corticotropin

Normally produced by the pituitary, stimulates the adrenal gland to produce both corticosteroids (hydrocortisone) and mineralocorticoids (aldosterone). Action requires intact adrenal responsiveness.
Actions resemble those of corticosteroid administration and include suppression of the normal immune response and inflammation.
Additional numerous intense metabolic effects.
Potent mineralocorticoid (sodium retention).
Suppresses adrenal function with chronic use.
Mechanism of anticonvulsant action is unknown.

Therapeutic effects:

Reduction in frequency of multiple sclerosis exacerbations.
Suppression of spasm.

Pharmacokinetics ⬆ ⬇

Absorption: Slowly absorbed from IM or SUBQ sites.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Metabolic fate unknown. Primarily excreted in the urine.

Half-Life: 15 min.

Time/Action Profile ⬆ ⬇

(effects on plasma cortisol levels)

ROUTE	ONSET	PEAK	DURATION
IM (gelatin repository)	unknown	3–12 hr	10–25 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to pork proteins;
Serious infections;
Scleroderma;
Recent surgery;
History or presence of peptic ulcer;
HF;
Uncontrolled hypertension;
Primary adrenocortical insufficiency.

Use Cautiously in:

Diabetes;
Myasthenia gravis;
Chronic treatment may result in adrenal suppression;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Chronic use in children may lead to growth suppression.

Adv. Reactions/Side Effects ⬆ ⬇

Chronic Use

CV: edema, HF, hypertension

Derm: ↓wound healing, petechiae, acne, ecchymoses, fragility, hirsutism

EENT: ↑intraocular pressure, cataracts

Endo: ↓growth in children, ADRENAL SUPPRESSION, hyperglycemia, menstrual irregularities

F and E: hypokalemia, hypocalcemia, metabolic alkalosis

GI: nausea, pancreatitis, peptic ulceration, vomiting

Hemat: THROMBOEMBOLISM

Local: atrophy at IM sites (repository dosage forms)

Metab: ↑appetite, weight gain

MS: avascular necrosis of joints, myopathy, osteoporosis

Neuro: depression, euphoria, psychoses

Misc: ↑susceptibility to infections, cushingoid appearance (moon face, buffalo hump), HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of live vaccines or live-attenuated vaccines is contraindicated.
Additive hypokalemia with amphotericin B, piperacillin/tazobactam, or potassium-losing diuretics.
Hypokalemia may ↑ the risk of digoxin toxicity.
May ↑ requirements for insulins or oral hypoglycemic agents.
Phenytoin, phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness.
Hormonal contraceptives may ↓ metabolism.

Drug-Natural Products:

Additive hypokalemia with licorice.

Route/Dosage ⬆ ⬇

Multiple Sclerosis

IM SC (Adults ): 80–120 units/day for 2–3 wk.

Infantile Spasms

IM (Children <2 yr): 75 units/m² twice daily for 2 wk, then taper over 2 wk.

Availability ⬆ ⬇

Solution for intramuscular or SUBQ injection (multidose vials): 80 units/mL
Solution for SUBQ injection (prefilled SelfJect injectors): 40 units/0.5 mL; 80 units/mL

Assessment ⬆ ⬇

Monitor BP and daily weight periodically during therapy. If hypertension develops during treatment, sodium restriction and diuretic therapy are used instead of discontinuation of corticotropin.
Assess for signs and symptoms of infection (fever, cough, vomiting, diarrhea) of patient and family members throughout therapy.

Lab Test Considerations:

Monitor CBC, serum calcium, electrolytes, phosphorus, serum fasting and postprandial glucose, and renal function tests with urinalysis before initiation of therapy. Use caution if results are abnormal.
- Monitor serum calcium, electrolytes, and phosphorus, and urinalysis with urine glucose periodically during therapy.

Implementation ⬆ ⬇

IM: Shake suspension in multidose vials before drawing up dose. Refrigerate. Warm to room temperature before administering. Use 22-gauge needle. Administer deep IM; massage well. Rotate sites. Inform patient that injection is painful.
SC: Remove prefilled SelfJect injectors from refrigerator and allow solution to warm to room temperature for 45 min prior to injection. SelfJect injectors are for SUBQ administration only and should not be administered intramuscularly. Inject in the upper thigh, abdomen, or back of arm. Avoid injecting within 1 inch of navel, knee, or groin area. Avoid injecting into areas with scars, tattoos, warts, birthmarks, or stretch marks, or where the skin is irritated. Rotate the injection site; do not use the same site more than once per wk. Store SelfJect injectors in refrigerator.

Patient/Family Teaching ⬆ ⬇

Instruct patient and/or parent on correct technique for administration and to continue medication as directed. Must be stopped gradually. If medication is stopped and patient appears weak, loses weight, has a ↓ in appetite, appears tired or lacking energy, appears pale, has stomach pain, appears sick, or has a fever, notify health care professional immediately.
Advise patient to notify health care professional if signs and symptoms of GI bleeding (stomach pain, vomiting blood, bloody or black stools) or infection or open cuts and sores occur and to avoid crowds and people who have an active infection due to ↑ susceptibility.
Caution patient and parents to avoid vaccinations without consulting health care professional.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Monitor infants born to mothers treated with corticotropin for signs of hypoadrenalism (poor feeding, irritability, weakness, vomiting) and manage accordingly.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