Home Drug Guide Corticotropin

Drug Guide

Generic Name

Corticotropin

Brand Names Acthar, Acth, Acthar Gel (autoinjector), Acthar Gel, Purified Cortrophin Gel

Classification

Therapeutic: Adrenal corticosteroid, anti-inflammatory

Pharmacological: Vasopressin analog

FDA Approved Indications

Multiple sclerosis relapse
Infantile spasms
Nephrotic syndrome (especially complex or steroid-resistant cases)
Rheumatoid arthritis and other inflammatory conditions
Addisonian crisis

Mechanism of Action

Corticotropin stimulates the adrenal cortex to increase production of cortisol, corticosterone, and other steroids, exerting anti-inflammatory and immunosuppressive effects.

Dosage and Administration

Adult: Varies by indication; typically 80-120 units IM or subcutaneously daily or as directed by the physician.

Pediatric: Dosing varies based on weight and condition; consult specific guidelines.

Geriatric: Adjust based on renal and hepatic function, monitor closely.

Renal Impairment: Adjust dose; use with caution due to increased risk of adverse effects.

Hepatic Impairment: No specific adjustment; monitor closely.

Pharmacokinetics

Absorption: Administered via injection; absorption is slow and sustained.

Distribution: Widely distributed; penetrates into tissues including the brain.

Metabolism: Metabolized in the liver and tissues.

Excretion: Excreted primarily in urine.

Half Life: Approximate half-life of 24-36 hours.

Contraindications

Hypersensitivity to corticotropin or adrenocorticotropic hormone.
Fungal infections.
Systemic fungal infections or herpes simplex keratitis.

Precautions

Use with caution in systemic infections, osteoporosis, hypertension, and diabetes mellitus; may exacerbate these conditions.
Pregnancy Category C; benefits should outweigh risks.

Adverse Reactions - Common

Fluid retention (Common)
Increase in blood pressure (Common)
Mood changes, euphoria or depression (Common)
Hyperglycemia (Common)

Adverse Reactions - Serious

Adrenal suppression with prolonged use (Serious)
Allergic reactions including anaphylaxis (Serious)
Cushingoid features, osteoporosis, glaucoma, peptic ulcers (Serious)

Drug-Drug Interactions

Barbiturates, phenytoin, and rifampin (may increase corticosteroid metabolism)
NSAIDs (increased risk of GI ulcers)
Other immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, blood pressure, blood glucose, electrolyte levels, emotional and behavioral changes.

Diagnoses:

Risk for infection
Imbalanced nutrition: less than body requirements,
Risk for electrolyte imbalance

Implementation: Administer as directed; monitor response and side effects; avoid abrupt discontinuation.

Evaluation: Evaluate for reduction of symptoms and adverse effects, including signs of HPA axis suppression.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of infection, swelling, mood changes, or symptoms of hyperglycemia.
Do not discontinue abruptly; taper as directed.
Avoid live vaccines during therapy.

Special Considerations

Black Box Warnings:

Long-term use can cause adrenal suppression. Use with caution in infectious diseases.

Genetic Factors: None specific.

Lab Test Interference: Can increase serum glucose and uric acid levels; may interfere with diagnostic tests for infections.

Overdose Management

Signs/Symptoms: Cushingoid appearance, muscle weakness, osteoporosis, electrolyte imbalance.

Treatment: Supportive care; manage fluid and electrolyte imbalance; consider administration of hydrocortisone or other corticosteroids as needed.

Storage and Handling

Storage: Store in a refrigerator (36°F to 46°F, 2°C to 8°C). Protect from light.

Stability: Stable until expiration date when stored properly.