Can you take ACTH with Voclosporin?

The corticotropin in ACTH has a moderate potential interaction with Abnormal Glucose Tolerance.

Adrenocorticotropic agents may impair glucose tolerance and cause hyperglycemia. Therapy with these agents should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during adrenocorticotropic therapy, and their antidiabetic regimen adjusted accordingly.

The corticotropin in ACTH has a major potential interaction with Adrenal Insufficiency.

The use of adrenocorticotropic agents is contraindicated in patients with primary adrenocortical insufficiency because of the lack of adrenal responsiveness.

Voclosporin has a moderate potential interaction with Arrhythmia.

The use of voclosporin prolongs the QTc interval in a dose-dependent manner. Studies have demonstrated that after a single dose administration at a dose higher than the recommended lupus nephritis therapeutic dose, dose-dependent QT prolongation effect was observed. Care is recommended when using this drug in patients at risk, such as patients taking concomitant drugs known to prolong the QTc interval, patients with bradycardia, hypokalemia, or hypomagnesemia, and the presence of congenital prolongation of the QT interval. Consider obtaining electrocardiograms and monitoring electrolytes in patients at high risk.

The corticotropin in ACTH has a moderate potential interaction with Cirrhosis.

Adrenocorticotropic agents may have enhanced effects in patients with cirrhosis. Dosage adjustments may be necessary in these patients.

The corticotropin in ACTH has a moderate potential interaction with Depression.

Adrenocorticotropic agents may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during adrenocorticotropic therapy.

The corticotropin in ACTH has a moderate potential interaction with Diabetes Mellitus.

Adrenocorticotropic agents may impair glucose tolerance and cause hyperglycemia. Therapy with these agents should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during adrenocorticotropic therapy, and their antidiabetic regimen adjusted accordingly.

The corticotropin in ACTH has a major potential interaction with Diverticulitis.

Adrenocorticotropic agents may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with adrenocorticotropic agents should be administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.

The corticotropin in ACTH has a major potential interaction with Fluid Retention.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting fluid retention or conditions that may be aggravated by these effects. Dietary sodium restriction and potassium supplementation may be advisable. The manufacturers consider the use of adrenocorticotropic agents to be contraindicated in patients with congestive heart failure or uncontrolled hypertension.

The corticotropin in ACTH has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Prolonged use of adrenocorticotropic agents may cause elevated intraocular pressure and glaucoma with possible damage to the optic nerves. Long-term therapy with these agents should be administered cautiously in patients with preexisting glaucoma (particularly open-angle glaucoma) or increased intraocular pressure.

The corticotropin in ACTH has a major potential interaction with Heart Failure.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting fluid retention or conditions that may be aggravated by these effects. Dietary sodium restriction and potassium supplementation may be advisable. The manufacturers consider the use of adrenocorticotropic agents to be contraindicated in patients with congestive heart failure or uncontrolled hypertension.

The corticotropin in ACTH has a major potential interaction with Herpetic Keratitis.

Adrenocorticotropic agents should be used cautiously, if at all, in patients with ocular herpes simplex because of the risk of corneal perforation. The manufacturers consider their use to be contraindicated in such setting.

The corticotropin in ACTH has a major potential interaction with High Blood Pressure.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting fluid retention or conditions that may be aggravated by these effects. Dietary sodium restriction and potassium supplementation may be advisable. The manufacturers consider the use of adrenocorticotropic agents to be contraindicated in patients with congestive heart failure or uncontrolled hypertension.

Voclosporin has a moderate potential interaction with High Blood Pressure.

The use of voclosporin causes hypertension. Exercise care when using this agent in hypertensive patients, including patients on antihypertensive drugs. It is recommended to monitor blood pressure regularly during treatment and treat new-onset hypertension and exacerbations of preexisting hypertension according to medical practices. If a patient experiences increases in blood pressure that cannot be managed with dose reduction or other appropriate medical intervention, consider treatment discontinuation.

The corticotropin in ACTH has a major potential interaction with History, Peptic Ulcer.

Adrenocorticotropic agents may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. Delayed healing of peptic ulcers has also been reported. Therapy with adrenocorticotropic agents, if necessary, should be administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. The manufacturers consider their use to be contraindicated in such setting.

The corticotropin in ACTH has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.

Adrenocorticotropic agents may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. These agents should be used cautiously in patients with thrombotic or thromboembolic disorders.

The corticotropin in ACTH has a major potential interaction with History, Tuberculosis.

In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of adrenocorticotropic agents may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if adrenocorticotropic therapy is administered to these patients. During prolonged use, tuberculosis chemoprophylaxis may be considered.

The corticotropin in ACTH has a major potential interaction with Hyperadrenocorticism.

The use of adrenocorticotropic agents is contraindicated in patients with adrenocortical hyperfunction. These agents stimulate the release of cortisol and aldosterone and may aggravate symptoms of hyperadrenocorticism.

