可辛促素
Cosyntropin
Tetracosactide
別名: Cortrosyn · Synacthen · Nuvacthen Depot · Cortrosina · tetracosactide · alpha(1-24)corticotrophin · beta(1-24)-corticotrophin · tetracosactido · tetracosactidum · tetracosactrin · tetracosapeptide · Cosyntropin
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
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各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
可辛促素 (Cosyntropin) 是一種合成的多肽，可模擬內源性促腎上腺皮質素 (ACTH) 的作用。在獸醫學中主要作為診斷劑使用。
- 主要用途： 作為 ACTH 凝膠的替代品，用於腎上腺功能測試（ACTH 刺激試驗）。
- 適應症： 用於診斷腎上腺皮質機能減退症（愛迪生氏症）、醫源性腎上腺皮質機能亢進症（庫興氏症候群），以及監測 mitotane 或 trilostane 治療庫興氏症候群的反應。
- 優勢： 由於缺乏內源性促皮質素的 C 端部分，其免疫原性顯著較低，對於過去曾對動物來源 ACTH 產生過敏反應的病患更為安全。
作用機制
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).
安全性與警告
禁忌症
- Known hypersensitivity to cosyntropin
- No information available
不良反應
- 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.
藥物相互作用
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.
監測
- 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)
藥物動力學
半衰期
吸收
Rapidly absorbed after being given IM. Plasma cortisol levels reach their peak within an hour after IM or rapid IV administration.
分佈
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.
排除
Unknown.
過量
Unlikely to be of clinical consequence if used one-time only for diagnostic purposes.
可用產品
劑型
- Solution for Injection
- 0.25 mg/ml injectable solution
- 0.1 mg/ml injectable solution
- 0.25 mg/ml lyophilized powder for injection
人用標示
- 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
各地核准狀態
Human product often used under the cascade.
POM, Special. Human product used under the cascade.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
僅供診斷使用： 此藥物專門在獸醫診所內使用，用於測試寵物腎上腺的功能。
- 程序： 獸醫會先抽取寵物的少量血液樣本，注射此藥物後，在 30 至 60 分鐘後再次抽血。
- 準備事項： 請告知獸醫您的寵物正在服用的任何藥物，特別是類固醇（如氫化可的松或潑尼松）或螺內酯 (spironolactone)，因為這些藥物可能會干擾測試結果。
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