juvenile chronic arthritis, Multiple sclerosis, Osteoarthritis, Rheumatoid arthritis, Ulcerative colitis.

Tetracosactrin is contraindicated in conditions like Asthma, Cushing's syndrome, Heart failure, Peptic ulcer, Psychosis, Infections, Hypersensitivity.

The severe or irreversible adverse effects of Tetracosactrin, which give rise to further complications include Hypertension, Diabetes, Osteoporosis, Growth retardation. Tetracosactrin produces potentially life-threatening effects which include Anaphylaxis. which are responsible for the discontinuation of Tetracosactrin therapy. The signs and symptoms that are produced after the acute overdosage of Tetracosactrin include Hyperglycemia. The symptomatic adverse reactions produced by Tetracosactrin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Pain, Bruising, Acne, Hirsutism, Menstrual irregularity, Skin atrophy.

Concerns related to adverse effects: • Corticotropin allergy: Cortrosyn: Use with caution in patients with a history of allergic reactions to corticotropin or preexisting allergic disease. Synacthen Depot [Canadian product] is contraindicated in patients with allergic conditions. • Hypersensitivity reactions: Synacthen Depot [Canadian product]: 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. Disease related concerns: • Cardiovascular disease: Synacthen Depot [Canadian product]: Use caution in patients with hypertension or thromboembolic disease. • Gastrointestinal disease: Synacthen Depot [Canadian product]: Use caution in patients with nonspecific ulcerative colitis, diverticulitis, or recent intestinal anastomosis. • Hepatic disease: Synacthen Depot [Canadian product]: Enhanced effects may be observed in patients with cirrhosis of the liver. • Infections: Synacthen Depot [Canadian product]: 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: Synacthen Depot [Canadian product]: 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: Synacthen Depot [Canadian product]: 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: Synacthen Depot [Canadian product]: Use caution in patients with renal insufficiency. • Thyroid disease: Synacthen Depot [Canadian product]: Enhanced effects may be observed with hypothyroidism. Dosage forms specific issues: • Synacthen Depot [Canadian product]: Contains benzyl alcohol; avoid use in infants and children <3 years of age; contraindicated in neonates. Other warnings/precautions: • Immunizations: Synacthen Depot [Canadian product]: Live vaccines should not be given concurrently. • Surgery/trauma: Synacthen Depot [Canadian product]: Augmentation or resumption of therapy may be necessary in patients undergoing surgery or subjected to trauma either during or within 1 year of therapy discontinuation; adjunctive rapid acting corticosteroids may be necessary during periods of stress.

Concerns related to adverse effects: • Corticotropin allergy: Cortrosyn: Use with caution in patients with a history of allergic reactions to corticotropin or preexisting allergic disease. Synacthen Depot [Canadian product] is contraindicated in patients with allergic conditions. • Hypersensitivity reactions: Synacthen Depot [Canadian product]: 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. Disease related concerns: • Cardiovascular disease: Synacthen Depot [Canadian product]: Use caution in patients with hypertension or thromboembolic disease. • Gastrointestinal disease: Synacthen Depot [Canadian product]: Use caution in patients with nonspecific ulcerative colitis, diverticulitis, or recent intestinal anastomosis. • Hepatic disease: Synacthen Depot [Canadian product]: Enhanced effects may be observed in patients with cirrhosis of the liver. • Infections: Synacthen Depot [Canadian product]: 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: Synacthen Depot [Canadian product]: 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: Synacthen Depot [Canadian product]: 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: Synacthen Depot [Canadian product]: Use caution in patients with renal insufficiency. • Thyroid disease: Synacthen Depot [Canadian product]: Enhanced effects may be observed with hypothyroidism. Dosage forms specific issues: • Synacthen Depot [Canadian product]: Contains benzyl alcohol; avoid use in infants and children <3 years of age; contraindicated in neonates. Other warnings/precautions: • Immunizations: Synacthen Depot [Canadian product]: Live vaccines should not be given concurrently. • Surgery/trauma: Synacthen Depot [Canadian product]: Augmentation or resumption of therapy may be necessary in patients undergoing surgery or subjected to trauma either during or within 1 year of therapy discontinuation; adjunctive rapid acting corticosteroids may be necessary during periods of stress.

3.57 ug/kg (3.6 (3.57)) As recommended. IM — For Once or As Required Scraped Dose — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product Solution Reconstituted, Injection: Generic: 0.25 mg (1 ea [DSC]) Solution Reconstituted, Injection [preservative free]: Cortrosyn: 0.25 mg (1 ea) Generic: 0.25 mg (1 ea)

25 ug/kg (25 (25)) As recommended. Intra Muscular — Single Dose 25 ug/kg (25 (25)) As recommended. Intra Venous — Single Dose

36 ug/kg (36 (36)) As recommended. Intramuscular — Single dose

ClonazePAM: Cosyntropin may enhance the hepatotoxic effect of ClonazePAM. Monitor therapy Corticosteroids (Orally Inhaled): May diminish the diagnostic effect of Cosyntropin. Monitor therapy Corticosteroids (Systemic): May diminish the diagnostic effect of Cosyntropin. Monitor therapy Cortisone: May diminish the diagnostic effect of Cosyntropin. Management: Patients receiving cortisone should omit their pre-test dose on the day selected for cosyntropin testing. Consider therapy modification DiazePAM: Cosyntropin may enhance the hepatotoxic effect of DiazePAM. Monitor therapy Estrogen Derivatives: May diminish the diagnostic effect of Cosyntropin. Management: Discontinue estrogen containing drugs 4 to 6 weeks prior to cosyntropin (ACTH) testing. Consider therapy modification Hydrocortisone (Systemic): May diminish the diagnostic effect of Cosyntropin. Management: Patients receiving hydrocortisone should omit their pre-test dose on the day selected for cosyntropin testing. Consider therapy modification Nitrazepam: Cosyntropin may enhance the hepatotoxic effect of Nitrazepam. Monitor therapy PHENobarbital: Cosyntropin may enhance the hepatotoxic effect of PHENobarbital. Monitor therapy Phenytoin: Cosyntropin may enhance the hepatotoxic effect of Phenytoin. Monitor therapy Primidone: Cosyntropin may enhance the hepatotoxic effect of Primidone. Monitor therapy Spironolactone: May diminish the diagnostic effect of Cosyntropin. Management: Patients receiving spironolactone should omit their pre-test dose on the day selected for cosyntropin testing. Consider therapy modification Valproate Products: Cosyntropin may enhance the hepatotoxic effect of Valproate Products. Management: Avoid concomitant use of Synacthen Depot (dosage form available in Canada) with valproic acid. Avoid combination

IV Inj, IM Inj Store in refrigerator. Protect from Sunlight.