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H.P. Acthar

Generic Name: corticotropin (Injection route)

kor-ti-koe-TROE-pin ree-POZ-i-tor-ee

Commonly used brand name(s)

In the U.S.

  • H.P. Acthar

In Canada

  • Acthar

Available Dosage Forms:

  • Gel/Jelly

Therapeutic Class: Diagnostic Agent, Adrenocortical Function

Pharmacologic Class: Corticotropin

Uses For H.P. Acthar

Repository corticotropin injection is used to treat infantile spasms (seizures) in babies and children younger than 2 years of age. It is also used to treat multiple sclerosis in adults.

This medicine is also used to treat joint disorders (e.g., psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis); autoimmune diseases (e.g., systemic lupus erythematosus or SLE, polymyositis); and certain conditions of the skin (e.g., erythema multiforme, Stevens-Johnson syndrome), eyes (e.g., keratitis, optic neuritis), and lungs (e.g., sarcoidosis). It is also used to treat certain allergies (e.g., serum sickness) and swelling (edema) of the body.

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This medicine is available only with your doctor's prescription.

Before Using H.P. Acthar

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of repository corticotropin injection to treat infantile spasms in babies and children younger than 2 years of age.

Geriatric

No information is available on the relationship of age to the effects of repository corticotropin injection in geriatric patients.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Rotavirus Vaccine, Live

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Bupropion
  • Itraconazole

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alatrofloxacin
  • Balofloxacin
  • Cinoxacin
  • Ciprofloxacin
  • Clinafloxacin
  • Enoxacin
  • Fleroxacin
  • Flumequine
  • Gemifloxacin
  • Grepafloxacin
  • Levofloxacin
  • Licorice
  • Lomefloxacin
  • Moxifloxacin
  • Norfloxacin
  • Ofloxacin
  • Pefloxacin
  • Prulifloxacin
  • Rosoxacin
  • Rufloxacin
  • Saiboku-To
  • Sparfloxacin
  • Temafloxacin
  • Tosufloxacin
  • Trovafloxacin Mesylate

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Adrenal problems or
  • Allergy to pork proteins, history of or
  • Congenital (inborn) infections or
  • Congestive heart failure or
  • Fungus infections, systemic or
  • Herpes simplex of the eye or
  • Hypertension (high blood pressure), uncontrolled or
  • Osteoporosis (thinning of the bones) or
  • Peptic ulcer, or history of or
  • Scleroderma (autoimmune disease) or
  • Surgery, recent—Should not be used in patients with these conditions.
  • Cataracts or
  • Cirrhosis (liver problem) or
  • Cushing's syndrome (adrenal gland disorder) or
  • Depression, history of or
  • Diabetes or
  • Edema (fluid retention or swelling) or
  • Emotional problems or
  • Eye infections (fungus, virus) or
  • Glaucoma or
  • Hypertension (high blood pressure), controlled or
  • Hypokalemia (low potassium in the blood) or
  • Hypothyroidism (underactive thyroid) or
  • Kidney disease, severe or
  • Mental illness (e.g., psychosis) or
  • Myasthenia gravis (severe muscle weakness) or
  • Stomach problems (ulcer, bleeding, or perforation) or
  • Tuberculosis, latent—Use with caution. May make these conditions worse.
  • Infection (bacteria, virus, parasite, or protozoa)—May decrease your body's ability to fight infection.
  • Lennox-Gastaut syndrome—May cause this condition to occur while using this medicine to treat infantile spasms.

Proper Use of corticotropin

This section provides information on the proper use of a number of products that contain corticotropin. It may not be specific to H.P. Acthar. Please read with care.

A nurse or other trained health professional will give you or your child this medicine. This medicine is given as a shot under your skin or into one of your muscles.

Repository corticotropin injection may sometimes be given at home to patients who do not need to be in the hospital. If you are using this medicine at home, your or your child's doctor will teach you how to prepare and inject the medicine. Be sure that you understand exactly how the medicine is prepared and injected.

If your child is receiving repository corticotropin injection to treat infantile spasms, this medicine usually comes with a Medication Guide. It is very important that you read and follow the instructions carefully. Be sure to ask your child's doctor about anything you do not understand.

You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems from the injections.

To use:

  • Take the vial from the refrigerator and let it warm to room temperature before using it. Do not over-pressurize the vial before withdrawing the medicine.
  • Wash your hands before and after using this medicine.
  • Wipe the injection site with a new sterile alcohol wipe and let it dry before giving an injection.
  • Clean the top of the rubber stopper vial with a new sterile alcohol wipe.
  • Use a new needle or syringe to get the prescribed amount of medicine to be injected.
  • Give the medicine the way your doctor has instructed you.
  • Return the vial to the refrigerator after using it.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form (gel):
    • For infantile spasms:
      • Children 2 years of age and older—Use and dose must be determined by your doctor.
      • Infants and children younger than 2 years of age—Dose is based on body size and must be determined by your child's doctor. The dose is 150 units per square meter (U/m2) of body size divided into two equal doses injected into a muscle per day for 2 weeks. Your child's doctor will adjust the dose as needed.
    • For multiple sclerosis:
      • Adults—The dose is usually 80 to 120 units injected under your skin or into a muscle per day for 2 to 3 weeks. Your doctor will adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
    • For other indications (joint disorders, autoimmune diseases, allergies, swelling, and certain conditions of the skin, eyes, and lungs):
      • Adults—The dose is usually 40 to 80 units injected under your skin or into a muscle every 24 to 72 hours. Your doctor will adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

This medicine needs to be given on a fixed schedule. If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions.