The corticotropin in ACTH has a major potential interaction with Hypernatremia.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, hypocalcemia, and fluid retention. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

The corticotropin in ACTH has a major potential interaction with Hypocalcemia.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, hypocalcemia, and fluid retention. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

The corticotropin in ACTH has a major potential interaction with Hypokalemia.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, hypocalcemia, and fluid retention. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

The corticotropin in ACTH has a major potential interaction with Infection.

The immunosuppressant and anti-inflammatory effects of adrenocorticotropic agents, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. In general, adrenocorticotropic agents should not be used in patients with active infections, especially systemic fungal infections, unless they are medically necessary and effective antimicrobial therapy or other appropriate treatment has been instituted. For patients who have received prolonged adrenocorticotropic therapy who develop a severe or life-threatening infection, supplemental doses of rapid-acting corticosteroids may be required, since these patients may have hypothalamic-pituitary insufficiency.

Voclosporin has a major potential interaction with Infection.

Serious and sometimes fatal infections have been reported in patients receiving immunosuppressive agents. Patients receiving immunosuppressants are at increased risk of developing bacterial, viral, fungal, and protozoal infections, and new or reactivated viral infections including opportunistic infections. Caution should be exercised when considering their use in patients with severe or chronic infections. It is recommended to interrupt therapy in patients who develop a new infection while undergoing treatment and to monitor these patients closely for any sign or symptom indicative of infection.

Voclosporin has a moderate potential interaction with Infection.

Calcineurin-inhibitors, may cause pure red cell aplasia (PRCA). Care should be exercised when using voclosporin in patients at risk for PRCA, such as parvovirus B19 infection, underlying disease, or concomitant medications associated with PRCA. It is recommended to consider treatment discontinuation if PRCA is diagnosed.

The corticotropin in ACTH has a major potential interaction with Intestinal Anastomoses.

Adrenocorticotropic agents may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with adrenocorticotropic agents should be administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.

Voclosporin has a major potential interaction with Liver Disease.

Voclosporin is predominantly metabolized by CYP450 3A4. Avoid the use of voclosporin in patients with severe hepatic impairment (Child-Pugh C). It is recommended to reduce the dose of voclosporin to 15.8 mg twice a day in patients with mild and moderate hepatic impairment (Child-Pugh A and Child-Pugh B).

The corticotropin in ACTH has a moderate potential interaction with Myasthenia Gravis.

While corticotropin has been used effectively in severe, refractory myasthenia gravis to increase muscle strength, it should nevertheless be administered with extreme caution in such setting. Patients must be treated in an intensive care unit and receive respiratory support, since muscle strength will markedly decrease initially. Improvement usually occurs several days after the first or second course of treatment. Similar responses might be expected of other adrenocorticotropic agents, although their use in myasthenia gravis has not been studied extensively.

The corticotropin in ACTH has a moderate potential interaction with Myoneural Disorder.

Toxic myopathy may occur with the prolonged use of adrenocorticotropic agents, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadraparesis. Elevations of creatine kinase may also occur, albeit infrequently. After withdrawal of ACTH therapy, recovery may be slow and incomplete. Therapy with adrenocorticotropic agents should be administered cautiously in patients with preexisting myopathy or myoneural disorders, since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal or no changes of myopathy on EMG, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of adrenocorticotropic therapy should be considered.

The corticotropin in ACTH has a moderate potential interaction with Myopathy.

Toxic myopathy may occur with the prolonged use of adrenocorticotropic agents, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadraparesis. Elevations of creatine kinase may also occur, albeit infrequently. After withdrawal of ACTH therapy, recovery may be slow and incomplete. Therapy with adrenocorticotropic agents should be administered cautiously in patients with preexisting myopathy or myoneural disorders, since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal or no changes of myopathy on EMG, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of adrenocorticotropic therapy should be considered.

Voclosporin has a moderate potential interaction with Neurological Disorders.

The use of voclosporin may cause a spectrum of neurotoxicities. It is recommended to monitor for neurologic symptoms and to consider dosage reduction or discontinuation if neurotoxicity occurs. Care should be exercised when using this drug in patients with preexisting neurological conditions such as seizures, delirium, posterior reversible encephalopathy syndrome.

The corticotropin in ACTH has a major potential interaction with Osteoporosis.

Adrenocorticotropic agents inhibit the absorption of intestinal calcium and increase urinary excretion of calcium, which can result in bone resorption and bone loss during prolonged therapy. In addition, bone matrix may be affected by the protein-catabolic effects of these agents, especially when given in high dosages or for prolonged periods, leading to aseptic necrosis and fractures. Long-term or high-dose adrenocorticotropic therapy should be administered cautiously and only if necessary in patients with or at risk for osteoporosis. The manufacturers consider the use of adrenocorticotropic agents to be contraindicated in such setting.

The corticotropin in ACTH has a major potential interaction with Peptic Ulcer.

Adrenocorticotropic agents may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. Delayed healing of peptic ulcers has also been reported. Therapy with adrenocorticotropic agents, if necessary, should be administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. The manufacturers consider their use to be contraindicated in such setting.

Voclosporin has a moderate potential interaction with Posterior Reversible Encephalopathy Syndrome.

