corticotropin (Rx)

Brand and Other Names:HP 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

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              Serious - Use Alternative (8)

              • amphotericin B deoxycholate

                amphotericin B deoxycholate, corticotropin. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Potential for hypokalemia.

              • axicabtagene ciloleucel

                corticotropin decreases effects of axicabtagene ciloleucel by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid prophylactic use of systemic corticosteroids as premedication before axicabtagene ciloleucel. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.

              • influenza virus vaccine quadrivalent, adjuvanted

                corticotropin decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                corticotropin decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • macimorelin

                corticotropin, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin. .

              • testosterone intranasal

                testosterone intranasal, corticotropin. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration increases risk for edema, particularly in patients with cardiac, renal, or hepatic disease.

              • tisagenlecleucel

                corticotropin decreases effects of tisagenlecleucel by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid using corticosteroids as premedication or during treatment with tisagenlecleucel, except for life-threatening emergence (eg, cytokine release syndrome).

              • tofacitinib

                corticotropin, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (34)

              • atracurium

                atracurium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • cholera vaccine

                corticotropin decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • ciprofloxacin

                corticotropin and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • cisatracurium

                cisatracurium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • cyclosporine

                corticotropin, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase or decrease cyclosporine concentrations. Also, cyclosporine may increase the plasma concentrations of the corticosteroids. Monitor for changes in cyclosporine concentrations and for toxicities of corticosteroids and/or cyclosporine.

              • dengue vaccine

                corticotropin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • gemifloxacin

                corticotropin and gemifloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • hyaluronidase

                corticotropin decreases effects of hyaluronidase by Other (see comment). Use Caution/Monitor. Comment: Corticotropin (ACTH), when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Patients may require larger amounts of hyaluronidase for equivalent dispersing effect. .

              • hydrochlorothiazide

                corticotropin increases toxicity of hydrochlorothiazide by increasing renal clearance. Use Caution/Monitor. May enhance hypokalemic effect of thiazide diuretics.

              • influenza A (H5N1) vaccine

                corticotropin decreases effects of influenza A (H5N1) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids used in greater than physiologic doses may reduce immune response to H5N1 vaccine.

              • influenza virus vaccine (H5N1), adjuvanted

                corticotropin decreases effects of influenza virus vaccine (H5N1), adjuvanted by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids used in greater than physiologic doses may reduce immune response to H5N1 vaccine.

              • insulin degludec

                corticotropin decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Endogneous cortisol is a regulatory hormone that increases blood glucose levels; exogenous systemic corticosteroids have been associated with hyperglycemia and may cause diabetes with chronic, high dose use; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

              • insulin degludec/insulin aspart

                corticotropin decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Endogneous cortisol is a regulatory hormone that increases blood glucose levels; exogenous systemic corticosteroids have been associated with hyperglycemia and may cause diabetes with chronic, high dose use; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

              • insulin inhaled

                corticotropin decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Endogneous cortisol is a regulatory hormone that increases blood glucose levels; exogenous systemic corticosteroids have been associated with hyperglycemia and may cause diabetes with chronic, high dose use; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

              • levofloxacin

                corticotropin and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • lonapegsomatropin

                lonapegsomatropin decreases effects of corticotropin by Other (see comment). Use Caution/Monitor. Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.

                corticotropin decreases effects of lonapegsomatropin by Other (see comment). Use Caution/Monitor. Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.

              • mechlorethamine

                mechlorethamine, corticotropin. immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • metformin

                corticotropin decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.

              • moxifloxacin

                corticotropin and moxifloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • ocrelizumab

                corticotropin and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with high doses of corticosteroids is expected to increase the risk of immunosuppression.

              • ofatumumab SC

                ofatumumab SC, corticotropin. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • ofloxacin

                corticotropin and ofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • olodaterol inhaled

                corticotropin and olodaterol inhaled both decrease serum potassium. Use Caution/Monitor.

              • ozanimod

                ozanimod, corticotropin. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

              • pancuronium

                pancuronium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • ponesimod

                ponesimod and corticotropin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • rocuronium

                rocuronium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                corticotropin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of corticotropin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of corticotropin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • succinylcholine

                succinylcholine, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • trastuzumab

                trastuzumab, corticotropin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, corticotropin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • vecuronium

                vecuronium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              Minor (11)

              • bendroflumethiazide

                corticotropin, bendroflumethiazide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • bumetanide

                corticotropin, bumetanide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • chlorothiazide

                corticotropin, chlorothiazide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • chlorthalidone

                corticotropin, chlorthalidone. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • cyclopenthiazide

                corticotropin, cyclopenthiazide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • ethacrynic acid

                corticotropin, ethacrynic acid. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • furosemide

                corticotropin, furosemide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • indapamide

                corticotropin, indapamide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • methyclothiazide

                corticotropin, methyclothiazide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • metolazone

                corticotropin, metolazone. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

              • torsemide

                corticotropin, torsemide. pharmacodynamic synergism. Minor/Significance Unknown. Possible enhanced electrolyte loss.

