corticorelin (Rx)

Brand and Other Names:Acthrel
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 100mcg

Cushing Syndrome Differential Diagnosis

Indicated to differentiate between pituitary and ectopic ACTH production in patients with ACTH-dependent Cushing syndrome

1 mcg/kg IV infused over 30-60 seconds is the lowest dose that may produce maximal cortisol response and significant (perhaps sub-maximal) ACTH responses  

Doses >1 mcg/kg not recommended

Draw ACTH baseline 15 minutes before dose (ie, average of 2 venous blood samples)

Draw postdose blood samples at 15, 30, and 60 minutes

Dosage Forms & Strengths

powder for injection

  • 100mcg

Cushing Syndrome Differential Diagnosis

Indicated to differentiate between pituitary and ectopic ACTH production in patients with ACTH-dependent Cushing syndrome

1 mcg/kg IV infused over 30-60 seconds is lowest dose that may produce maximal cortisol response and significant (perhaps sub-maximal) ACTH responses  

Doses >1 mcg/kg not recommended

Draw ACTH baseline 15 minutes before dose (ie, average of 2 venous blood samples)

Draw postdose blood samples at 15, 30, and 60 minutes

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Interactions

Interaction Checker

and corticorelin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (1)

            • heparin

              heparin increases toxicity of corticorelin by unknown mechanism. Contraindicated. Do not use heparin to maintain IV cannula patency during corticorelin test; may lead to severe hypot'n.

            Serious - Use Alternative (0)

              Monitor Closely (4)

              • beclomethasone, inhaled

                beclomethasone, inhaled decreases effects of corticorelin by unspecified interaction mechanism. Use Caution/Monitor. May blunt plasma ACTH response to corticorelin.

              • dexamethasone

                dexamethasone decreases effects of corticorelin by unspecified interaction mechanism. Use Caution/Monitor. ACTH response to corticorelin may be blunted with pretreatment with dexamethasone.

              • mometasone inhaled

                mometasone inhaled decreases effects of corticorelin by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may blunt plasma ACTH response to corticorelin.

              • mometasone topical

                mometasone topical decreases effects of corticorelin by pharmacodynamic antagonism. Use Caution/Monitor. Recent or current corticosteroid therapy may blunt the response to corticorelin, potentially interfering with the corticorelin stimulation test results.

              Minor (0)

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                Adverse Effects

                >10%

                Flushing of face, neck, and upper chest

                1-10%

                Dyspnea

                <1%

                Dizziness

                Asystole

                Seizure

                Tachycardia

                Xerostomia

                Vomiting

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                Warnings

                Contraindications

                None listed in the manufacturer's label

                Cautions

                >1 mcg/kg not recommended, more adverse events but no benefit

                Plasma ACTH response to corticorelin injection is inhibited or blunted in normal subjects pretreated with dexamethasone; use of heparin solution to maintain IV. cannula patency during corticorelin test not recommended; possible interaction between corticorelin and heparin associated with major hypotensive reaction reported after corticorelin administration

                Carcinogenic potential of corticorelin not studied

                Use caution in patients with hypersensitivity to sheep products

                False negative reported to occur in up to 5-10% of Cushing's disease patients

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                Pregnancy & Lactation

                Pregnancy Category: C

                Lactation: Excretion in milk unknown; use with caution

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Synthetic ovine corticotropin-releasing hormone; aids the clinician in differentiating between the causes of ACTH-dependent hypercortisolism (pituitary Vs ectopic) by measuring plasma ACTH and cortisol response to corticotropin-releasing hormone

                Pharmacokinetics

                Onset of ACTH Release: 2 min

                ACTH Release Peak Plasma Time: 15-60 min

                Onset of Cortisol Release: 10 min

                Cortisol Release Peak Plasma Time: 60-120 min

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                Administration

                IV Preparation

                Reconstituted aseptically with 2 mL of NS by injecting it into lyophilized drug (conc=50 mcg/mL)

                Roll vial to dissolve, do not shake

                IV Administration

                Give as bolus; however, some adverse events can be reduced by giving it as 30-sec infusion

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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.