Corticotropin (Adrenocorticotropic hormone; ACTH)

( Adrenocorticotropic hormone; ACTH ) Pronunciation: (core-tih-koe-TROE-pin)Class: Adrenalcortical steroid

Trade Names:ACTH- Powder for Injection 40 units/vial

Trade Names:HP Acthar- Powder for Injection 25 units/vial- Powder for Injection 40 units/vial

Pharmacology

Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

Pharmacokinetics

Absorption

T max is within 1 h.

Elimination

Plasma concentrations begin to decrease after 2 to 4 h.

Onset

Rapid.

Indications and Usage

Diagnostic testing of adrenocortical function; include diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Unlabeled Uses

Treatment of infantile spasms.

Contraindications

Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction; IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

Dosage and Administration

Repository Injection

IM/Subcutaneous 40 to 80 units every 24 to 72 h. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 units/day for 2 to 3 wk.

General Advice

Medication may be given via IM or subcutaneous route. Do not use IV route.

Drug Interactions

Anticholinesterases

Effects of these agents may be antagonized in myasthenia gravis.

Barbiturates

May decrease effects of corticotropin.

Laboratory Test Interactions

May decrease I ¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

Adverse Reactions

Cardiovascular

Hypertension; CHF; necrotizing angiitis.

CNS

Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri.

Dermatologic

Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne.

EENT

Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos.

GI

Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer.

Metabolic

Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use.

Miscellaneous

Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in patients with diabetes, secondary adrenocortical, pituitary unresponsiveness.

Precautions

Monitor

Blood glucose

In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.

Adverse reactions

Report any of the following to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Because prolonged use inhibits skeletal growth, careful monitoring is necessary.

Fluid and electrolyte balance

Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion.

Immunosuppression

Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin.

Infection

Drug may mask signs of infection; resistance to infection may be decreased.

Long-term administration

May lead to irreversible adverse reactions. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects.

Sensitivity to porcine proteins

Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration.

Stress

Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

Patient Information

Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
Advise patient to avoid receiving live virus vaccinations while taking this medication.
Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
Advise patient to contact health care provider before discontinuing medication.
Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.