NAME OF DRUG
corticotropin

CLASSIFICATION

Adrenocorticotropic Hormone

ALTERNATE NAME

ACTH, ACTHAR, ACTHAR GEL, DURACTON

 INDICATIONS

• diagnostic testing of adrenocortical function
• anti-inflammatory, immunosuppressant

 RECONSTITUTION AND STABILITY

• stable in the dry form at room temperature
• reconstitute 40 unit vial with 2.0 mL sterile water for injection or NS to yield a 20 unit/mL solution
• reconstituted solutions should not be stored longer than 24 hours in refrigerator
• repository (gel) form must be refrigerated

 COMPATIBILITY

• compatible with D5W, D5S, LR, NS
• compatible with aminophylline, ascorbic acid, calcium gluconate, heparin, multiple vitamin infusion (MVI), potassium chloride, vitamin K
• repository (gel) form should not be mixed with any other drug or solution

 ROUTES OF ADMINISTRATION

• SC
• IM - deeply into gluteal muscle
• IV direct - over 1-2 minutes
• IV infusion - in 500-1,000 mL of D5W or NS over 8 hours
• REPOSITORY (GEL) FORM SHOULD NOT BE ADMINISTERED IV

 VH & HSC ADMINISTRATION POLICY

E - Direct IV route can be administered by nurses on general nursing units provided a venous access has been established, and according to policies and recommendations stated in this manual.

 DOSAGE

- individualized according to diagnosis, severity and probable duration of the disease.

Verification of adrenal responsiveness:

• 25 units IM or direct IV
• may be administered as an IV infusion over 8 hours if greater stimulus to adrenal cortex desired
• (Note: - cosyntropin is preferred test)

Anti-inflammatory, immunosuppressant:

• 20 units IM, SC four times daily or 40-80 units IM, SC every 24-72 hours if repository (gel) injection is used

Acute exacerbations of multiple sclerosis:

• 80-120 units IM daily in divided doses for 2-3 weeks

Myasthenia gravis:

• 100 units by IV infusion over 8 hours daily for 10 days; repeat after 5-10 days or 100 units of repository (gel) IM daily for 10 days; repeat after 5-10 days

 POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• transient local induration, pain, and abscesses may occur at IM or SC injection site.
• burning and tingling of perineal area after IV administration may occur
• during IV administration or immediately after IM or SC injection all patients should be carefully observed for hypersensitivity reactions

 IMPORTANT IMPLICATIONS

• chronic use of more than 40 units daily may cause severe adverse effects:  hypothalamic pituitary insufficiency, muscle wasting, delayed healing, Cushingoid state, glucose intolerance, mental disturbances, seizures, skin atrophy
• electrolyte imbalances may occur including:  sodium and water retention, hypokalemia, hypocalcemia
• perform skin testing prior to treatment of all patients suspected of sensitivity to porcine protein
• may mask signs of infection
• contraindicated in patients with active tuberculosis, peptic ulcer, ocular herpes simplex, acute psychosis
• may increase insulin requirements in diabetics
• for verification of adrenal responsiveness: measure baseline plasma cortisol levels immediately before and 60 minutes after IV or IM injection

Rev. November 1999