Acthar Gel
Acthar Gel (corticotropin) is a mixture of adrenocorticotropic hormone (ACTH) analogs, similar to ACTH that's naturally made in the body. It's used in adults and children to treat different conditions, including infantile spasms, multiple sclerosis, and rheumatoid arthritis. Acthar Gel (corticotropin) is available as a vial and prefilled SelfJect injector. The medication is given as an injection under the skin or into the muscle once or twice per day for a few days to few weeks, depending on your age and your condition. Common side effects include injection site reactions, tiredness, and weakness.
What is Acthar Gel (corticotropin)?
What is Acthar Gel (corticotropin) used for?
Multiple sclerosis flare up
Rheumatic condition flare-up (e.g., psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis)
Skin conditions (e.g., severe erythema multiforme, Stevens-Johnson syndrome)
Eye inflammation
Breathing conditions (e.g., sarcoidosis)
Fluid build-up from kidney damage due to lupus or unknown cause
How Acthar Gel (corticotropin) works
Acthar Gel (corticotropin) is made up of a mixture of proteins and adrenocorticotropic hormone (ACTH) analogs, similar to those found in your body.
The exact way it treats various FDA-approved conditions isn't well-understood, but it works similarly to ACTH. Acthar Gel (corticotropin) is thought to lower inflammation and the activity of the immune system by triggering the release of steroid hormones (e.g., cortisol) and binding to certain proteins.
Drug Facts
What are the side effects of Acthar Gel (corticotropin)?
Common Side Effects
- Infection (20%)
- Seizures (12%)
- High blood pressure (11%)
- Irritability (7%)
- Fever (5%)
- Injection site reactions
- Tiredness
- Weakness
- Low energy
- Swelling
- Trouble sleeping
- Headache
- Higher blood sugar levels
Other Side Effects
- Vomiting
- Diarrhea
- Changes in appetite
- Cushingoid (e.g., face swelling, weight gain)
Serious Side Effects
- Serious infections: fever, difficulty breathing, headache, weakness, confusion, sweating, chills, stiff neck, fast heart rate, muscle aches, diarrhea
- Severe allergic reaction: hives; swelling of the lips, tongue, or face; difficulty breathing; chest pain
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Backache
blurred vision
body aches or pain
chest pain or tightness
chills
difficulty with breathing
dizziness
ear congestion
facial hair growth in females
fractures
full or round face, neck, or trunk
headache
increased thirst or urination
irritability
loss of sexual desire or ability
loss of voice
menstrual irregularities
muscle wasting
nervousness
pounding in the ears
redness or swelling in the ear
runny or stuffy nose
seizures
slow or fast heartbeat
unusual tiredness or weakness
white patches in the mouth or throat or on the tongue
white patches with diaper rash
Incidence not known
Accumulation of pus
bruising
bulging soft spot on the head of an infant
change in the ability to see colors, especially blue or yellow
decreased range of motion
decreased urine output
dilated neck veins
extreme tiredness or weakness
eyeballs bulge out of the eye sockets
fast, weak pulse
full or bloated feeling
irregular breathing
irregular heartbeat
joint pain
large, flat, blue, or purplish patches in the skin
lightheadedness
limp
loss of appetite
noisy, rattling breathing
pressure in the stomach
severe headache
slow healing
small red or purple spots on the skin
swelling of the stomach area
swelling of the face, fingers, feet, or lower legs
swollen, red, or tender area of infection
trouble sleeping
vomiting
Incidence not known-For adults only
cold clammy skin
confusion
coughing up blood
dark urine
feeling of constant movement of self or surroundings
headache, sudden and severe
increased sweating
indigestion
loss of appetite
pain in the muscles
pains in the stomach, side, or abdomen, possibly radiating to the back
redness of the face
sensation of spinning
skin rash
sweating
thinning of the skin
unusual weight loss
weakness
yellow eyes or skin
Incidence not known-For infants only
excess air or gas in the stomach or bowels
mood changes
muscle pain or cramps
numbness or tingling in the hands, feet, or lips
passing gas
problems with speech or speaking
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Changes in appetite
Incidence not known
Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
general feeling of discomfort or illness
increased hair growth, especially on the face
muscle weakness
unusual drowsiness, dullness, tiredness, weakness or feeling of sluggishness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Acthar Gel (corticotropin)
Pros
Can help treat many different inflammatory conditions
Available as prefilled SelfJect injector, which makes under-the-skin injections easier
Can be used in children under 2 years old for certain conditions
Cons
Brand-name medication only
Can raise your risk of infections
Can cause withdrawal symptoms if stopped too suddenly
Pharmacist tips for Acthar Gel (corticotropin)
Acthar Gel (corticotropin) can raise your risk of getting a serious or life-threatening infection. Get medical help right away if you develop symptoms of an infection (e.g., fever, cough, difficulty breathing, diarrhea, weakness, sweating, chills) while you're taking Acthar Gel (corticotropin). You might have to stop taking Acthar Gel (corticotropin) so your body can fight and fully recover from the infection.
