Corticotropin (ACTH), Injection

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KEY POINTS

• This medicine is given by injection to treat many conditions, including infantile spasms and multiple sclerosis. Use it exactly as directed.
• You may get infections more easily when you are taking this medicine.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause adrenal gland problems, or other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: corticosteroid

Generic and brand names: corticotropin, injection; repository corticotropin, injection; adrenocorticotropic hormone (ACTH); H.P. Acthar Gel

What is this medicine used for?

This medicine is given by injection (shots) to treat:

• Infantile spasms (a type of seizures in infants and children younger than 2 years of age)
• Multiple sclerosis
• Arthritis
• Lupus and other immune system problems
• Psoriasis and other skin problems
• Allergies
• Breathing disorders

Your healthcare provider will explain why you are being given these shots.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have:

• An allergic reaction to any medicine or to pork
• Adrenal problems
• Diabetes
• Eye infections caused by herpes virus or other eye problems
• Heart failure
• High blood pressure
• Liver or kidney disease
• Myasthenia gravis
• Osteoporosis
• Psychosis or other mental health problem
• Scleroderma (a skin disorder)
• Thyroid problems
• Tuberculosis (TB)
• Ulcers

Also tell your provider if you have recently:

• Had surgery
• Had a recent vaccination or are scheduled to receive any vaccinations
• Been exposed to tuberculosis (TB)
• Had an infection

Females of childbearing age: Talk with your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

If your child is receiving this medicine for infantile spasms, read the Medication Guide that comes in the medicine package each time your child receives a treatment.

This medicine is available only through a specialty pharmacy. These shots are usually given by a healthcare provider. They are given into a muscle or just under the skin. Keep all appointments for your shots.

Sometimes you can give yourself these shots or have someone at home give them to you. Your healthcare provider will tell you where to give the injection, how much to give, how often and when to give it. Be sure you know how and when to have shots and how much medicine to use. If you are not sure of how to give yourself the shots, ask your healthcare provider or pharmacist for help.

Do not stop using this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually.

What if I miss a dose?

This medicine should be given on a regular schedule. If you miss a dose, contact your healthcare provider.

What if I overdose?

Symptoms of an acute overdose have not been reported.

What should I watch out for?

You may get infections more easily when you are taking this medicine. It may also cause an inactive infection to become active, such as tuberculosis (TB). Report any signs of infection to your healthcare provider. Stay away from people with colds, flu, or other infections. Do not have any vaccinations with live vaccines while receiving this medicine. Check with your healthcare provider first.

Using this medicine for a long time may increase your risk of adrenal gland problems. Symptoms may include increased upper body fat around the neck, rounded or "moon" face, weight gain, thin skin or easy bruising, slowed growth rate in children, and weak bones. When you stop taking this medicine, you may not produce enough of a hormone (cortisol) on your own. Talk with your healthcare provider about this.

Your blood pressure needs to be checked regularly while you are taking this medicine. You will also need to have blood tests regularly to see how this medicine affects you. Keep all appointments for these tests.

Follow your healthcare provider's instructions about diet or supplements. You may need to cut back on salt or take a potassium supplement. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine. This medicine may interfere with skin tests and certain lab tests. Tell all healthcare providers that you are taking this medicine.

If you have diabetes: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Swelling of the ankles or legs; stomach pain or vomiting; severe diarrhea; new or worsening seizures; muscle weakness; headache that continues; bloody or black, tarry bowel movements; unusual tiredness or weakness; vision changes; fever; unexplained sore throat or cough; unusual mood or behavior changes; increased thirst or urination; unexplained weight changes; fast or irregular heartbeat; trouble breathing.

Other: Skin discoloration, change in skin texture, increased hair growth, pimples, dizziness, nausea, irritability, trouble sleeping, menstrual irregularities, confusion, increased appetite, weight gain, constipation, diarrhea, increased sweating.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alzheimer’s disease medicines such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon)
• Antibiotics such as ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, Erythrocin), levofloxacin (Levaquin), moxifloxacin (Avelox), rifampin (Rifadin), and telithromycin (Ketek)
• Antifungal medicines such as amphotericin b (Abelcet, AmBisome, Amphotec), fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• Aprepitant (Emend)
• Aspirin and other salicylates
• Barbiturates such as butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital, and secobarbital (Seconal)
• Diabetes medicines such as glipizide (Glucotrol), glyburide (Glynase), insulin, metformin (Fortamet, Glucophage, Riomet), pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia)
• Digoxin (Lanoxin)
• Diuretics (water pills) such as bumetanide, chlorothiazide (Diuril), chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide), indapamide, metolazone (Zaroxolyn), and torsemide (Demadex)
• Echinacea
• Immunosuppressants such as leflunomide (Arava), pimecrolimus (Elidel), tacrolimus (Astagraf, Prograf, Protopic), and tofacitinib (Xeljanz)
• Live vaccines
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Phenytoin (Dilantin, Phenytek)
• Warfarin (Coumadin)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine in the refrigerator. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.