Acthar (ACTH)

Indications

• acute exacerbation of multiple sclerosis
• diagnostic aid in adrenocortical insufficiency
• severe muscle weakness in myasthenia gravis

Dosage

• multiple sclerosis: 80-120 units/day for 2-3 weeks
• diagnostic aid:
  • 20 units IM/SC QID
  • 10-25 units in 500 mL D5W over 8 hours

Injection: 25 & 40 units/vial

Injection: (repository) 40 & 80 units/mL (5 mL)

Pharmacokinetics

• 1/2 life in blood of ACTH is 10 minutes

Adverse effects

• common (> 10%)
  • increased appetite, insomnia, indigestion, nervousness
• less common (1-10%)
  • cataracts, hyperglycemia, diabetes mellitus, hirsuitism, joint pain, epistaxis
• uncommon (< 1%)
  • seizures, mood swings, headache, skin atrophy, bruising, hyperpigmentation, acne, amenorrhea, Na+ & H2O retention, Cushing's syndrome, bone growth suppression, abdominal distention, ulcerative esophagitis, pancreatitis, muscle wasting, hypersensitivity reactions, delirium, hallucinations, euphoria

Mechanism of action

• ACTH induces secretion of corticoteroids (cortisol, DHEA) from adrenal cortex

More general terms

• adrenocorticotropic hormone
• endocrine agent

Additional terms

• ACTH (corticotropin) in plasma
• adrenocorticotropic hormone receptor; ACTH receptor; ACTH-R; adrenocorticotropin receptor; melanocortin receptor 2; MC2-R (MC2R ACTHR)
• corticotropin-releasing factor; corticoliberin; CRF; corticotropin-releasing hormone (CRH)
• cosyntropin (Cortrosyn)
• ectopic ACTH syndrome
• pituitary adenoma/ACTH secreting