If you or your child experience mood changes, swelling in the body, symptoms of an infection, or symptoms of Cushing's syndrome (e.g., more fat in the face or middle of the body, easier bruising, weight gain, muscle weakness, high blood pressure), let your or your child's prescriber know. These are Acthar Gel (corticotropin) side effects that might need more medical attention.
Avoid getting live vaccines while you're taking Acthar Gel (corticotropin) since it's not known how your body will respond to it during treatment. Before getting any vaccines, let your prescriber or pharmacist know that you're taking Acthar Gel (corticotropin). Talk to them if you're not sure whether you can receive the vaccine.
Don't stop taking Acthar Gel (corticotropin) suddenly, since this can lead to withdrawal symptoms (e.g., weakness, skin color changes, weight loss, low blood pressure, or abdominal pain). Work with your or your child's prescriber to stop Acthar Gel (corticotropin) slowly.
Make sure your care team knows your entire medical history, since certain conditions (e.g., thyroid problems, liver problems) can cause this medication to have a stronger effect. Other conditions (e.g., diabetes, myasthenia gravis) can get worse while taking Acthar Gel (corticotropin).
Acthar Gel (corticotropin) comes as a multiple-dose vial and single-dose prefilled SelfJect injector. Make sure you the strength of your product and how to prepare and administer the dose properly to avoid accidentally wasting the medication or injuring yourself.
Keep Acthar Gel (corticotropin) in the original carton to protect it from light. Place the cartons in the refrigerator. Once out of the refrigerator, you can keep the medication at room temperature for up to 24 hours. Once it's been out at room temperature, don't place the medication back in the refrigerator.
Before it's time for your dose, take Acthar Gel (corticotropin) out of the refrigerator, and lay it on a flat surface to warm up. This will take about 45 minutes. Don't try to warm up the medication any other way.
Look at the Acthar Gel (corticotropin) liquid to make sure it's clear light yellow or orange color. It also might have some air bubbles in it, which is normal. But it shouldn't have any particles (solid chunks) floating around in it. Don't use the medication if the liquid is cloudy, discolored, or has particles. Instead, call your care team for a replacement.
For injections under the skin (vial or SelfJect Injector): Inject Acthar Gel (corticotropin) into the fatty part of the skin either on top of your thigh or at your stomach (at least 1 inch away from the belly button). You can also ask someone to help inject the medication into the fatty part of the skin at the back of your upper arm.
For injections into a muscle (vial only): You can inject Acthar Gel (corticotropin) from the vial into the front of your upper thigh or your upper arm. Never inject into your vein or belly button.
Don't inject Acthar Gel (corticotropin) into skin that's irritated, has tattoos, warts, scars, birthmarks, has stretch marks, or within 1 inch of the knee or groin area. Also, don't inject through clothing.
Choose a different injection site each time you inject Acthar Gel (corticotropin). Don't use the same injection site more than 1 time per week. Use the calendar in the Acthar Gel treatment journal to record the details of your Acthar Gel (corticotropin) injections.
After injecting the medication, throw away the Acthar Gel (corticotropin) pen in a sharps container or something made of heavy-duty plastic, such as an empty milk carton or laundry detergent bottle. This helps lower the risk of needle-stick injuries. Don't throw away needles or syringes in your trash can. For guidance on how to throw away your sharps container safely for your specific state, visit the FDA's website.
Frequently asked questions about Acthar Gel (corticotropin)
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What are the risks and warnings for Acthar Gel (corticotropin)?
Acthar Gel (corticotropin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Infections
Acthar Gel (corticotropin) can affect your body's ability to fight off infections. This raises your risk of serious and sometimes life-threatening bacterial, viral, or fungal infections. Treatment with Acthar Gel (corticotropin) can also cause new or old tuberculosis (TB) infections to come back. If you get sick, your HCP might ask you to stop taking Acthar Gel (corticotropin) so your body can fight the infection. Go to the hospital right away if you develop symptoms of an infection, including fever, chills, and tiredness.