Storage

Store in the refrigerator. Do not freeze.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using H.P. Acthar

It is very important that your doctor check the progress of you or your child at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for any unwanted effects.

Do not receive live vaccines while you or your child are using this medicine.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

This medicine may increase your risk of developing infections. Avoid being near people who are sick or have infections while you are using this medicine. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems (e.g., Cushing's syndrome). The risk is greater for children and patients who use large amounts for a long time. Talk to your doctor right away if you or your child have more than one of these symptoms while you are using this medicine: blurred vision; dizziness or fainting; a fast, irregular, or pounding heartbeat; fractures; increased thirst or urination; irritability; round or "moon" face, neck, or trunk; stomach pain; thin skin or easy bruising; weight gain or loss; or unusual tiredness or weakness.

This medicine may cause fluid retention (edema) in some patients. Carefully follow your doctor's instructions about any special diet (especially on salt intake).

This medicine may mask or hide symptoms of other diseases while you are using it. Check with your doctor if you or your child have symptoms of infection; black, tarry stools; changes in body weight; difficulty with breathing; fast heart rate; increased thirst; stomach pain; unusual tiredness; or vomiting.

Check with your doctor right away if you start having severe abdominal or stomach burning, cramps, or pains; bloody or black, tarry stools; constipation or diarrhea; heartburn; indigestion; nausea; or vomiting of material that looks like coffee grounds. These could be symptoms of a serious stomach or bowel problem.

This medicine may cause changes in mood and behavior. Check with your doctor if you or your child have trouble sleeping, feeling depressed or irritable, mood swings, or other changes in behavior.

Check with your doctor right away if you or your child have any changes to your eyes, such as redness, itching, swelling, or vision changes while you are using this medicine. Your doctor may want you to have your eyes checked by an eye doctor.

This medicine may decrease bone mineral density when used for a long time. A low bone mineral density can cause slow growth and may lead to osteoporosis at any age. If you have any questions about this ask your doctor.

Do not stop using this medicine suddenly without checking first with your doctor. Your doctor may want you or your child to gradually reduce the amount you are using before stopping it completely.

H.P. Acthar Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Backache
  • blurred vision
  • body aches or pain
  • chest pain
  • cough
  • difficulty with breathing
  • dizziness
  • ear congestion
  • earache
  • facial hair growth in females
  • fever or chills
  • fractures
  • full or round face, neck, or trunk
  • headache
  • increased thirst or urination
  • irritability
  • loss of sexual desire or ability
  • loss of voice
  • menstrual irregularities
  • muscle wasting
  • nasal congestion
  • nervousness
  • pounding in the ears
  • redness or swelling in the ear
  • runny nose
  • shortness of breath
  • slow or fast heartbeat
  • sneezing
  • sore throat
  • tightness in the chest
  • troubled breathing
  • unusual tiredness or weakness
  • wheezing
  • white patches in the mouth or throat or on the tongue
  • white patches with diaper rash
Less common
  • Convulsions (seizures)
Incidence not known
  • Accumulation of pus
  • bruising
  • bulging soft spot on the head of an infant
  • change in the ability to see colors, especially blue or yellow
  • cold, clammy skin
  • confusion
  • decreased range of motion
  • decreased urine output
  • dilated neck veins
  • extreme fatigue
  • eyeballs bulge out of eye sockets
  • fast, weak pulse
  • full or bloated feeling
  • heartburn
  • insomnia
  • irregular breathing
  • irregular heartbeat
  • joint pain
  • large, flat, blue, or purplish patches in the skin
  • lightheadedness
  • limp
  • loss of appetite
  • nausea and vomiting
  • pressure in the stomach
  • severe headache
  • small red or purple spots on the skin
  • sweating
  • swelling of abdominal or stomach area
  • swelling of the face, fingers, feet, or lower legs
  • swollen, red, or tender area of infection
  • trouble healing
  • weight gain
  • wheezing
Incidence not known-For adults only
  • Bloating
  • chills
  • confusion
  • constipation
  • coughing up blood
  • darkened urine
  • fast heartbeat
  • fever
  • headache
  • headache, sudden and severe
  • increased sweating
  • indigestion
  • loss of appetite
  • pain in the muscles
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • redness of the face
  • skin rash
  • unusual weight loss
  • weakness
  • yellow eyes or skin
Incidence not known-For infants only
  • Decreased carbohydrate tolerance
  • hypokalemic alkalosis
  • reversible brain shrinkage

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Blemishes on the skin
  • diarrhea
  • pimples
Less common
  • Increased or decreased appetite
Incidence not known
  • Increased hair growth, especially on the face
  • menstrual changes
  • muscle weakness
Incidence not known-For adults only
  • Feeling of constant movement of self or surroundings
  • sensation of spinning
  • thinning of the skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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