Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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
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
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.Pharmacology
Half-Life: 15 min
Mechanism of Action
Porcine ACTH, stimulates adrenocortical hormone production
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Patient Handout
Formulary
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