Corticotropin: Uses, Dosage, Side Effects and More

This information is not country-specific. Please refer to the Hong Kong prescribing information.

Generic Medicine Info

Indications and Dosage

Intramuscular, Subcutaneous
Ankylosing spondylitis, Juvenile rheumatoid arthritis, Psoriatic arthritis, Rheumatoid arthritis

Adult: As adjunctive treatment for acute episodes or exacerbation: Acthar or Purified Cortrophin 40-80 units via IM or SC inj 24-72 hourly. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Acute exacerbations in multiple sclerosis

Adult: Acthar or Purified Cortrophin 80-120 units daily via IM or SC inj for 2-3 weeks. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular
Infantile spasms

Child: <2 years Acthar 75 units/m² twice daily via IM inj for 2 weeks. Discontinue gradually by tapering the dose over a 2-week period. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Acute gouty arthritis

Adult: As adjunctive treatment of acute episode or exacerbations: Purified Cortrophin 40-80 units via IM or SC inj 24-72 hourly. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Systemic dermatomyositis, Systemic lupus erythematosus

Adult: As treatment of exacerbations or as maintenance therapy: Acthar or Purified Cortrophin 40-80 units via IM or SC injection 24-72 hourly. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Allergic and inflammatory conditions of the eye

Adult: For severe acute and chronic cases (e.g. anterior segment inflammation, diffuse posterior uveitis and choroiditis, chorioretinitis, keratitis, iritis, iridocyclitis, optic neuritis): Acthar or Purified Cortrophin 40-80 units via IM or SC injection 24-72 hourly. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Serum sickness, Severe erythema multiforme, Stevens-Johnson syndrome, Symptomatic sarcoidosis

Adult: Acthar or Purified Cortrophin 40-80 units via IM or SC inj 24-72 hourly. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Diuresis in nephrotic syndrome

Adult: For diuresis induction or proteinuria remission: Acthar or Purified Cortrophin 40-80 units via IM or SC inj 24-72 hourly. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Intramuscular, Subcutaneous
Atopic dermatitis, Severe psoriasis

Adult: Purified Cortrophin 40-80 units via IM or SC inj 24-72 hourly. Discontinue gradually by tapering the dose. Dosage is individualised based on the disease severity and patient's clinical response. Administration recommendations may vary among individual products (refer to specific product guidelines).

Contraindications

Hypersensitivity. Scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, history of or current peptic ulcer, CHF, uncontrolled hypertension, primary adrenocortical insufficiency, adrenocortical hyperfunction, recent surgery. Suspected congenital infections in <2 years old (Acthar). Co-administration with live or live-attenuated vaccines (Acthar).

Special Precautions

Patient with hypertension, psychiatric conditions (e.g. emotional instability, psychotic tendencies), diabetes mellitus, gastrointestinal disease (e.g. diverticulitis, ulcerative colitis, risk of impending perforation, fresh intestinal anastomoses), gastrointestinal perforation or bleeding, liver cirrhosis, myasthenia gravis, cataracts, glaucoma, risk for osteoporosis, thyroid disease (e.g. hypothyroidism, hyperthyroidism). Avoid abrupt withdrawal. Corticotropin is available in multiple brands that are approved for specific indications; these brands may not be interchangeable and must be used according to their approved indication; refer to specific product guidelines before administration. Renal and hepatic impairment. Children. Pregnancy and lactation.

Adverse Reactions

Significant: Hypercortisolism or HPA axis suppression (particularly in younger children or at high doses for prolonged periods); salt and water retention, hypertension, hypokalaemia; increased risk of hypersensitivity reactions (prolonged use); increased susceptibility to secondary infection, exacerbate or prolong existing infection, mask acute infection; behavioural and mood disturbances; hyperglycaemia; gastrointestinal bleeding or gastric ulcer; exacerbation of myasthenia gravis; increased IOP, open-angle glaucoma, cataracts; decreased bone density and osteoporotic fractures (long-term use or at high doses).
Cardiac disorders: Cardiac hypertrophy.
Ear and labyrinth disorders: Otitis media.
Gastrointestinal disorders: Diarrhoea, vomiting.
General disorders and administration site conditions: Fever.
Investigations: Weight gain.
Metabolism and nutrition disorders: Decreased appetite.
Nervous system disorders: Seizure.
Psychiatric disorders: Irritability.
Respiratory, thoracic and mediastinal disorders: Nasal congestion, pneumonia, URTI.

Pregnancy Category (US FDA)

IM/Parenteral/SC: C

Monitoring Parameters

Monitor blood pressure, cardiac function, electrolytes, serum glucose and weight. Assess for signs and symptoms of adrenal insufficiency, Cushing's syndrome and secondary ocular infections. Monitor growth in children, bone mass density and cataract formation after prolonged use.

Drug Interactions

May diminish the therapeutic effect or enhance the adverse effects of live or live-attenuated vaccines.

Lab Interference

May diminish the wheal and flare reactions to skin test antigens.

Action

Description:
Mechanism of Action: Corticotropin, a polypeptide hormone, is naturally secreted by the basophilic cells of the anterior lobe of the pituitary gland. It stimulates the adrenal cortex to secrete cortisol, weak androgenic substances and aldosterone.
Synonym(s): Adrenocorticotropic hormone (ACTH).
Onset: 3-12 hours (cortisol serum concentration).
Duration: 10-25 hours, up to 3 days (repository inj).
Pharmacokinetics:
Absorption: IM: Rapidly absorbed.
Excretion: Via urine. Elimination half-life: 15 minutes.

Chemical Structure

Storage

Store between 2-8°C. Pre-filled injector or syringe: Store between 20-25°C for up to 24 hours. Protect from light. Storage recommendations may vary between individual products (refer to specific product guidelines).

MIMS Class

Trophic Hormones & Related Synthetic Drugs

ATC Classification

H01AA01 - corticotropin ; Belongs to the class of ACTH. Used in anterior pituitary lobe hormone and analogue preparations.

References

Acthar Repository Corticotropin Injection (Mallinckrodt ARD LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 09/05/2025.

Brayfield A, Cadart C (eds). Corticotropin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/05/2025.

Corticotropin, ACTH. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 09/05/2025.

Corticotropin. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/05/2025.

Corticotropin. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/05/2025.

Purified Cortrophin Gel (ANI Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 09/05/2025.

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