DRUG	SUPPLIED	DOSE	COMMENTS
COSYNTROPIN (Paeds) (Cortrosyn, Synacthen Depot, synthetic corticotropin, synthetic ACTH, tetracosactide) Mechanism of action: synthetic ACTH Ref: 4, 32, 44, 162, 682, 683 Last update: 2022-06-16	injection: Cortrosyn: 0.25 mg/mL Synacthen Depot: 1 mg/mL Acthar gel (=repository corticotropin inj) 80 IU/mL; 5 mL vial ($21,000 per vial): available only through the Special Access Program.	*High-Dose ACTH Stimulation Test: (use Cortrosyn) 250 mcg IV/IM *Low-Dose ACTH Stimulation Test: (use Cortrosyn) 1 mcg IV Infantile Spasms: (use Synacthen Depot) Initial (low dose): 0.03 mg/kg IM every 2 days x 2 weeks If no response, use high dose: 0.06 mg/kg IM every 2 days x 2 weeks, then reassess	1 mg = 100 IU (Cortrosyn and Synacthen Depot). Synacthen Depot & Acthar gel are for IM use only. 40 IU Acthar gel daily = 0.5 mg Synacthen Depot every other day. Common adverse effects include: hypertension (which may require treatment), weight gain, irritability, gastric irritation, electrolyte imbalance. *Refer to BCCH Endocrine Test Protocols. Please note:  Acthar gel and Synacthen Depot may be difficult to procure. Standard Prescription: Cortrosyn __mg IV/IM x 1 dose Synacthen __mg IM__(frequency) (__mg/kg/dose)