Peptides / Sexual health and hormones

Natural fragment · 24 amino acids · 2,933.4 Da

Cosyntropin

ApprovedBanned in sport

Cosyntropin (Cortrosyn), or tetracosactide, is a fragment of the hormone ACTH approved in the US to test for adrenal insufficiency, and it is banned in sport. Studies in people tested it on pain, nausea during chemotherapy and adrenal function, and tracked side effects. PepBank shows 70 results on cosyntropin from 21 studies in people, and 27 from animal and lab studies. The strongest evidence is a randomized trial in people. Data as of 2026-10-30.

Also known as ACTH(1-24), Cortrosyn, Tetracosactide, Tetracosactrin

24 amino acids, from first to last0 changed amino acids

Evidence level: Large trials in people70 of 97 results come from studies in people, including randomized trials.

Results in people

72% of 97 results

Results in animals

26% of 97 results

Results in lab cells

2% of 97 results

From computer models

0% of 97 results

Overview

Cosyntropin at a glance

What it is	Natural fragment, 24 amino acids
Approval	Approved in the US (Cortrosyn)
In sport	Banned in sport (WADA S2.2.2)
Studies	57 studies with results. 28 of them gave cosyntropin, with 97 results. 70 in people25 in animals2 in lab cells
Best study in people	Randomized controlled trial with 126 people (2023)
Clinical trials	27 registered: 4 active or planned, 8 with posted results
Community use	Adult diagnostic screening of adrenocortical insufficiency

The science

What is cosyntropin?

Cosyntropin, or tetracosactide, matches the first 24 residues of ACTH.

Amino acids in one chain

The history of cosyntropin

1968
The oldest paper on cosyntropin in PepBank is from 1968.
2008July
A registered trial of cosyntropin started (NCT00694863).

Cosyntropin structure and chemistry

The key facts about the molecule. Long codes are in the closed section below.

Sequence, 24 amino acidsFrom the first amino acid to the last

S1YSM−E5HF+RWG10+KPVG+K15+K+R+RPV20+KVYP

Darker means more water-repelling+ and − show charge in the body

Structure

Cosyntropin is a natural fragment of 24 amino acids, with no ring, no changed amino acids.

Formula

C₁₃₆H₂₁₀N₄₀O₃₁S

Molecular weight

2,933.4 g/mol

CAS number

16960-16-0

Target

Melanocortin 2 receptor (gene MC2R): agonistEvidence: Open Targets mechanism table, curated from ChEMBL

Development

Highest phase: past the trial stage (see status).

Identifiers

PubChem 16133751, ChEMBL CHEMBL2103784, UNII 72YY86EA29, DrugBank DB01284

Full sequence, SMILES and InChIKey

InChIKey
ZOEFCCMDUURGSE-SQKVDDBVSA-N

SMILES
CC(C)[C@@H](C(=O)NCC(=O)N[C@@H](CCCCN)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N1CCC[C@H]1C(=O)N[C@@H](C(C)C)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C(C)C)C(=O)N[C@@H](CC2=CC=C(C=C2)O)C(=O)N3CCC[C@H]3C(=O)O)NC(=O)[C@@H]4CCCN4C(=O)[C@H](CCCCN)NC(=O)CNC(=O)[C@H](CC5=CNC6=CC=CC=C65)NC(=O)[C@H](CCCNC(=N)N)NC(=O)[C@H](CC7=CC=CC=C7)NC(=O)[C@H](CC8=CN=CN8)NC(=O)[C@H](CCC(=O)O)NC(=O)[C@H](CCSC)NC(=O)[C@H](CO)NC(=O)[C@H](CC9=CC=C(C=C9)O)NC(=O)[C@H](CO)N

See charge, composition and 3D structure on the Scientific page

The evidence

What cosyntropin studies show

Results grouped by what the studies measured. Each card shows where its results come from.

Large trials in people70 of 97 results come from studies in people, including randomized trials.

