Drug reference

Tetracosactide

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 806, 807

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Diagnosis of adrenocortical insufficiency (diagnostic 30-minute test) ▶BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: 250 micrograms for 1 dose Diagnosis of adrenocortical insufficiency (diagnostic 5-hour test) ▶BY INTRAMUSCULAR INJECTION USING DEPOT INJECTION ▶Adult: 1 mg for 1 dose Alternative to corticosteroids in conditions such as Crohn’s disease or rheumatoid arthritis (formerly used but value was limited by the variable and unpredictable therapeutic response and by the waning of effect with time) ▶BY INTRAMUSCULAR INJECTION USING DEPOT INJECTION ▶Adult: Initially 1 mg daily, alternatively initially 1 mg every 12 hours, (in acute cases), then reduced to 1 mg every 2–3 days, followed by 1 mg once weekly, alternatively 500 micrograms every 2–3 days

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Contra Indications

Acute psychosis. adrenogenital syndrome. allergic disorders. asthma. avoid injections containing benzyl alcohol in neonates. Cushing’s syndrome. infectious diseases. peptic ulcer. primary adrenocortical insufﬁciency. refractory heart failure

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Cautions

Active infectious diseases (should not be used unless adequate disease-speciﬁc therapy is being given). active systemic diseases (should not be used unless adequate disease-speciﬁc therapy is being given). diabetes mellitus. diverticulitis. history of asthma. history of atopic allergy. history of eczema. history of hayfever. history of hypersensitivity. hypertension. latent amoebiasis (may become activated). latent tuberculosis (may become activated). myasthenia gravis. ocular herpes simplex. osteoporosis. predisposition to thromboembolic . pscyhological disturbances may be triggered. recent intestinal anastomosis. reduced immune response (should not be used unless adequate disease-speciﬁc therapy is being given). ulcerative colitis CAUTIONS, FURTHER INFORMATION ▶Risk of anaphylaxis Should only be administered under medical supervision. Consult product literature. ▶Hypertension Patients already receiving medication for moderate to severe hypertension must have their dosage adjusted if treatment started. ▶Diabetes mellitus Patients already receiving medication for diabetes mellitus must have their dosage adjusted if treatment started.

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Allergy And Cross Sensitivity

Contra-indicated in patients with history of hypersensitivity to tetracosactide/corticotrophins or excipients.

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Safety

Side Effects

Abdominal distension. abscess. adrenocortical unresponsiveness. angioedema. appetite increased. bone fractures. congestive heart failure. Cushing’s syndrome. diabetes mellitus exacerbated. dizziness. dyspnoea. electrolyte imbalance. exophthalmos. ﬂuid retention. ﬂushing. gastrointestinal disorders. glaucoma. growth retardation. haemorrhage. headache. healing impaired. hirsutism. hyperglycaemia. hyperhidrosis. hypersensitivity (may be more severe in patients susceptible to allergies, especially asthma). hypertension. idiopathic intracranial hypertension exacerbated. increased risk of infection. leucocytosis. malaise. menstruation irregular. muscle weakness. myopathy. nausea. osteonecrosis. osteoporosis. pancreatitis. papilloedema. pituitary unresponsiveness. posterior subcapsular cataract. protein catabolism. psychiatric disorder. seizure. skin reactions. tendon rupture. thromboembolism. vasculitis necrotising. vertigo. vomiting. weight increased

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Pregnancy

Avoid (but may be used diagnostically if essential).

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Breast Feeding

Avoid (but may be used diagnostically if essential).

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Hepatic Impairment

For depot injection, manufacturer advises caution in cirrhosis (may enhance effect of tetracosactide therapy).

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Renal Impairment

Use with caution in patients with renal impairment. l EFFECT ON LABORATORY TESTS May suppress skin test reactions. Post administration total plasma cortisol levels during 30-minute test for diagnosis of adrenocotical insufﬁciency might be misleading due to altered cortisol binding globulin levels in some special clinical situations including, patients on oral contraceptives, post-operative patients, critical illness, severe liver disease and nephrotic syndrome.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Synacthen (Atnahs Pharma UK Ltd) Tetracosactide acetate 250 microgram per 1 ml Synacthen 250micrograms/1ml solution for injection ampoules | 1 ampoule P £38.00 DT = £38.00 Suspension for injection EXCIPIENTS: May contain Benzyl alcohol ▶Synacthen Depot (Atnahs Pharma UK Ltd) Tetracosactide acetate 1 mg per 1 ml Synacthen Depot 1mg/1ml suspension for injection ampoules | 1 ampoule P £346.28 DT = £346.28 7.2 Assessment of pituitary function PITUITARY AND HYPOTHALAMIC HORMONES AND ANALOGUES › GONADOTROPHIN- RELEASING HORMONES

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Dose text by age group

Adult

250 micrograms for 1 dose

First-line fragment. Read the complete Indications and Dose section above.

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Adult

1 mg for 1 dose

First-line fragment. Read the complete Indications and Dose section above.

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Adult

Initially 1 mg daily, alternatively initially 1 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 806

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Tetracosactide

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 806, 807

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 806

Contra Indications

PDF page 806

Cautions

PDF page 806

Allergy And Cross Sensitivity

Contra-indicated in patients with history of hypersensitivity to tetracosactide/corticotrophins or excipients.

PDF page 806

Safety

Side Effects

PDF page 806

Pregnancy

Avoid (but may be used diagnostically if essential).

PDF page 806

Breast Feeding

Avoid (but may be used diagnostically if essential).

PDF page 806

Hepatic Impairment

For depot injection, manufacturer advises caution in cirrhosis (may enhance effect of tetracosactide therapy).

PDF page 806

Renal Impairment

PDF pages 806, 807

Dose and formulations

Medicinal Forms

PDF page 807

Dose text by age group

Adult

250 micrograms for 1 dose

First-line fragment. Read the complete Indications and Dose section above.

PDF page 806

Adult

1 mg for 1 dose

First-line fragment. Read the complete Indications and Dose section above.

PDF page 806

Adult

Initially 1 mg daily, alternatively initially 1 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 806

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.