Storing, Preparing and Injecting Acthar

Injection Preparation and Instructions for Subcutaneous (SC) Injection

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The following sections provide easy step-by-step instructions on how to subcutaneously inject Acthar. They review all the items you will need when injecting, how to find areas on the body where Acthar can be injected, how to complete the injection itself, how to store Acthar, and how to throw it away.

Getting Started With Acthar

Acthar can be given by a subcutaneous (beneath the skin) injection. The steps included here are intended only to supplement the detailed instructions and training provided to you in person by your doctor or nurse. You also are eligible to have a licensed nurse visit you in the privacy of your home to provide Home Injection Training Services to help you or your care partner learn how to inject Acthar. If you are interested in these services, more information is available here.

Once you receive Acthar:

1. Check the vial to make sure that it's Acthar.
2. Check the expiration date on the Acthar vial to make
   sure you are using it before the date listed
3. Prior to each use, check for any signs of contamination (cloudiness, small flecks, etc)

Do not use if:

• the vial is expired
• any signs of contamination are seen
4. Refrigerate Acthar as soon as you receive it and check that your refrigerator is set between 36°–46°F or 2°–8°C.
5. Read the entire instruction guide before your first injection.

Items you will need when injecting Acthar:

1. Vial of Acthar
2. A 23g or 25g needle
   • Some packages may include a 20g needle (not for injection), which can speed the process of drawing Acthar into the syringe.
3. Syringe
4. Alcohol swabs
5. Gauze pads
6. Adhesive bandage
7. Puncture-resistant container to safely dispose of syringe and needles after use

A 23g or 25g needle can be used to draw Acthar into the syringe and it should be used to inject Acthar

Preparing to inject

1. Gather all your needed supplies in one place that will be easy to access when injecting.

2. Take the vial of Acthar out of the refrigerator. Recheck the expiration date to make sure the vial has not expired. Warm the vial to room temperature by rolling it between the palms of your hands or by holding it under your arm for a few minutes. Do not inject Acthar directly after removing it from the refrigerator.

3. Wash your hands with soap and warm water.
4. Remove the cap of the vial and use an alcohol swab to wipe the rubber stopper on top of the vial.

5. Remove the needle cap. Insert the needle through the rubber stopper and inject air into the upright vial by pushing down on the plunger until it cannot be pushed farther.

6. While the syringe is still in the vial, turn the vial and syringe upside down.

7. While keeping the needle tip in the gel, slowly pull back the plunger to the exact amount your doctor prescribed.
   
   

   Keep needle tip in gel at all times.

8. With the tip of syringe upright and the needle still in the vial, tap the syringe with your finger until any air bubbles rise to the top. If bubbles are present, very slowly press the plunger until only the bubbles are pressed out of the syringe and a droplet starts to form at the needle tip. Check that you still have the amount your doctor prescribed in the syringe. If not, place the needle tip in the gel and draw in the amount you need and remove bubbles again.

9. If using the wider (20g) needle to draw Acthar into the syringe, replace the needle cap,detach the needle, and attach the thinner (23g or 25g) needle; continue to pages 12-19 to find an injection site and learn how to inject Acthar.

   If using the thinner (23g or 25g) needle to draw Acthar into the syringe, continue to the following sections to find an injection site and learn how to inject Acthar.

Before injecting, ensure that the needle remains sterile (ie, do not place on unclean surface)

A Few Things to Remember Before Injecting

• Ask your doctor or nurse which injection areas may be best for you. Common areas include upper arm or thigh.
• When injecting yourself, the muscle along the upper-outer thigh may be best. When injecting others, the muscle in the upper arm may be best.
• You may inject into the same area more than once a week, but rotate the injection sites in that area each time, keeping 1 inch between sites.

Do not inject into:

• Same site (small area of the muscle) more than once a week
• An area that has skin irritation, including red, swollen, or painful areas
• An area that has hardened or is sensitive to touch
• Tattoos, warts, scars, or birthmarks
• Stomach
• Knee or groin area
• The belly button or the 1-inch area around it

Injecting the Upper Thigh

The following instructions are for self-injections.

You may inject into the same area more than once in a week, but rotate the injection sites in that area each time, keeping 1 inch between sites.

1. Sit comfortably on a firm chair to keep the thigh area relaxed.

2. To locate the correct area, place one hand on your knee and one hand on your upper thigh near your hip. Draw an imaginary line down the center front of your thigh from hip to knee. The area between your hands and from the center of your thigh to the outer side of the leg is the area that should be injected.

3. See "How to inject" for additional instructions.

Injecting the Abdomen

The following instructions are for self-injections.

1. Sit comfortably on a firm chair.

2. 
   
   To locate the area, place your hands on your lower ribs. Injections should be done below where your hands are in any area that has enough tissue to pinch. However, it is important to not inject the belly button or the 1-inch area around it.

3. See "How to inject" for additional instructions.

Injecting the Upper Arm

The upper arm is a common area used when injecting another person. Injections can be given on either the side or the back of the upper arm. The person receiving the injection can either sit or lie down, whichever is more comfortable, with his or her arm relaxed. The following instructions are for the person giving the injection.

Side of the upper arm

1. Run your fingers along the collarbone until you reach the shoulder bone at the outermost tip of the shoulder.

2. Place 4 fingers of your hand just below the shoulder bone.

3. 
   
   Now place 4 fingers of your other hand on the elbow. Draw an imaginary line down the center front and down the outer side of the upper arm from shoulder to elbow. Injections can be given between these imaginary lines and your hands if there is enough tissue to pinch.

4. See "How to inject" for additional instructions.

Back of the arm

1. Run your fingers along the collarbone until you reach the shoulder bone.

2. Place 4 fingers of your hand behind the arm just below the shoulder bone.

3. 
   
   Now place 4 fingers of your other hand on the back side of the elbow. Draw an imaginary line down the center back and down the outer side of the back upper arm from shoulder to elbow. Injections can be given between these imaginary lines and your hands if there is enough tissue to pinch.

4. See "How to inject" for additional instructions.

How to Inject

The steps are the same whether you are injecting yourself or someone else. The steps below should be done after the person receiving the injection has removed clothing around the area to be injected, an injection site has been found, and the person receiving the injection is ready for the injection (see previous instructions for more information).

1. Clean the area to be injected with an alcohol swab; let the alcohol dry before injecting.

2. Press the plunger until a droplet forms at the tip of the needle.

3. Pinch the skin around the injection site between the thumb and fingers of the hand that is not holding the syringe.

4. Hold the syringe like a pencil or dart with your right hand if you are right-handed and your left if you are left-handed. Using a quick motion, insert the needle at a 90° angle through the skin.

5. Once the needle is fully in, draw back on the plunger to check for blood. It is important to make sure you are not injecting into a vein, and checking for blood will determine this.

   • If no blood enters the syringe, slowly push the plunger in until the syringe is empty.
   • If blood enters the syringe, withdraw the needle and, using a gauze pad, place pressure on the injection site. Start over with a new syringe and a new site for injection.

6. Once the syringe is empty, pull the needle straight out. It may be helpful to hold a gauze pad over the injection site and use it to apply pressure once the needle has been removed. Use an ice cube if you feel pain at the injection site.

7. If there is any blood, wipe it off and, if necessary, apply an adhesive bandage.

8. Dispose of the used syringe, needle, and needle cap in a puncture-resistant container. Do not replace the needle cap prior to disposal (see following section for more information about proper disposal of syringes, needles, and vials).

9. Wash your hands with soap and warm water.