Pain

21 results · 21 in people

At an interim check in postpartum patients with PDPH, tetracosactide did not significantly change blood patch use compared with placebo. British journal of anaesthesia, 2025

Top results

At an interim check in postpartum patients with PDPH, tetracosactide did not significantly change blood patch use compared with placebo. (British journal of anaesthesia, 2025)
In patients with rotator cuff tendinitis, tetracosactide reduced pain less than triamcinolone. (Rheumatology advances in practice, 2025)
In parturients after accidental dural puncture, cosyntropin reduced headache incidence versus saline. (Anesthesiology, 2010)

Hormones

15 results · 12 in people · 3 animal

In normal young males, tetracosactrin had lower potency than C-41795-Ba in stimulating adrenal responses. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 1975

Top results

In normal young males, tetracosactrin had lower potency than C-41795-Ba in stimulating adrenal responses. (Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 1975)
In normal men, sodium, potassium, renin activity, angiotensin-II and cortisol did not differ significantly between pulsatile and continuous cosyntropin infusions. (The Journal of clinical endocrinology and metabolism, 1989)
In healthy adults, cosyntropin increased cortisol while cortisol fell during placebo infusion. (Endocrine connections, 2021)

Stomach and gut

7 results · 7 in people

In chemotherapy patients, tetracosactide and methylprednisolone gave similar rates of no nausea. Bulletin du cancer, 1989

Top results

In chemotherapy patients, tetracosactide and methylprednisolone gave similar rates of no nausea. (Bulletin du cancer, 1989)
In breast cancer chemotherapy patients, tetracosactrin and methylprednisolone did not differ in vomiting. (European journal of cancer, 1991)
In cisplatin chemotherapy patients, tetracosactide and dexamethasone with the same background drugs did not differ significantly in efficacy. (Bulletin du cancer, 1989)

Brain and nerves

14 results · 5 in people · 9 animal

In infants with epileptic spasms, tetracosactide and prednisolone did not differ significantly in early spasm cessation. European journal of paediatric neurology, 2023

Top results

In infants with epileptic spasms, tetracosactide and prednisolone did not differ significantly in early spasm cessation. (European journal of paediatric neurology, 2023)
In infants assigned tetracosactide, 19/25 (76%) had no spasms on days 13 and 14. (Lancet, 2004)
In rabbits with spinal cord injury, tetracosactide reduced tissue myeloperoxidase. (Archives of medical science, 2018)

Heart and blood vessels

5 results · 5 in people

In healthy adults, cosyntropin lowered baroreflex sensitivity during infusion compared with placebo. The Journal of clinical endocrinology and metabolism, 2020

Top results

In healthy adults, cosyntropin lowered baroreflex sensitivity during infusion compared with placebo. (The Journal of clinical endocrinology and metabolism, 2020)
In healthy adults, cosyntropin lowered next-day baroreflex sensitivity compared with placebo. (The Journal of clinical endocrinology and metabolism, 2020)
In healthy adults, baroreflex sensitivity fell during cosyntropin infusion compared with baseline. (The Journal of clinical endocrinology and metabolism, 2020)

Bones and joints

3 results · 3 in people

In patients with rotator cuff tendinitis, tetracosactide improved joint function less than triamcinolone. Rheumatology advances in practice, 2025

Top results

In patients with rotator cuff tendinitis, tetracosactide improved joint function less than triamcinolone. (Rheumatology advances in practice, 2025)
In healthy adults, cosyntropin did not significantly change serum sclerostin compared with placebo. (Endocrine connections, 2021)
In patients with rotator cuff tendinitis, joint function improved from baseline after tetracosactide, as after triamcinolone. (Rheumatology advances in practice, 2025)

Cosyntropin has 992 linked papers. PepBank read up to 120 of the most-cited studies that gave it to people, up to 20 other studies, and the main trials.

All 57 cosyntropin studies by area Open the Scientific page

Key cosyntropin studies

Studies in people come first, then studies in animals and in the lab.

