Yes

Corticosteroid, Parenteral

Acute exacerbations of multiple sclerosis; diagnostic aid in adrenocortical insufficiency, severe muscle weakness in myasthenia gravis

C

Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; peptic ulcer; hypersensitivity to corticotropin or any component

>10%:

Central nervous system: Insomnia, nervousness

Gastrointestinal: Increased appetite, indigestion

1% to 10%:

Dermatologic: Hirsutism

Endocrine & metabolic: Diabetes mellitus

Neuromuscular & skeletal: Arthralgia

Ocular: Cataracts

Respiratory: Epistaxis

Decreased effect: Can antagonize the effect of anticholinesterases (eg, neostigmine) in patients with myasthenia gravis

Decreased corticotropin levels with barbiturates

Store repository injection in the refrigerator; reconstituted solution remains stable for 24 hours to 7 days when refrigerated depending on product; warm gel before administration

Stimulates the adrenal cortex to secrete adrenal steroids (including hydrocortisone, cortisone), androgenic substances, and a small amount of aldosterone

Injection has a rapid onset and duration of activity of approximately 2 hours; the repository injection has a slower onset, but may sustain effects for less than or equal to 3 days

Anti-inflammatory/immunosuppressant:

I.M., I.V., S.C. (aqueous): 1.6 units/kg/day or 50 units/m²/day divided every 6-8 hours

I.M. (gel): 0.8 units/kg/day or 25 units/m²/day divided every 12-24 hours

Infantile spasms: Various regimens have been used. Some neurologists recommend low-dose ACTH (5-40 units/day) for short periods (1-6 weeks), while others recommend larger doses of ACTH (40-160 units/day) for long periods of treatment (3-12 months). Well designed comparative dosing studies are needed. Example of low dose regimen:

Initial: I.M. (gel): 20 units/day for 2 weeks, if patient responds, taper and discontinue; if patient does not respond, increase dose to 30 units/day for 4 weeks then taper and discontinue

I.M. usual dose (gel): 20-40 units/day or 5-8 units/kg/day in 1-2 divided doses; range: 5-160 units/day

Oral prednisone (2 mg/kg/day) was as effective as I.M. ACTH gel (20 units/day) in controlling infantile spasms

Adults: Acute exacerbation of multiple sclerosis: I.M.: 80-120 units/day for 2-3 weeks

Diagnostic purposes: I.V.: 10-25 units in 500 mL 5% dextrose in water infused over 8 hours

Repository injection: I.M., S.C.: 40-80 units every 24-72 hours

May increase renal loss of potassium, calcium, zinc, and vitamin C; may need to increase dietary intake or give supplements

Reconstitute powder with 1-2 mL sterile water or NS. I.V. infusion - do not use gel; dissolve 10-25 units into 500 mL D₅W and administer over 8 hours.

Insomnia and nervousness are common; may cause euphoria or hallucinations

Barbiturates may decrease the levels of corticotropin

No information available to require special precautions

No effects or complications reported

Do not abruptly discontinue the medication; your physician may want you to follow a low salt/potassium rich diet; tell physician you are using this drug before having skin tests, before surgery, or emergency treatment if you get a serious infection or injury

Do not administer zinc hydroxide suspension S.C. or I.V.; do not abruptly discontinue the medication

Injection, repository (H.P. Acthar® Gel): 40 units/mL (1 mL, 5 mL); 80 units/mL (1 mL, 5 mL)

Powder for injection (Acthar®): 25 units, 40 units