コシントロピン
Cosyntropin
Tetracosactide
別名: Cortrosyn · Synacthen · Nuvacthen Depot · Cortrosina · tetracosactide · alpha(1-24)corticotrophin · beta(1-24)-corticotrophin · tetracosactido · tetracosactidum · tetracosactrin · tetracosapeptide · Cosyntropin
VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
動物種別用量
🌎 NA — North America🌍 EU — Europe
犬
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Tentative diagnosis of Addison's disease | 0.25 mg (250 micrograms) of cosyntropin IV or IM | IV/IM | Once | — | 🌎 NA |
| ACTH Stimulation test | 1 microgram/kg or 250 micrograms/dog IV or IM | IV/IM | Once | — | 🌎 NA |
| Low dose ACTH stimulation test | 0.5 micrograms/kg IV | IV | Once | — | 🌎 NA |
| ACTH stimulation test | 5 μg/kg | IV/IM | once | single dose | 🌍 EU |
- Tentative diagnosis of Addison's disease: Draw baseline cortisol, give dexamethasone SP 2-5 mg/kg, give cosyntropin, draw second sample 45-60 mins later.
- ACTH Stimulation test: Measure serum cortisol before and 1 hour post injection.
- Low dose ACTH stimulation test: Peak concentrations at 60 minutes after dose.
- ACTH stimulation test: The same doses may be used for the lyophilized product but must be administered IM.
猫
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Tentative diagnosis of Addison's disease | 0.125 mg of cosyntropin IV or IM | IV/IM | Once | — | 🌎 NA |
| ACTH Stimulation test | 0.125 mg (total dose-125 mcg) IM or IV | IM/IV | Once | — | 🌎 NA |
| Diagnosis of hyperadrenocorticism | 125 micrograms/cat IM or IV | IM/IV | Once | — | 🌎 NA |
| Low dose ACTH stimulation test | 5 micrograms/kg | IV/IM | Once | — | 🌎 NA |
| ACTH stimulation test | 5 μg/kg or 125 μg/cat | IV/IM | once | single dose | 🌍 EU |
- Tentative diagnosis of Addison's disease: Draw baseline cortisol, give dexamethasone SP 2-5 mg/kg, give cosyntropin, draw second sample 45-60 mins later.
- ACTH Stimulation test: Begin test between 8-9 AM; obtain preinjection cortisol level and 30 minutes and 1 hour post.
- Diagnosis of hyperadrenocorticism: Cortisol measurements before and at 30 and 60 minutes post.
- Low dose ACTH stimulation test: Cortisol concentrations peak at 60 minutes post-dose.
- ACTH stimulation test: Cortisol response is less dramatic than in dogs; use feline-specific reference ranges.
馬
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Relative adrenal insufficiency (RIA) evaluation in critically ill horses | 0.1 micrograms/kg | IV/IM | Once | — | 🌎 NA |
| ACTH Stimulation test | 1 mg IV | IV | Once | — | 🌎 NA |
| ACTH Stimulation test (Foals) | 0.5 micrograms/kg IV | IV | Once | — | 🌎 NA |
- Relative adrenal insufficiency (RIA) evaluation in critically ill horses: Cortisol will peak after 30 minutes.
- ACTH Stimulation test: Administer between 8 and 10 AM; take post ACTH cortisol levels at 2 hours post dose.
- ACTH Stimulation test (Foals): Peak cortisol levels occur at 30 minutes post dose.
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
概要
コシントロピンは、内因性副腎皮質刺激ホルモン（ACTH）の作用を模倣する合成ポリペプチドです。主に獣医学において診断薬として使用されます。
- 主な用途: 副腎機能検査（ACTH刺激試験）におけるACTHゲルの代替薬。
- 適応症: 副腎皮質機能低下症（アジソン病）、医原性副腎皮質機能亢進症（クッシング症候群）の診断、およびミトタンやトリロスタン治療の反応モニタリング。
- 利点: 内因性コルチコトロピンのC末端部分を欠いているため、免疫原性が著しく低く、過去に動物由来のACTHにアレルギー反応を示した患者に対してより安全です。
作用機序
Cosyntropin acts identically to endogenous ACTH. It binds to melanocortin type 2 receptors (MC2R) in the adrenal cortex → stimulates the production of intracellular cAMP → promotes the conversion of cholesterol to pregnenolone → rapidly stimulates the adrenal cortex to secrete cortisol, corticosterone, and weak androgens.
Because it only contains the first 24 amino acids of natural corticotropin (which has 39), it retains full biological activity but lacks the highly immunogenic C-terminal amino acids (25-39).
安全性・警告
禁忌
- Known hypersensitivity to cosyntropin
- No information available
有害事象
- Hypersensitivity reactions (rare, but possible)
- Pain on intramuscular (IM) injection
注意事項
Hypersensitivity Warning: Use with caution in patients who have shown hypersensitive reactions to ACTH in the past, as cross-reactivity is a distinct possibility.
- Laboratory Interference: High bilirubin or free plasma hemoglobin can cause falsely high cortisol values in some assays.
医薬品相互作用
Cross-reacts with cortisol assays; patients should not receive these on test day (dexamethasone does not interfere).
May cause falsely high cortisol values if using a fluorometric analysis.
監視
- Plasma or serum cortisol levels (baseline and post-stimulation)
- Patient monitoring for rare hypersensitivity reactions during the test
- Serum cortisol levels (baseline/pre-ACTH and post-ACTH, typically at 1 hour post-injection)
薬物動態
半減期
吸収
Rapidly absorbed after being given IM. Plasma cortisol levels reach their peak within an hour after IM or rapid IV administration.
分布
Rapidly distributed to the adrenal glands.
代謝
Inactivated by gut enzymes if given orally. It is unknown exactly how cosyntropin is inactivated or eliminated systemically.
消失
Unknown.
過剰投与
Unlikely to be of clinical consequence if used one-time only for diagnostic purposes.
製品
製剤
- Solution for Injection
- 0.25 mg/ml injectable solution
- 0.1 mg/ml injectable solution
- 0.25 mg/ml lyophilized powder for injection
ヒト用医薬品
- Cosyntropin Powder for Injection: 0.25 mg lyophilized (250 mcg) in single-dose vials with diluent; Cortrosyn (Amphastar)
- Cosyntropin Solution for Injection: 0.25 mg/mL, preservative free in 1 mL single-dose vials; generic (Sandoz)
- Synacthen 0.25 mg/ml solution for injection
規制ステータス
Human product often used under the cascade.
POM, Special. Human product used under the cascade.
規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
保管・安定性
After reconstituting with sterile normal saline, the solution is stable for 24 hours at room temperature; 21 days if refrigerated. Do not add the drug to blood or plasma infusions. Reconstituted cosyntropin can be stored frozen (-20°C) in plastic syringes for up to 6 months and retain biologic activity in dogs. It is recommended to freeze in small aliquots to avoid repeated thawing and refreezing.
飼主向け情報
診断目的のみ: この薬は、ペットの副腎が正常に機能しているかを検査するために、動物病院内でのみ使用されます。
- 手順: ペットから少量の血液を採取し、この薬を注射した後、30〜60分後に再度血液を採取します。
- 準備: ペットが服用している薬、特にステロイド（ヒドロコルチゾンやプレドニゾンなど）やスピロノラクトンは検査結果に影響を与える可能性があるため、必ず獣医師に伝えてください。
VetSheet医薬品リファレンスは獣医専門家の臨床意思決定支援を目的としており、専門的判断または製造業者の最新医薬品情報の代替にはなりません。