corticotropin (Rx)

Brand and Other Names:HP Acthar Gel, Acthar Gel
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 80 units/mL

Verification of Adrenal Responsiveness

40-80 unit IM/SC q24-72hr

Acute Exacerbations of Multiple Sclerosis

80-120 unit IM qDay for 2-3 weeks may be administered

Nephrotic Syndrome

Induces diuresis or a remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that due to lupus erythematosus

40-80 units IM/SC q1-3days

Other Indications & Uses

Diagnostic: Testing of adrenal cortex function

Therapeutic: As corticosteroids

Edematous State: Indicated to induce diuresis or remission of proteinuria in nephrotic syndrome without uremia of the idiopathic type or that due to lupus erythematosus

Rheumatic Disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: psoriatic arthritis, rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy), ankylosing spondylitis

Collagen Diseases: During an exacerbation or as maintenance therapy in selected cases of: systemic lupus erythematosus, systemic dermatomyositis (polymyositis)

Dermatologic Diseases: Severe erythema multiforme, Stevens-Johnson syndrome

Allergic States: Serum sickness

Ophthalmic Diseases: Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: keratitis, iritis, iridocyclitis, diffuse posterior uveitis and choroiditis; optic neuritis; chorioretinitis; anterior segment inflammation

Respiratory Diseases: Symptomatic sarcoidosis

Infantile spasms (West syndrome): Indicated as monotherapy for the treatment of infantile spasms in infants and children <2 years

Dosage Forms & Strengths

injectable solution

  • 80 unit/mL

Anti-Inflammatory/Immunosuppressant

0.8 unit/kg/day IM or 25 units/m²/day divided q12-24hr

Infantile Spasms (West Syndrome)

<2 years: 75 units/m² IM BID x2 weeks, THEN gradually taper over 2 weeks

Tapering schedule

  • 30 units/m² IM qAM for 3 days, THEN
  • 15 units/m² IM qAM for3 days, THEN
  • 10 units/m² IM qAM for 3 days, THEN
  • 10 units/m² every other morning for 6 days

Nephrotic Syndrome

Induces diuresis or a remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that due to lupus erythematosus

<2 years: Safety and efficacy not established

≥2 years: 40-80 units IM/SC q1-3days

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Interactions

Interaction Checker

and corticotropin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Common

            • Edema, hypertension
            • Psychotic disorder
            • Disorder of skin
            • Hyperglycemia
            • Peptic ulcer disease
            • Immune hypersensitivity reaction
            • Muscle weakness

            Serious

            • Cardiomegaly, congestive heart failure, necrotizing arteritis
            • Encephalitis due to human herpes simplex virus, relapse
            • Decreased body growth, Children
            • Pancreatitis
            • Thromboembolic disorder
            • Glaucoma

            Postmarketing Reports

            Injection site reactions

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            Warnings

            Contraindications

            Sensitivity to porcine proteins

            IV administration

            Suspected congenital infections in infants

            Coadministration of live or live attenuated vaccines with immunosuppressive doses of corticotropin

            Scleroderma

            Osteoporosis

            Systemic fungal infections

            Ocular herpes simplex

            Recent surgery

            Active/history of peptic ulcer

            CHF, HTN

            Cautions

            Increases susceptibility to new infection and risk of exacerbation, dissemination or reactivation of latent infections; signs and symptoms of infection may be masked

            Adrenal insufficiency may occur after prolonged therapy; monitor for effects of hypothalamic-pituitary-axis suppression after stopping treatment

            Cushing’s syndrome may occur after prolonged therapy; monitor for signs and symptoms

            Elevated blood pressure, salt and water retention and hypokalemia may occur; monitor blood pressure and sodium and potassium levels

            Do not administer live or live attenuated vaccines to patients on immunosuppressive doses

            May mask symptoms of other underlying disease/disorders; monitor patients for signs of other underlying disease/disorders that may be masked

            Gastrointestinal perforation and bleeding may occur; there is a risk for gastric ulcers and bleeding; there is an increased risk of perforation in patients with certain GI disorders; signs and symptoms may be masked; monitor for signs of perforation and bleeding

            Behavioral and mood disturbances may occur; may include euphoria, insomnia, mood swings, personality changes, severe depression and psychosis; existing conditions may be aggravated

            Symptoms of diabetes and myasthenia gravis may be worsened with treatment Monitor for cataracts, infections and glaucoma

            Neutralizing antibodies with chronic administration may lead to a loss of endogenous ACTH activity

            In patients with hypothyroidism or liver cirrhosis, may result in an enhanced effect

            Monitor pediatric patients on long term therapy for growth and physical development

            Monitor for osteoporosis in patients on long term therapy

            May have embryocidal effect in pregnancy; apprise women of potential harm to the fetus

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excretion in milk unknown; use with caution

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Half-Life: 15 min

            Mechanism of Action

            Porcine ACTH, stimulates adrenocortical hormone production

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.