H.P. Acthar Gel
Classifications: hormone; adrenal corticosteroid; Therapeutic: hormone; adrenal corticosteroid
Pregnancy Category: C
40 units/mL, 80 units/mL
Adrenocorticotropic hormone (ACTH) extracted from pituitary of domestic animals (usually pigs). Stimulates functioning adrenal
cortex to produce and secrete corticosterone, cortisol (hydrocortisone), several weak androgens, and limited amounts of aldosterone.
Therapeutic effects appear more rapidly than do those of prednisone. Suppresses further release of corticotropin by negative
feedback mechanism. Chronic administration of exogenous corticosteroids decreases ACTH store and causes structural changes
Diagnostic test of adrenocortical function and adjunctively to treat adrenal insufficiency secondary to inadequate corticotropin
secretion. Effective in treatment of adrenocorticoid-responsive diseases, such as multiple sclerosis, but adrenocorticoid
therapy is preferred.
Ocular herpes simplex; recent surgery; CHF; scleroderma; osteoporosis; systemic fungoid infections; hypertension; adrenal
insufficiency; heart failure; herpes infection, active infection; scleroderma; sensitivity to porcine proteins; conditions
accompanied by primary adrenocortical insufficiency or hyperfunction; long-term use in children, pregnancy (category C),
Patients with latent tuberculosis or those reacting to tuberculin; hypothyroiditis, diabetes mellitus; seizure disorders;
renal disease; psychosis, emotional instability; thromboembolic disease; GI disease; impaired hepatic function.
Route & Dosage
Adult: IM/SC 4080 U q2472h
Child: IM/IV/SC 0.8 U/kg/d divided q12h
Acute Multiple Sclerosis
Adult: IM/SC 80120 U/d for 23 wk
- Dosage is individualized. Changes in dosage regimen are gradual and only after full drug effects have become apparent.
- Corticotropin repository is only for SC and IM use. Do not use IV.
- Shake corticotropin zinc hydroxide bottle well before injecting drug deep into gluteal muscle.
- Give deep IM into a large muscle.
- IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.
PREPARE: Continuous: Use only the vial labeled for IV use. Dilute powder with 2 mL sterile water or NS for injection; desired dose is withdrawn
from vial and further diluted with 500 mL of D5W.
ADMINISTER: Continuous: Give over 8 h.
INCOMPATIBILITIES Solution/additive: Aminophylline, sodium bicarbonate.
- Administration of the hormone at high dosage levels is tapered rather than withdrawn suddenly. A 25 d period of adrenocortical
hypofunction follows discontinuation of corticotropin.
- Storage: Corticotropin for injection (reconstituted solution) is stable for 24 h or 7 d, depending on product, when stored
at 2°8° C (36°46° F). Store corticotropin repository at 2°15° C (36°59°
F). Store corticotropin zinc hydroxide at 15°30° C (59°86° F).
Adverse Effects (≥1%) Body as a Whole:
Loss of muscle mass, hypersensitivity, activation of latent tuberculosis
, vertebral compression fracture. GI:
Nausea, vomiting, abdominal distention, peptic ulcer
with perforation and hemorrhage. Endocrine:
Hirsutism, amenorrhea, osteoporosis, cushingoid state, activation of latent diabetes
Sodium and water retention; potassium and calcium loss, negative nitrogen balance, hyperglycemia. CNS:
, headache, convulsions, papilledema, mood swings, depression
. Skin: Acne
, impaired wound healing, fragile skin, petechiae, ecchymosis. Special Senses: Cataract
Interactions Drug: Aspirin, nsaids
increase potential for hypoprothrombinemia; barbiturates
, phenytoin, rifampin
decrease effects of corticotropin; estrogens
may increase corticotropin binding and effects; amphotericin B, thiazide and loop diuretics
increase potassium loss.
6 h. Duration:
1224 h repository. Distribution:
Concentrated in many tissues; not known if crosses placenta or distributed into breast milk. Metabolism:
In liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Before giving corticotropin to patient with suspected sensitivity to porcine proteins, hypersensitivity skin testing should
- Observe patient closely for 15 min for hypersensitivity reactions during IV administration or immediately after SC or IM
injections (urticaria, pruritus, dizziness, nausea, vomiting, anaphylactic shock). Epinephrine 1:1000 should be readily
available for emergency treatment.
- Prolonged use of corticotropin increases risk of hypersensitivity reaction (see Appendix F).
- Adrenal response to corticotropin is measured against a baseline plasma cortisol level 1 h before the 8 h test. Another
plasma level is determined after at least 1 h of the infusion.
- Corticotropin may suppress S&S of chronic disease.
- New infections can appear during treatment. Because of decreased resistance and inability to localize the infection, it
may be severe. Report immediately.
- Monitor carefully growth and development of a child receiving this drug.
Patient & Family Education
- Corticotropin administration increases requirements for insulin and oral antidiabetic agents. If you have diabetes mellitus,
monitor blood glucose closely until response to the drug is stabilized.
- Monitor weight and report a steady gain, especially if accompanied by edema. Also promptly report headache, muscle weakness,
- Do not self-medicate with OTC drugs without consulting physician.
- Eye examinations should be done before initiation of expected long-term therapy and periodically during treatment. Report
to physician if blurred vision occurs.
- Dietary salt restriction and potassium supplementation may be necessary to minimize edema caused by overstimulation of the
adrenal cortex by corticotropin.
- Do not receive live vaccine immunizations while receiving corticotropin.