People
Prednisolone or tetracosactide depot for infantile epileptic spasms syndrome? A prospective analysis of data embedded within two randomised controlled trials
Osborne et al. 2023 · European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society · 126 people · cited by 8
4 results
People
No effect of tetracosactide for treatment of postdural puncture headaches in parturient women: a double-blind randomised controlled clinical trial
Dziadzko et al. 2025 · British journal of anaesthesia · 44 people · cited by 2
7 results
People
Comparison of Cosyntropin, Vigabatrin, and Combination Therapy in New-Onset Infantile Spasms in a Prospective Randomized Trial
Knupp et al. 2022 · Journal of child neurology · 21 people · cited by 12
1 result
People
[Comparison of the antiemetic effectiveness of high-dose corticosteroids with synacthene in nausea induced by chemotherapy: results of a randomized study]
Brice et al. 1989 · Bulletin du cancer · 102 people · cited by 3
3 results
People
Effect of early administration of tetracosactide on mortality and host response in critically ill patients requiring rescue surgery: a sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial
Noera et al. 2024 · Military Medical Research · 100 people · cited by 0
3 results

All 57 Cosyntropin studies

Cosyntropin clinical trials

ClinicalTrials.gov lists 27 trials of cosyntropin. 4 are active or planned, and 8 have posted results. PepBank does not show trial results.

Solid bars are dates that happened. Hatched bars are planned dates. Data from ClinicalTrials.gov.

Is Adrenal Insufficiency Under-diagnosed in Hospitalized Cirrhosis Patients?

Phase 3completed100 people

The Adrenal Contribution to Androgen Production in Girls During Puberty

Phase 3completed50 people

Cosyntropin Versus Epidural Blood Patch (EBP) for Treatment of Treatment of Post Dural Puncture Headache

Phase 4completed29 people

All 9 Cosyntropin trials

Status and safety

Is cosyntropin approved?

FDA

United States

Approved

An approved medicine contains it.

EMA

European Union

Status unknown

Status unknown.

WADA

Sport

Banned

On the 2026 Prohibited List, section S2.2.2.

Yes. Approved in the US (Cortrosyn). The FDA label for Cortrosyn says: “Diagnostic screening of adrenocortical insufficiency in adults and pediatric patients, in combination with other diagnostic tests” Banned in sport (WADA S2.2.2).

Laws and labels change, so check the regulator for the current status.

Cosyntropin side effects and safety

PepBank has 6 safety results from studies of cosyntropin. 6 of them come from studies in people.

Safety results from studies (6)

In chemotherapy patients, secondary effects occurred in 5% with tetracosactide and 8% with methylprednisolone, with no significance stated. (Bulletin du cancer, 1989)
In cisplatin chemotherapy patients, tetracosactide and dexamethasone with the same background drugs did not differ significantly in side effects. (Bulletin du cancer, 1989)
No infants died in the trial, including infants assigned tetracosactide. (Lancet, 2004)
In postpartum patients with PDPH, no side effects of tetracosactide were observed. (British journal of anaesthesia, 2025)
In rheumatic-disease inpatients, local reactions to depot tetracosactrin injection were relatively frequent. (British medical journal, 1969)
No hypersensitive asthmatic patient developed allergic reactions to depot-tetracosactrin. (British medical journal, 1968)

See every safety result on the Scientific page

Doses studied (17 shown)

The doses that these studies used. They are not recommendations.