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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

              Decreased carbohydrate tolerance (infants only), hirsutism, and menstrual irregularities

              Pancreatitis (adults only), abdominal distention, and ulcerative esophagitis

              Headache (adults only), vertigo (adults only), subdural hematoma, intracranial hemorrhage (adults only), and reversible brain shrinkage (usually secondary to hypertension) (infants only)

              Hypokalemic alkalosis (infants only) and fluid retention (including peripheral swelling)

              Blood glucose increased

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              Warnings

              Contraindications

              Sensitivity to porcine proteins

              IV administration

              Infants <2 years suspected of congenital infections

              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; effects are reversible once therapy stopped

              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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Acthar injection
              -
              80 unit/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              corticotropin injection

              CORTICOTROPIN - INJECTION

              (KOR-ti-koe-TROE-pin)

              COMMON BRAND NAME(S): Acthar

              USES: This medication is used to treat a certain type of seizure in children (infantile spasms). This medication is also used to treat conditions such as multiple sclerosis, arthritis, lupus, eye conditions, skin/kidney/lung diseases, and immune system disorders. It decreases your immune system's response to various diseases to reduce symptoms such as swelling, pain, and allergic-type reactions. Corticotropin is a hormone.

              HOW TO USE: If you are using this medication to treat infantile spasms, read the Medication Guide provided by your pharmacist before you start using corticotropin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is usually given by injection into a muscle or under the skin, as directed by your doctor. For infantile spasms, this medication should be given by injection into a muscle. The dosage is based on your body size, medical condition, and response to treatment. Do not increase your dose or use this drug more often than prescribed without consulting your doctor. Your condition will not improve any faster, and your risk of side effects will increase.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. To warm the medication before use, remove the medication from the refrigerator and roll the vial in your hands for a few minutes. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Do not stop using this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time(s) each day.Tell your doctor if your condition gets worse.

              SIDE EFFECTS: Vomiting, diarrhea, trouble sleeping, appetite changes, or pain/redness/swelling at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may rarely make your blood sugar rise, which can cause or worsen diabetes. Tell your doctor right away if you have symptoms of high blood sugar, such as increased thirst/urination. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This medication may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as fever, chills, sore throat that doesn't go away, cough, white patches in the mouth).This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: weakness, puffy face, unusual weight gain, slow wound healing, thinning skin, bone pain, menstrual period changes, mental/mood changes (such as mood swings, depression, agitation), easy bruising/bleeding, increased thirst/urination, vision problems, swelling ankles/feet/hands, fast/slow/irregular heartbeat.This drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. If you notice any of the following unlikely but serious side effects, get medical help right away: stomach/abdominal pain that doesn't go away, black stools, vomit that looks like coffee grounds.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using corticotropin, tell your doctor or pharmacist if you are allergic to it; or to pork products; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: adrenal gland problems, brittle bones (osteoporosis), current/ past infections (such as those caused by tuberculosis, threadworm, herpes, fungus), stomach/intestinal problems (such as diverticulitis, ulcer, ulcerative colitis), heart problems (such as congestive heart failure, recent heart attack), high blood pressure, eye diseases (such as cataracts, glaucoma, herpes infection of the eye), diabetes, kidney disease, liver disease, mental/mood conditions (such as psychosis, anxiety, depression), a certain skin/connective tissue disease (scleroderma), thyroid problems.This medicine may cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding. Limit alcoholic beverages. Consult your doctor or pharmacist for more information.Corticotropin can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.This medication may cause vaccines to not work as well. Live vaccines may cause serious problems (such as infection) if given while you are using this medication. Do not have immunizations, vaccinations, or skin tests without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Using this medication for a long time can make it more difficult for your body to respond to physical stress. Before having surgery or emergency treatment, or if you get a serious illness/injury, tell your doctor or dentist that you are using this medication or have used this medication within the past 12 months. Tell your doctor right away if you develop unusual/extreme tiredness or weight loss. If you will be using this medication for a long time, carry a warning card or medical ID bracelet that identifies your use of this medication.Older adults may be more sensitive to the side effects of this drug, especially brittle bones (osteoporosis). Talk to your doctor about ways to prevent osteoporosis. See also Notes section.This medication may slow down a child's growth if used for a long time. Consult the doctor or pharmacist for more details. See the doctor regularly so your child's height and growth can be checked.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood sugar/mineral levels, blood pressure, eye exams, bone density tests, height/weight measurements) should be done while you are using this medication. Consult your doctor for more details.Lifestyle changes that help reduce the risk of bone loss (osteoporosis) during long-term treatment include increasing weight-bearing exercise, stopping smoking, limiting alcohol, and eating well-balanced meals that contain adequate calcium and vitamin D. Consult your doctor for specific advice.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Store in the refrigerator. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              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.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
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              QL Quantity Limits
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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.