Tetracosactide


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV/IM Diagnostic test for investigation of adrenocortical insufficiency As plain preparation: 250 mcg; measure plasma cortisol concentration immediately before and exactly 30 mins after inj. As acetate depot preparation: 1 mg via IM inj; measure plasma cortisol concentration before and exactly 30 mins, 1, 2, 3, 4 and 5 hr after inj. IM Corticosteroid therapy; Adjunct in rheumatoid arthritis and osteoarthrosis 1 mg/day. Acute: 1 mg 12 hrly. Maintenance: 1 mg every 2-3 days. Good-responders: 0.5 mg every 2-3 days or 1 mg/wk.
Dosage Details
Intramuscular
Adjunct in rheumatoid arthritis and osteoarthritis, Corticosteroid therapy
Adult: 1 mg daily, may give dose every 12 hr in acute/critical conditions. Maintenance: 1 mg every 2-3 days. For good-responders, may reduce dose to 0.5 mg every 2-3 days or 1 mg wkly.

Intramuscular
Infantile spasms
Child: ≥1 mth: 500 mcg on alternate days, adjust dose according to response.

Parenteral
Diagnostic test for investigation of adrenocortical insufficiency
Adult: As plain preparation: Measure plasma cortisol concentration immediately before and exactly 30 min after IM/IV inj of 250 mcg. Post-inj rise in plasma cortisol concentration ≥200 nmol/l (70 mcg/l) if normal adrenocortical function. As depot preparation (if inconclusive results with plain preparation): Measure plasma cortisol concentration before and exactly 30 min, 1, 2, 3, 4 and 5 hr after an IM inj of 1 mg tetracosactide acetate depot. Adrenocortical function normal if the post-inj rise in plasma cortisol concentration increases 2-fold in 1st hr, and continues to rise steadily. Expected levels in 1st hr: 600-1,250 nmol/l, increasing slowly up to 1000-1800 nmol/l by 5th hr.
Child: IV 250 mcg/1.73 m2 BSA.
Contraindications
Uncontrolled acute infections, active or quiescent TB. Live vaccines. History of allergic disorders e.g. asthma. Pregnancy and lactation (therapeutic use).
Special Precautions
Heart failure, recent MI, glaucoma, hypothyroidism, hepatic failure, renal impairment, hypertension, epilepsy, migraine, osteoporosis, psychoses/severe affective disorders, peptic ulcer, non-specific ulcerative colitis, diverticulitis, DM, thromboembolic tendencies, myasthenia gravis, risk of chickenpox/severe herpes zoster. Monitor child's growth and echocardiographic recordings in long-term use. Abrupt withdrawal may result in symptoms of hypopituitarism.
Adverse Reactions
Sodium and water retention, potassium loss. Hypersensitivity reactions e.g. dyspnoea, urticaria.
Potentially Fatal: Anaphylactic reactions.
IM/IV/Parenteral: C
Drug Interactions
Increased requirement of antidiabetic and antihypertensive drugs. Increased risk of hypokalaemia with potassium-depleting drugs, amphotericin B or bronchodilator therapy with xanthines or β2-agonists. Response to anticoagulants may be altered. Effect of antimuscarinics in myasthenia gravis may be decreased. Effects reduced by barbiturates, carbamazepine, phenytoin, primidone, rifampicin. Concentrations increased by oral contraceptives or ritonavir. Increased incidence of GI bleeding and ulceration with NSAIDs.
Action
Description: Tetracosactide is a synthetic polypeptide which induces hyperplasia and icreases weight of the adrenal glands. It stimulates secretion of the adrenocortical hormones, especially cortisol (hydrocortisone), some mineralocorticoids e.g. corticosterone, and to a lesser extent, androgens. It has little effect on aldosterone secretion which proceeds independently.
Pharmacokinetics:
Distribution: Rapidly eliminated from plasma, mostly by distribution to the adrenal glands and kidneys.
Metabolism: Metabolised by serum endopeptidases into inactive oligopeptides and then by aminopeptidases into free amino acids.
Excretion: Excreted via urine. Terminal half-life: 3 hr.
Storage
Intramuscular:
Store between 2-8°C.
Parenteral:
Store at 2-8°C. Protect from light.
Disclaimer: This information is independently developed by MIMS based on Tetracosactide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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