Dose as reported	Class	Species	Route	Duration	Design	Source
0·5 mg on alternate days	Human	human	intramuscular	two weeks	Randomized trial in people · n = 126	Osborne 2023
1 mg	Human	human	intravenous	single dose	Randomized trial in people · n = 44	Dziadzko 2025
3 mg on D1 and 2 mg/d on D2 and D3	Human	human	Not reported	3 days	Randomized trial in people · n = 102	Brice 1989
10 mg	Human	human	intravenous bolus	single dose before surgery	Randomized trial in people · n = 100	Noera 2024
1 mg	Human	human	intravenous	Not reported	Randomized trial in people · n = 90	Hakim 2010
1 mg	Human	human	intramuscular	Not reported	Randomized trial in people · n = 86	Orandi 2025
70 μg/hour	Human	human	intravenous infusion	2.5 hours in the morning and again in the early afternoon	Randomized trial in people	Leung 2020
Minimum 0.5 mg (40 IU) on alternate days	Human	human	intramuscular	Not reported	Trial in people without random groups · n = 25	Lux 2004
2 mg	Human	human	intravenous	Not reported	Trial in people without random groups · n = 33	Culine 1989
1 mg and 0.5 mg	Human	human	intramuscular	Not reported	Trial in people without random groups · n = 13	el-Shaboury 1968
about 0.25 mg depot tetracosactrin to 50 units of corticotrophin gel (stated dose relationship)	Human	human	subcutaneous	Not reported	Trial in people without random groups · n = 12	Treadwell 1969
250 μg	Human	human	Not reported	Not reported	Trial in people without random groups · n = 10	Heksch 2021
1 μg	Human	human	Not reported	Not reported	Trial in people without random groups · n = 10	Heksch 2021
4 U/24 h	Human	human	intravenous	48 or 72 h	Trial in people without random groups · n = 8	Seely 1989
4 micrograms/rat	Animal	rats	Brain lateral ventricle injection	First hour after treatment	Study in live animals	Vergoni 1986
0.0625 mg/kg, 0.031 mg/kg, or 0.016 mg/kg	Animal	Anas platyrhynchos domesticus	intramuscular	Not reported	Study in live animals	Tetel 2022
3 doses: 0.4, 0.2, 0.2 mg	Animal	horse	intramuscular	24 h	Study in live animals	Rossdale 1982

From the community

How people use it

What people report online. It comes from forums and guides, not from studies.

Community-reported. Not tested in trials.

The official US label reports prescription use. The regimen below is label information.

Reported routines and cautions

What people use it for

Adult diagnostic screening of adrenocortical insufficiencyS1

Reported regimens

Regimens that community sources report for Cosyntropin. Community-reported, not tested in trials.
Context	Route	Amount	How often	How long	Agreement	Sources
Adults: diagnostic screening of adrenocortical insufficiency with Cortrosyn lyophilized powder, in combination with other diagnostic testsOfficial label dosing of an approved product	intravenous or intramuscular injection	0.25 mg per dose	single diagnostic administration	Not stated	Single official US label source.	S1

Cautions

The label contraindicates use with prior hypersensitivity to cosyntropin or its excipients.S1
The label reports hypersensitivity reactions, including anaphylaxis. It requires monitoring and treatment as needed.S1

Status notes

No product-specific central EMA authorisation was established. This does not decide national authorisations.S2

Community sources

S1Cortrosyn US prescribing information (opens in a new tab)dailymed.nlm.nih.gov
S2EMA regulatory information (opens in a new tab)ema.europa.eu

Gaps

This record covers one selected adult US label regimen. It does not establish a separate community regimen. The label also includes pediatric use. This record does not describe depot tetracosactide or repeated therapeutic administration.

Questions and more

Ask a question about cosyntropin

The answer links to every study it uses.

What does the evidence say about cosyntropin?Is cosyntropin tested in people?Compare with Oxytocin Compare with Melanotan I (afamelanotide)

Sources

Database: PepBank data for cosyntropin (data version 308560)
Regulator: FDA status record
Regulator: EMA status record
Regulator: WADA status record
Trial registry: ClinicalTrials.gov
Community: community sources (forums and guides), as summarized in the PepBank community file

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

PepBank is a research reference. Talk to a doctor before you use any peptide.

