Tetracosactide acetate injection(synacthen) is a synthetic polypeptide drug. Its core function is to stimulate the adrenal cortex to secrete glucocorticoids such as cortisol and aldosterone, thereby exerting pharmacological effects including anti-inflammation, immunoregulation, and anticonvulsion. With high specificity and favorable tolerability, this drug is widely used in multiple clinical fields, such as pediatric epilepsy and neurological disorders, and adjuvant therapy for tumor chemotherapy.
Products Description
Tetracosactide\Tetracosactide AcetateCOA
Application in Pediatric Epilepsy and Neurological Disorders
In pediatric epilepsy and neurological disorders, some severe conditions (e.g., infantile spasms, Lennox-Gastaut syndrome) show limited response to conventional antiepileptic drugs. By regulating systemic glucocorticoid levels, tetracosactide acetate injection can effectively control epileptic seizures and improve neurological function, making it an important therapeutic agent for such diseases, especially as a first-line treatment for infantile spasms.
(1) Infantile Spasms (West Syndrome)
Infantile spasms (West syndrome) is a severe refractory epileptic syndrome occurring in infancy (mostly onset at 3–12 months after birth), with an incidence of approximately 1 in 4,000 to 1 in 6,000 live births, accounting for 13%–14.5% of infantile epilepsy cases. Its typical clinical manifestations include nodding spasms and hypsarrhythmia on electroencephalography (EEG), often accompanied by long-term neurological impairments such as intellectual developmental delay. Without timely intervention, it severely affects the growth, development and quality of life of affected infants. The product is currently one of the first-line drugs for this condition. Its core mechanism is to exert potent anticonvulsant effects by stimulating the adrenal cortex to secrete cortisol, while modulating abnormal electrical activity in the central nervous system to control seizures.
The efficacy of it in treating infantile spasms has been confirmed by multiple clinical studies. A combined retrospective and prospective study enrolling 50 children with infantile spasms showed that treatment with intramuscular sustained-release synacthen acetate (0.02 mg/kg/day) combined with other antiepileptic drugs achieved complete cessation of spasms in 84% of patients and EEG improvement in 82%, indicating significant short-term efficacy of this combination regimen. In addition, a single-center retrospective cohort study of 200 Chinese children with infantile spasms demonstrated a clear dose-dependent efficacy of tetracosactide acetate, with a recommended starting dose of 2–3 IU/kg/day to achieve the optimal balance between efficacy and safety.
The response rate for a full treatment course (up to 28 days) reached 73.9%, and most patients showed therapeutic response within the first 14 days. If complete remission was not achieved by day 14, extending the course to 28 days increased the response rate by an additional approximately 24%.
The advantages of this drug in treating infantile spasms include rapid onset of action and effectiveness in some patients unresponsive to conventional antiepileptic drugs. As a synthetic polypeptide, it also has lower allergenicity and better tolerability compared to natural ACTH. Notices for use in infants include strict dose control, individualized regimens based on age and body weight, and close monitoring of blood pressure, electrolytes and signs of infection to avoid adverse reactions. In particular, neonates (especially preterm infants) should avoid use, as benzyl alcohol in the formulation may cause severe adverse reactions. In countries such as France, it is also listed as a second-line treatment for infantile spasms in patients unresponsive to oral glucocorticoids.
Information source: Bachem. Tetracosactide (Bachem) [EB/OL]; ChemicalBook. Tetracosactide acetate [EB/OL]. March 18, 2026.
Lennox-Gastaut syndrome (LGS) is a refractory epileptic syndrome with onset in childhood (mostly at 3–5 years of age). It has complex etiologies, including genetic, metabolic, structural and other types. Clinical features include diverse seizure types (tonic seizures, atonic seizures, absence seizures, etc.), characteristic slow-wave activity on EEG, and frequent complications such as intellectual developmental delay and behavioral abnormalities, leading to a poor prognosis. Conventional antiepileptic drugs show limited efficacy, and most patients fail to achieve seizure freedom. The main therapeutic goals are to reduce seizure frequency and severity and improve quality of life. As an adjuvant therapy, tetracosactide acetate injection plays an important role in the management of this syndrome.
The mechanism of it as adjuvant therapy for LGS is similar to that for infantile spasms: it mainly stimulates the adrenal cortex to secrete cortisol, modulates inflammatory responses and abnormal electrical activity in the central nervous system, and assists in seizure control. It is especially suitable for refractory cases unresponsive to first-line antiepileptic drugs such as valproic acid and lamotrigine. Due to the refractoriness of LGS, monotherapy rarely achieves ideal outcomes, and multidrug combination regimens are commonly used clinically. The product can act synergistically with other antiepileptic drugs to further reduce seizure frequency and severity, while lowering the dosage of concomitant medications and decreasing the incidence of adverse reactions.