The use of voclosporin may cause a spectrum of neurotoxicities. It is recommended to monitor for neurologic symptoms and to consider dosage reduction or discontinuation if neurotoxicity occurs. Care should be exercised when using this drug in patients with preexisting neurological conditions such as seizures, delirium, posterior reversible encephalopathy syndrome.

The corticotropin in ACTH has a moderate potential interaction with Psychosis.

Adrenocorticotropic agents may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during adrenocorticotropic therapy.

Voclosporin has a moderate potential interaction with Psychosis.

The use of voclosporin may cause a spectrum of neurotoxicities. It is recommended to monitor for neurologic symptoms and to consider dosage reduction or discontinuation if neurotoxicity occurs. Care should be exercised when using this drug in patients with preexisting neurological conditions such as seizures, delirium, posterior reversible encephalopathy syndrome.

Voclosporin has a moderate potential interaction with Pure Red Cell Aplasia.

Calcineurin-inhibitors, may cause pure red cell aplasia (PRCA). Care should be exercised when using voclosporin in patients at risk for PRCA, such as parvovirus B19 infection, underlying disease, or concomitant medications associated with PRCA. It is recommended to consider treatment discontinuation if PRCA is diagnosed.

The corticotropin in ACTH has a major potential interaction with Renal Dysfunction.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting fluid retention or conditions that may be aggravated by these effects. Dietary sodium restriction and potassium supplementation may be advisable. The manufacturers consider the use of adrenocorticotropic agents to be contraindicated in patients with congestive heart failure or uncontrolled hypertension.

Voclosporin has a moderate potential interaction with Renal Dysfunction.

The use of voclosporin, like other calcineurin-inhibitors, can cause acute and/or chronic nephrotoxicity. Voclosporin use is not recommended in patients with a baseline estimated glomerular filtration rate (eGFR) of 45 mL/min/1.73 m2 or less unless the benefit exceeds the risk. A reduced dose should be used when treating patients with severe renal impairment at baseline. No dosage adjustment is recommended in patients with mild or moderate renal impairment at baseline. It is recommended to establish a baseline eGFR and regularly monitor eGFR during treatment. Consideration should be given to the risks and benefits of voclosporin treatment in light of the patient's treatment response and risk of worsening nephrotoxicity. Consider dose reduction or discontinuation in patients with decreases in eGFR from baseline. Persistent decrease of eGFR should be evaluated for chronic calcineurin-inhibitor nephrotoxicity.

The corticotropin in ACTH has a major potential interaction with Seizures.

Adrenocorticotropic agents may cause hypernatremia, hypokalemia, hypocalcemia, and fluid retention. Therapy with these agents, particularly if intended for longer than brief periods, should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

Voclosporin has a moderate potential interaction with Seizures.

The use of voclosporin may cause a spectrum of neurotoxicities. It is recommended to monitor for neurologic symptoms and to consider dosage reduction or discontinuation if neurotoxicity occurs. Care should be exercised when using this drug in patients with preexisting neurological conditions such as seizures, delirium, posterior reversible encephalopathy syndrome.

The corticotropin in ACTH has a major potential interaction with Systemic Sclerosis.

The use of adrenocorticotropic agents is contraindicated in patients with scleroderma. Adrenocorticotropic agents may precipitate renal crisis with malignant hypertension in these patients, possibly via steroid-induced increases in renin substrate and angiotensin II levels and decreases in vasodilator prostaglandin production. Renal failure may ensue. If treatment is required for inflammatory myositis or pericarditis, glucocorticoids are preferable because of their more predictable pharmacologic effect. However, glucocorticoids should also be avoided in the long-term treatment of patients with scleroderma for similar reasons.

The corticotropin in ACTH has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.

Adrenocorticotropic agents may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. These agents should be used cautiously in patients with thrombotic or thromboembolic disorders.

The corticotropin in ACTH has a major potential interaction with Tuberculosis, Latent.

In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of adrenocorticotropic agents may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if adrenocorticotropic therapy is administered to these patients. During prolonged use, tuberculosis chemoprophylaxis may be considered.

The corticotropin in ACTH has a major potential interaction with Ulcerative Colitis.

Adrenocorticotropic agents may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with adrenocorticotropic agents should be administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.

The corticotropin in ACTH has a moderate potential interaction with Underactive Thyroid.

Adrenocorticotropic agents may have enhanced effects in patients with hypothyroidism. Dosage adjustments may be necessary in these patients.

The corticotropin in ACTH has a major potential interaction with Vaccination.

The administration of live or live, attenuated vaccines is contraindicated in patients receiving large or immunosuppressive doses of adrenocorticotropic agents. Inactivated viral or bacterial vaccines should be used with caution, since their administration may pose a risk of neurological complications in these patients. Additionally, a diminished or inadequate serum antibody response may be anticipated.

Voclosporin has a moderate potential interaction with Vaccination.

The use of live vaccines should be avoided during treatment with voclosporin, including but not limited to the intranasal influenza, measles, mumps, rubella, oral polio, BCG, yellow fever, varicella, and TY21a typhoid vaccines. In addition, inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment with voclosporin.