Adverse Reactions
Fluid and electrolyte disturbances:
Sodium retention; fluid retention; potassium loss; hypokalemic
alkalosis; calcium loss.
Musculoskeletal:
Muscle weakness; steroid myopathy; loss of muscle mass;
osteoporosis; vertebral compression fractures; aseptic necrosis of
femoral and humeral heads; pathologic fracture of long bones.
Gastrointestinal:
Peptic ulcer with possible perforation and hemorrhage; pancreatitis;
abdominal distention; ulcerative esophagitis.
Dermatologic:
Impaired wound healing; thin fragile skin; petechiae and ecchymoses;
facial erythema; increased sweating; suppression of skin
test reactions; acne; hyperpigmentation.
Cardiovascular:
Hypertension; necrotizing angiitis; congestive heart failure.
Neurological:
Convulsions; increased intracranial pressure with papilledema,
(pseudo-tumor cerebri) usually after treatment; headache; vertigo.
Endocrine:
Menstrual irregularities; development of Cushingoid state; suppression
of growth in children; secondary adrenocortical and
pituitary unresponsiveness, particularly in times of stress, as in
trauma, surgery or illness; decreased carbohydrate tolerance;
manifestations of latent diabetes mellitus; increased requirements
for insulin or oral hypoglycemic agents in diabetics; hirsutism.
Ophthalmic:
Posterior subcapsular cataracts; increased intraocular pressure;
glaucoma with possible damage to optic nerve; exophthalmos.
Metabolic:
Negative nitrogen balance due to protein catabolism.
Allergic reactions:
Especially in patients with allergic responses to proteins manifesting
as dizziness, nausea and vomiting, shock, skin reactions.
Miscellaneous:
Abscess; prolonged use of ACTH may result in antibodies to it and
resulting loss of stimulatory effect.
Drug Abuse and Dependence:
Although drug dependence does not occur, sudden withdrawal of
corticotropin after prolonged use may lead to recurrent symptoms
which make it difficult to stop. It may be necessary to taper the
dose and increase the injection interval to gradually discontinue the
medication.