Home Drug Guide Corticotropin (H.P. Acthar Gel)

Drug Guide

Generic Name

Corticotropin (H.P. Acthar Gel)

Brand Names Acthar Gel

Classification

Therapeutic: Anti-inflammatory, Immunosuppressant

Pharmacological: Adrenocorticotropic hormone (ACTH) analogue

FDA Approved Indications

  • Multiple sclerosis relapses, including those associated with neuro-Behçet's syndrome
  • Infantile spasms (West syndrome)
  • Alzheimer's disease (off-label)
  • Multiple other inflammatory conditions

Mechanism of Action

Stimulates the adrenal cortex to secrete corticosteroids and adrenal hormones, thereby exerting anti-inflammatory and immunomodulatory effects.

Dosage and Administration

Adult: Dosage varies depending on condition; for infantile spasms, typically 20-40 units subcutaneously or intramuscularly daily for 2-4 weeks.

Pediatric: Dose as per condition; for infantile spasms, 20-40 units daily for 2 weeks.

Geriatric: Adjustment may be necessary based on response and comorbidities.

Renal Impairment: No specific adjustment; monitor closely.

Hepatic Impairment: No specific adjustment noted.

Pharmacokinetics

Absorption: Well absorbed after IM or subcutaneous injection.

Distribution: Widely distributed; specific volume not established.

Metabolism: Metabolized via hepatic pathways; metabolites eliminated by renal and hepatic routes.

Excretion: Metabolites excreted primarily in urine.

Half Life: Approximately 1-3 hours.

Contraindications

  • Hypersensitivity to corticotropin or synthetic adrenocorticotropic hormones.
  • Active systemic infections.

Precautions

  • Use with caution in patients with existing infections, osteoporosis, or psychiatric conditions. Monitor for signs of adrenal suppression with prolonged use. Pregnancy category C; benefit-risk assessment needed. Consider lactation implications.

Adverse Reactions - Common

  • Injection site reactions (Common)
  • Fluid retention, edema (Common)
  • Hypertension (Common)

Adverse Reactions - Serious

  • Infections due to immunosuppression (Serious)
  • Severe allergic reactions (Rare)
  • Cushingoid features (Uncommon)

Drug-Drug Interactions

  • Potent CYP3A4 inhibitors (e.g., ketoconazole) may increase corticosteroid effects.
  • Vaccines: Live vaccines may pose risk during therapy.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for allergic reactions, signs of infection, electrolyte imbalance, blood pressure, blood glucose levels.

Diagnoses:

  • Risk of infection related to immunosuppression
  • Fluid volume excess related to corticosteroid effects

Implementation: Administer as prescribed, monitor vital signs, blood glucose, electrolytes, and signs of adverse effects.

Evaluation: Assess therapeutic response and adverse effects regularly to adjust treatment accordingly.

Patient/Family Teaching

  • Report signs of infection promptly.
  • Do not stop medication abruptly.
  • Monitor blood glucose if diabetic.
  • Follow up on scheduled laboratory tests.

Special Considerations

Black Box Warnings:

  • Long-term use may lead to adrenal suppression, osteoporosis, and other corticosteroid-related side effects.
  • Use caution in patients with infections.

Genetic Factors: Genetic variations may influence metabolism and response.

Lab Test Interference: May cause increased cortisol levels in laboratory tests, affecting diagnostic assessments.

Overdose Management

Signs/Symptoms: Symptoms of adrenal suppression or corticosteroid excess, such as hyperglycemia, hypertension, or infection.

Treatment: Discontinue drug immediately, provide supportive care, and monitor vital signs and laboratory parameters.

Storage and Handling

Storage: Store at 2-8°C (36-46°F). Do not freeze.

Stability: Stable until expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.