Information source: Bachem. Tetracosactide (Bachem) [EB/OL]; Guidelines for the Diagnosis and Treatment of Lennox-Gastaut Syndrome (2025 Edition) [EB/OL]. July 17, 2025.
Application in Oncology and Chemotherapy Adjuvant Therapy
Chemotherapy is a major clinical approach for malignant tumors. However, chemotherapeutic agents damage normal cells while killing tumor cells, particularly causing immunosuppression, leading to reduced immune function, increased susceptibility to infections, fatigue, anorexia and other adverse reactions. In severe cases, chemotherapy may be interrupted, compromising therapeutic outcomes. Additionally, some patients with advanced tumors develop cancer-related cachexia, characterized by weight loss, muscle atrophy and anorexia, which severely reduces quality of life and survival time. By regulating immune function and metabolic status, it can effectively serve as an adjuvant to tumor chemotherapy, improve patient tolerability, and provide certain management for cancer-related cachexia.
(1) Adjuvant Therapy for Malignant Tumor Chemotherapy
During chemotherapy, chemotherapeutic drugs directly damage immune cells (T lymphocytes, B lymphocytes, macrophages, etc.), resulting in immunosuppression manifested as leukopenia, reduced lymphocyte count, decreased immunoglobulin levels, etc. This increases infection risk and impairs immune surveillance and elimination of tumor cells, hindering tumor control. As an immunomodulator, it regulates systemic immune responses by stimulating cortisol secretion from the adrenal cortex, ameliorating chemotherapy-related immunosuppression.
Its specific mechanism: cortisol modulates the proliferation, differentiation and function of immune cells, enhances phagocytosis of macrophages and activity of natural killer cells, promotes lymphocyte proliferation and cytokine secretion, thereby boosting immune function and reducing immunosuppression-related adverse events of chemotherapy.
Clinical studies show that combined use of the product during chemotherapy significantly increases leukocyte, lymphocyte and immunoglobulin levels, reduces infection incidence, alleviates systemic symptoms such as fatigue, anorexia, nausea and vomiting, improves chemotherapy tolerability, and enables uninterrupted chemotherapy.
Furthermore, tetracosactide acetate injection exerts anti-inflammatory effects to alleviate tissue damage and inflammation caused by chemotherapy, such as chemotherapy-related stomatitis and esophagitis, relieving pain and discomfort and further improving quality of life.
For chemotherapy adjuvant use, administration should start 1–2 days before chemotherapy, with dosage adjusted based on body weight and chemotherapy regimen, usually via intramuscular injection. During treatment, adrenal function, blood glucose, blood pressure and other indicators require close monitoring to avoid adverse reactions from excessive cortisol, such as hypertension, hyperglycemia and osteoporosis. For patients with diabetes or hypertension, dosage should be adjusted according to condition, with concomitant symptomatic therapy if necessary.
Information source: MedChemExpress. Tetracosactide acetate [EB/OL]; ChemicalBook. Tetracosactide acetate [EB/OL]. March 18, 2026.
Cancer-related cachexia is a common complication of advanced malignant tumors, with an incidence of approximately 50%–80%. It is characterized by progressive weight loss, muscle atrophy, anorexia, fatigue, anemia, etc. Its pathogenesis involves inflammatory factors secreted by tumor cells, metabolic disorders, immune dysfunction and other factors. It not only severely impairs quality of life but also reduces tolerance to chemotherapy, radiotherapy and other treatments, shortening survival. Current management of cancer-related cachexia relies on comprehensive intervention, with pharmacotherapy as an important component. As an adjuvant drug, the product manages cachexia by regulating systemic metabolism and immune function.
The core role of the product in cancer-related cachexia is: stimulating adrenal cortisol secretion to regulate glucose, protein and fat metabolism, reduce protein catabolism, promote fat utilization, thereby alleviating weight loss and muscle atrophy; its anti-inflammatory effect mitigates tumor-related inflammation, relieves fatigue and anorexia, and improves food intake and nutritional status. Additionally, it enhances immune function and host anti-tumor resistance, indirectly slowing cachexia progression.
Information source: Bachem. Tetracosactide (Bachem) [EB/OL]; MedChemExpress. Tetracosactide acetate [EB/OL].
Contraindications
Contraindicated in patients with tuberculosis, hypertension, diabetes mellitus, peptic ulcer disease, and in pregnant women.
Use with caution in children under 2 years of age; dosage should be adjusted according to body weight.
Information source: Electronic Medicines Compendium (emc). Synacthen Depot Ampoules 1 mg/ml [EB/OL]. 2025-05-01. Chinese Medicine Encyclopedia. Tetracosactide [EB/OL]. 2017-03-17.
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