Low adrenal gland function and Cushing's syndrome
Risk factors: High doses | Using this medication for a long period of time | Young children | Stress (such as trauma, injury, or infection)
Acthar Gel (corticotropin) acts like the hormone ACTH that's naturally in your body. Having higher ACTH level causes your body to release more stress hormone (cortisol). When this happens, you're at risk for developing symptoms of Cushing's syndrome, including swelling, weight gain, and muscle weakness.
Taking Acthar Gel (corticotropin) can affect how ACTH is released by your own body. If you suddenly stop taking Acthar Gel (corticotropin) after receiving it regularly, your body might not be able to produce enough of its own ACTH hormone. This can lead to symptoms of withdrawal including low energy, feeling tired, and weakness. If you need to stop Acthar Gel (corticotropin), your healthcare team will instruct you to do so safely by slowly lowering your dose over time. Talk to your care team before making any sudden changes in your medication.
Risk of stomach ulcers or bleeding
Risk factors: Stomach ulcers or bleeding | Taking other medications that can cause stomach damage at the same time | Drinking alcohol
Taking Acthar Gel (corticotropin) raises the risk of damaging your stomach, including bleeding and ulcers. Depending on the risk of stomach problems, your HCP might ask you to take an additional medication to protect your stomach if you need to take Acthar Gel (corticotropin) for a longer period of time. Tell your healthcare team right away if you have stomach pain that doesn't go away or you get bloody or dark stools.
High blood pressure, swelling, and electrolyte problems
Risk factors: Heart failure | High blood pressure | Kidney problems
Acthar Gel (corticotropin) can cause your body to hold on to more salt and water. This can lead to higher blood pressure and swelling, as well as electrolyte problems, like lower potassium and calcium levels. If you have heart failure, high blood pressure, or kidney problems, talk to your prescriber first before starting Acthar Gel (corticotropin). During treatment, it's important to monitor your blood pressure and tell your prescriber about any changes you notice.
Weakening of bones and slowed growth
Risk factors: Receiving Acthar Gel (corticotropin) for a longer period of time | Infants and young children | Females after menopause
Receiving Acthar Gel (corticotropin) over a longer period of time can lead to weakened bones. This can raise the risk of having bone fractures in older adults or slow growth in children. Discuss any concerns you have with your or your child's prescriber.
Eye problems
Risk factors: Cataracts or glaucoma | Using Acthar Gel (corticotropin) for a long period of time
Long-term use of Acthar Gel (corticotropin) leads to a higher risk of cataracts, glaucoma, and certain eye infections. Don't take Acthar Gel (corticotropin) if you have herpes simplex of the eye. Let your prescriber know if you experience blurry vision, eye pain, or any vision changes. If you are taking this medication for a long time, you might need to get regular eye exams.
Behavior changes
Acthar Gel (corticotropin) can cause changes in mood or behavior. Tell your prescriber right away if you notice depression, mood swings, trouble sleeping, anxiety, irritability, or hallucinations (hearing or seeing things that aren't there) while taking this medication. These side effects tend to go away after you stop Acthar Gel (corticotropin). But before you make any dose changes, talk to your care team first.
Serious allergic reaction
Risk factors: Allergy to pork-related products
Though rare, people who used Acthar Gel (corticotropin) have developed serious allergic reactions. Don't use Acthar Gel (corticotropin) if you have allergies to pork-related products. Get medical help right away if you notice trouble breathing, rash, and hives after receiving this medication.
Acthar Gel (corticotropin) dosage forms
Typical dosing for Acthar Gel (corticotropin)
In general, your dose depends on what condition you’re using Acthar Gel (corticotropin) for and how severe it is.
Infantile spasms (ages 2 years and under): Your child's pediatrician will calculate the dose based on body surface area (BSA), which takes into account your child's weight and height. The typical dose is 75 units/m2 injected into your child's muscle twice daily for 2 weeks.
Multiple sclerosis: Your prescriber will determine your dose based on your symptoms. The typical dose ranges from 80-120 units injected into the muscle or under your skin, once daily for 2-3 weeks.
Other conditions: Your prescriber will determine your dose based on your symptoms. The typical dose ranges from 40-80 units injected into the muscle or under your skin every 1 to 3 days.
