Adult Dosing
Acute Exacerbations of multiple sclerosis
- 80-120 U IM/SC q24 hrs x 2-3 wks
Rheumatic Disorders, Collagen Diseases, Dermatologic Diseases, Allergic States, Ophthalmic Diseases, Respiratory Diseases, Edematous State
Note:
- Gradually taper the dose and increase the injection interval to discontinue
Pediatric Dosing
Infantile Spasms (<2 yrs)
- 75 U/m2 IM q12 hrs x 2wks
- Gradually taper over a 2-wk period to avoid adrenal insufficiency
Rheumatic Disorders, Collagen Diseases, Dermatologic Diseases, Allergic States, Ophthalmic Diseases, Respiratory Diseases, Edematous State
- Children >2 yrs: 40-80 U IM/SC q24-72 hrs
- Gradually taper the dose and increase the injection interval to discontinue
[Outline]
- Increased susceptibility to new infection (viral, bacterial fungal, protozoan or helminthic) and increased risk of exacerbation or reactivation of latent tuberculosis. Closely monitor the patient and institute chemoprophylaxis if therapy is prolonged
- Hypothalamic-pituitary-axis (HPA) suppression and Cushing’s syndrome may occur after prolonged therapy. Monitor the patient for signs of insufficiency such as weakness, hyperpigmentation, weight loss, hypotension and abdominal pain
- Adrenal insufficiency can be minimized by tapering of the dose gradually when discontinuing treatment
- Repository corticotropin can cause elevated blood pressure, salt and water retention and hypokalemia. Monitor blood pressure and sodium and potassium levels and consider dietary salt restriction and potassium supplementation
- Do not administer live or attenuated vaccines to patients on immunosuppressive doses. Other immunization procedures can be undertaken with caution in patient receiving high dose of repository corticotropin because of the possible hazards of neurological complications and lack of antibody response
- Repository corticotropin therapy can mask the symptoms of other diseases/disorders without altering the course of the other disease/disorder. Monitor the patient carefully during and for a period following discontinuation of therapy for signs of infection, abnormal cardiac function, hypertension, hyperglycemia, change in body weight and fecal blood loss
- There is a risk for gastric ulcers and bleeding and also increased risk of perforation in patients with certain GI disorders. Signs and symptoms may be masked. Monitor for signs of perforation and bleeding
- Repository corticotropin therapy can be associated with behavioral and mood disturbances including euphoria, insomnia, mood swings, personality changes, severe depression and psychosis. Existing conditions may be aggravated
- Symptoms of diabetes and myasthenia gravis may be worsened with treatment, use with caution in these patients
- Prolonged use of repository corticotropin can cause subcapsular cataracts, glaucoma with possible damage to the optic nerves and may enhance the establishment of secondary ocular infections due to fungi and viruses. Monitor for cataracts, infections and glaucoma
- Neutralizing antibodies may develop with chronic administration leading to a loss of endogenous ACTH activity
- Prolonged administration may increase the risk of hypersensitivity reactions. Consider the risk of sensitivity to porcine protein before starting therapy and during the course of treatment
- Use in patients with hypothyroidism or liver cirrhosis may result in an enhanced effect
- Negative effects on growth and physical development in children have been reported. Monitor pediatric patients on long term therapy
- Decrease in bone density leading to inhibition of bone growth in children and adolescents, and development of osteoporosis at any age has been reported. Monitor bone density in patients on long term therapy
- Repository corticotropin can cause embryocidal effect. Apprise women of potential harm to the fetus.
Cautions: Use cautiously in
- Renal insufficiency
- Hypertension
- Abnormal cardiac function
- Congestive heart failure
- Hyperglycemia
- Risk of impending perforation
- GI abscess or other pyogenic infections
- Diverticulitis
- Fresh intestinal anastomoses,
- Active or latent peptic ulcer
- Diabetes
- Myasthenia gravis
- Latent tuberculosis
- Prolonged use
- Killed or inactivated vaccines
- Hypothyroidism
- Liver cirrhosis
- Risk of osteoporosis
Pregnancy Class: C
Breastfeeding: Safety unknown. It is not known whether this drug is excreted in human milk. As many drugs are excreted in human milk, and because of the potential for serious adverse reactions in nursing, a decision should be made whether to discontinue nursing or to discontinue the drug, considering the risk and benefit to the mother.
