Dosing and Administration
The usual dose of H.P. Acthar® Gel (Repository Corticotropin Injection) is 40-80 units given intramuscularly or subcutaneously every 24-72 hours. In the treatment of acute exacerbations of multiple sclerosis, daily intramuscular doses of 80-120 units for 2-3 weeks may be administered.
The chronic administration of more than 40 units daily of ACTH may be associated with uncontrollable adverse effects.
When reduction in dosage is indicated, this should be done gradually by either reducing the amount of each injection, administering injections at longer intervals, or by a combination of both strategies. During reduction of dosage, careful consideration should be given to the disease being treated, the general medical condition of the patient and the duration of ACTH administration.
Standard tests for verification of adrenal responsiveness to ACTH may use as much as 80 units of ACTH as a single injection or one or more injections of a smaller dosage. Verification tests should be performed prior to treating a patient with ACTH. The verification test should use the route(s) of administration that will be used for treatment. Following verification, dosage should be individualized for the disease under treatment and the general medical condition of each patient. Frequency and dose of the drug should be determined by considering severity of the disease, plasma and urine corticosteroid levels, and the initial response of the patient. Only gradual changes in dosage schedules should be attempted, after full drug effects have become apparent.
Preparation
Acthar (Repository Corticotropin Injection) should be warmed to room temperature before using.
Caution: Do not over pressurize the vial prior to withdrawing the product.