After your treatment is over, your prescriber might have you slowly lower your dose over the course of a few days before stopping completely to avoid withdrawal symptoms.
Interactions between Acthar Gel (corticotropin) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Rotavirus Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Balofloxacin
- Besifloxacin
- Bupropion
- Ciprofloxacin
- Enoxacin
- Fleroxacin
- Flumequine
- Gatifloxacin
- Gemifloxacin
- Levofloxacin
- Lomefloxacin
- Moxifloxacin
- Nadifloxacin
- Norfloxacin
- Ofloxacin
- Pazufloxacin
- Pefloxacin
- Prulifloxacin
- Rufloxacin
- Sparfloxacin
- Tosufloxacin
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Licorice
- Saiboku-To
Acthar Gel (corticotropin) contraindications
Injections into the veins
Receiving live vaccines
Infants under 2 years of age who might have infections present at birth
Scleroderma (a condition that causes skin to become hardened and tight)
Osteoporosis (weak bones)
Certain fungal infections
Recent surgery
History of or current stomach ulcer
Congestive heart failure
Uncontrolled high blood pressure
Primary adrenocortical insufficiency (a condition where your adrenal glands don't release enough of certain hormones)
Adrenocortical hyperfunction (a condition where too many substances are produced from a structure in your body called the adrenal cortex)
Allergy to pig (porcine) proteins
What are alternatives to Acthar Gel (corticotropin)?
Multiple sclerosis flare up
Rheumatic condition flare-up (e.g., psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis)
Skin conditions (e.g., severe erythema multiforme, Stevens-Johnson syndrome)
Eye inflammation
Breathing conditions (e.g., sarcoidosis)
Fluid build-up from kidney damage due to lupus or unknown cause
Allergies or allergic reactions
Joint conditions (e.g., rheumatoid arthritis)
Skin conditions (e.g. psoriasis)
Conditions affecting certain hormones (e.g., low adrenal hormones)
Gut conditions (e.g., ulcerative colitis)
Conditions related to red blood cells, white blood cells, and platelets
Certain cancers (e.g., leukemia)
Nervous system conditions (e.g., multiple sclerosis)
Eye conditions
Lung conditions
Kidney conditions
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References
Best studies we foundAllen, M. J., et al. (2023). Physiology, adrenocorticotropic hormone (ACTH). StatPearls.
Arnason, B. G., et al. (2013). Mechanisms of action of adrenocorticotropic hormone and other melanocortins relevant to the clinical management of patients with multiple sclerosis. Multiple Sclerosis.
Bandoli, G., et al. (2017). A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheumatic Diseases Clinics of North America.
Centers for Disease Control and Prevention. (2024). What causes HSV (herpes simplex virus) keratitis.
Drugs and Lactation Database (LactMed®). (2021). Corticotropin. National Institute of Child Health and Human Development.
Holst, J. P., et al. (2004). Steroid hormones: Relevance and measurement in the clinical laboratory. Clinics in Laboratory Medicine.
Kaplan, J., et al. (2023). Acthar® Gel treatment for patients with autoimmune and inflammatory diseases: An historical perspective and characterization of clinical evidence. Clinical Drug Investigation.
Mallinckrodt ARD LLC. (2024). Acthar- repository corticotropin injection; Acthar- repository corticotropin injection [package insert]. DailyMed.
Mallinckrodt Pharmaceuticals. (2021). Your Acthar Gel treatment journal.
Mallinckrodt Pharmaceuticals. (2021). Your step-by-step injection guide.
Mallinckrodt Pharmaceuticals. (2024). Mallinckrodt announces U.S. FDA approval of supplemental new drug application for Acthar® Gel (repository corticotropin injection) Single-Dose Pre-filled SelfJect™ Injector. PRNewswire.
Merck Manual Consumer Version. (2023). Erythema multiforme.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Cushing’s syndrome.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Nephrotic syndrome in adults.
National Institute of Neurological Disorders and Stroke. (2024). Infantile spasms.
Qudsiya, Z., et al. (2023). Dermatomyositis. StatPearls.
Rixe, N., et al. (2023). Serum sickness. StatPearls.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
Wan, G. J., et al. (2023). Acthar gel (RCI): A narrative literature review of clinical and economic evidence. ClinicoEconomics and Outcomes Research.
You and Your Hormones. (n.d.). Adrenocorticotropic hormone.
You and Your Hormones. (n.d.). Cortisol.
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