Intramuscular, Subcutaneous Acute exacerbations in multiple sclerosis
Adult: 80-120 units daily for 2-3 weeks via IM or SC injection. Frequency and dose is determined depending on the severity of the disease and initial response from the treatment. Gradually discontinue the treatment by tapering the dose.
Intramuscular Infantile spasms
Child: <2 years 75 units/m2/dose twice daily for 2 weeks. Frequency and dose is determined depending on the severity of the disease and initial response from the treatment. Gradually discontinue the treatment by tapering the dose (refer to detailed product guidelines).
Intramuscular, Subcutaneous Allergic and inflammatory conditions of the eye, Diuresis in nephrotic syndrome, Rheumatic disorders, Symptomatic sarcoidosis, Systemic lupus erythematosus
Adult: 40-80 units every 24-72 hours via IM or SC injection. Dosage is individualised according to medical condition being treated. Frequency and dose is determined depending on the severity of the disease and initial response from the treatment. Gradually discontinue the treatment by tapering the dose (refer to detailed product guidelines). Child: >2 years Same as adult dose.
Contraindications
Hypersensitivity to porcine proteins. Scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, peptic ulcer, recent surgery, CHF, uncontrolled hypertension, primary adrenocortical insufficiency or hyperfunction, suspected congenital infections in infants. Co-administration with live or live attenuated vaccines. Not indicated for intravenous administration.
Special Precautions
Patient with hypertension, pre-existing psychiatric conditions (e.g. emotional instability psychotic tendencies), diabetes mellitus, gastrointestinal disease (e.g. diverticulitis, ulcerative colitis, risk of perforation, fresh intestinal anastomoses), gastrointestinal perforation, gastrointestinal bleeding, liver cirrhosis, myasthenia gravis, cataracts, glaucoma, risk factors for osteoporosis, thyroid disease (e.g. hypothyroidism), seizure disorder. Avoid abrupt withdrawal or rapid dose reduction. Renal and hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Adrenal suppression (e.g. hypothalamic-pituitary-axis suppression, Cushing’s syndrome), electrolyte disturbance, hypersensitivity reactions, immunosuppression, psychiatric disturbances (e.g. depression, euphoria, insomnia, irritability, mood swings, personality changes, psychotic manifestations), fluid retention, hypertension, hyperglycaemia, exacerbation of myasthenia gravis, increased intraocular pressure, open-angle glaucoma, cataracts, increased bone loss and osteoporotic fractures (long-term use). Gastrointestinal disorders: Diarrhoea, vomiting. General disorders and administration site conditions: Fever. Infections and infestations: Infection. Investigations: Weight gain. Nervous system disorders: Seizures.
Monitor blood pressure, ECG, chest and spinal radiographs, cardiac function, weight, serum glucose, electrolytes, faecal blood and signs of infection during treatment and following discontinuation; signs and symptoms of adrenal insufficiency, Cushing’s syndrome and ocular infections. Monitor growth in children, bone mass density, and cataract formation following prolonged use.
Drug Interactions
May diminish therapeutic effect of inactivated vaccines. Potentially Fatal: May enhance toxic effect and diminish therapeutic effect of live vaccines.
Lab Interference
May suppress wheal and flare reactions to skin test antigens.
Action
Description: Mechanism of Action: Corticotropin is a naturally occurring hormone of the anterior lobe of pituitary gland. It stimulates the adrenal cortex to secrete cortisol, corticosterone, weakly androgenic substances, and aldosterone at a very limited extent.
Synonym: adrenocorticotrophic hormone (ACTH), adrenocorticotrophin, corticotrophin. Onset: 3-12 hours (cortisol serum concentration). Duration: 10-25 hours, up to 3 days. Pharmacokinetics: Absorption: IM: Rapidly absorbed. Approx 8-15 hours. Excretion: Mainly via urine. Elimination half-life: 15 minutes.
Chemical Structure
Corticotropin Source: National Center for Biotechnology Information. PubChem Database. Corticotropin, CID=16132265, https://pubchem.ncbi.nlm.nih.gov/compound/Corticotropin (accessed on Jan. 22, 2020)
H01AA01 - corticotropin ; Belongs to the class of ACTH. Used in anterior pituitary lobe hormone and analogue preparations.
References
Acton Prolongatum (Ferring). MIMS India. http://www.mims.com/india. Accessed 02/05/2018.Anon. Corticotropin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com/. Accessed 22/05/2018.Anon. Corticotropin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/05/2018.Buckingham R (ed). Corticotropin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/05/2018.H.P. Acthar Repository Injection (Mallinckrodt ARD Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/05/2018.
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