Ask your AI about cosyntropin

Cosyntropin

ApprovedBanned in sport

Also known as ACTH(1-24), Cortrosyn, Tetracosactide, Tetracosactrin

What it is

Natural fragment, 24 amino acids

Approval

Approved in the US (Cortrosyn)

In sport

Banned in sport (WADA S2.2.2)

Studies

57 studies with results. 28 of them gave cosyntropin, with 97 results.
70 in people25 in animals2 in lab cells

Best study in people

Randomized controlled trial with 126 people (2023)

Clinical trials

27 registered: 4 active or planned, 8 with posted results

Community use

Adult diagnostic screening of adrenocortical insufficiency

Dose as reported

Class

Species

Route

Duration

Design

Source

0·5 mg on alternate days

Human

human

intramuscular

two weeks

Randomized trial in people · n = 126

Osborne 2023

1 mg

Human

human

intravenous

single dose

Randomized trial in people · n = 44

Dziadzko 2025

3 mg on D1 and 2 mg/d on D2 and D3

Human

human

Not reported

3 days

Randomized trial in people · n = 102

Brice 1989

10 mg

Human

human

intravenous bolus

single dose before surgery

Randomized trial in people · n = 100

Noera 2024

1 mg

Human

human

intravenous

Not reported

Randomized trial in people · n = 90

Hakim 2010

1 mg

Human

human

intramuscular

Not reported

Randomized trial in people · n = 86

Orandi 2025

70 μg/hour

Human

human

intravenous infusion

2.5 hours in the morning and again in the early afternoon

Randomized trial in people

Leung 2020

Minimum 0.5 mg (40 IU) on alternate days

Human

human

intramuscular

Not reported

Trial in people without random groups · n = 25

Lux 2004

2 mg

Human

human

intravenous

Not reported

Trial in people without random groups · n = 33

Culine 1989

1 mg and 0.5 mg

Human

human

intramuscular

Not reported

Trial in people without random groups · n = 13

el-Shaboury 1968

about 0.25 mg depot tetracosactrin to 50 units of corticotrophin gel (stated dose relationship)

Human

human

subcutaneous

Not reported

Trial in people without random groups · n = 12

Treadwell 1969

250 μg

Human

human

Not reported

Trial in people without random groups · n = 10

Heksch 2021

1 μg

Human

human

Not reported

Trial in people without random groups · n = 10

Heksch 2021

4 U/24 h

Human

human

intravenous

48 or 72 h

Trial in people without random groups · n = 8

Seely 1989

4 micrograms/rat

Animal

rats

Brain lateral ventricle injection

First hour after treatment

Study in live animals

Vergoni 1986

0.0625 mg/kg, 0.031 mg/kg, or 0.016 mg/kg

Animal

Anas platyrhynchos domesticus

intramuscular

Not reported

Study in live animals

Tetel 2022

3 doses: 0.4, 0.2, 0.2 mg

Animal

horse

intramuscular

24 h

Study in live animals

Rossdale 1982

Context

Route

Amount

How often

How long

Agreement

Sources

Adults: diagnostic screening of adrenocortical insufficiency with Cortrosyn lyophilized powder, in combination with other diagnostic testsOfficial label dosing of an approved product

intravenous or intramuscular injection

0.25 mg per dose

single diagnostic administration

Not stated

Single official US label source.

Cosyntropin

Cosyntropin at a glance

What is cosyntropin?

The history of cosyntropin

Cosyntropin structure and chemistry

What cosyntropin studies show

Pain

Hormones

Stomach and gut

Brain and nerves

Heart and blood vessels

Bones and joints

Key cosyntropin studies

Cosyntropin clinical trials

Is cosyntropin approved?

Cosyntropin side effects and safety

How people use it

What people use it for

Reported regimens

Cautions

Status notes

Community sources

Ask a question about cosyntropin

Related peptides

Sources

Cosyntropin

Cosyntropin at a glance

What is cosyntropin?

The history of cosyntropin

Cosyntropin structure and chemistry

What cosyntropin studies show

Pain

Hormones

Stomach and gut

Brain and nerves

Heart and blood vessels

Bones and joints

Key cosyntropin studies

Cosyntropin clinical trials

Is cosyntropin approved?

Cosyntropin side effects and safety

How people use it

What people use it for

Reported regimens

Cautions

Status notes

Community sources

Ask a question about cosyntropin

Related peptides

Sources