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SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS › PITUITARY AND HYPOTHALAMIC HORMONES AND ANALOGUES › ANTERIOR PITUITARY LOBE HORMONES AND ANALOGUES › ACTH
corticotropin
H01AA01
Forms & Strengths
- Repository corticotropin injection: 80 units/mL
Adult Dosing
- Infantile spasms: 80 units/m² intramuscularly (IM) daily for 2 weeks, then tapered
- Multiple sclerosis exacerbation: 80 to 120 units IM/subcutaneously daily for 2 to 3 weeks
- Rheumatic, collagen, dermatologic, or ophthalmic disorders: 40 to 80 units IM/subcutaneously every 24 to 72 hours
Pediatric Dosing
- Infantile spasms: 150 units/m² IM divided twice daily for 2 weeks, then tapered over 2 weeks
- Alternative infantile spasms: 80 units/m² IM daily for 2 weeks, then tapered
Indications
- Infantile spasms
- Acute exacerbations of multiple sclerosis
- Rheumatic disorders (e.g., rheumatoid arthritis, systemic lupus erythematosus)
- Dermatologic diseases (e.g., severe erythema multiforme, Stevens-Johnson syndrome)
- Ophthalmic inflammatory conditions unresponsive to topical corticosteroids
- Diagnostic aid for adrenocortical insufficiency
Mechanism of Action
- Stimulates the adrenal cortex to secrete cortisol, corticosterone, aldosterone, and weak androgens
- Acts via melanocortin receptors to exert anti-inflammatory and immunomodulatory effects independent of the adrenal gland
Contraindications
- Scleroderma
- Osteoporosis
- Systemic fungal infections
- Ocular herpes simplex
- Recent surgery
- History of or active peptic ulcer
- Congestive heart failure
- Uncontrolled hypertension
- Primary adrenocortical insufficiency or hyperfunction
- Administration of live or live-attenuated vaccines during therapy
Adverse Reactions
- Fluid retention and edema
- Hypertension
- Hypokalemia
- Hyperglycemia and diabetes mellitus
- Increased susceptibility to infection
- Osteoporosis and vertebral compression fractures
- Peptic ulcer disease with potential perforation and hemorrhage
- Cushingoid state (moon facies, weight gain)
- Psychiatric disturbances (mood swings, psychosis)
- Growth suppression in pediatric patients
Drug Interactions
- Amphotericin B or potassium-depleting diuretics: increased risk of severe hypokalemia
- Antidiabetic agents: diminished glycemic control, requires dosage adjustment
- Coumarin anticoagulants: altered anticoagulant response, monitor INR closely
- Nonsteroidal anti-inflammatory drugs (NSAIDs): increased risk of gastrointestinal ulceration
- Live-attenuated vaccines: potential for enhanced replication of vaccine virus and decreased neurological response
Curated Content: Needs Vetting Before Put to Clinical Use