Drugs

Corticotropin (Acth & Adrenocorticotropin Hormone)

Type of Drug:

Natural (corticotropin, ACTH) and synthetic (cosyntropin) adrenocortico­tropic hormone.

How the Drug Works:

Corticotropin (ACTH) is secreted by the pituitary gland. It stimulates the adrenal cortex to produce and secrete adrenocortical hormones (corticosteroids, glucocorticoids). A functioning adrenal gland is necessary for corticotropin to work.

Uses:

Corticotropin and cosyntropin: Diagnostic testing of adrenal gland function.

Precautions:

Corticotropin: Although corticosteroid (eg, prednisone) therapy is the treatment of choice, ACTH may be used instead in the following disorders: Thyroid gland inflammation; high blood calcium levels due to cancer; acute worsening of multiple sclerosis; tuberculosis meningitis; trichinosis with brain or heart involvement; and treatment of glucocorticoid - responsive rheumatic, collagen, skin, allergic, kidney, eye, respiratory, blood, digestive tract disorders, and cancer.

Unlabeled Uses: Occasionally ACTH is used to treat infantile spasms.

Diabetes: The requirement for insulin or oral sulfonylureas may be increased in diabetic patients receiving corticotrophin.

Electrolytes: Corticotropin can increase blood pressure, potassium and calcium excretion, and cause salt and water retention. Dietary salt restriction and potassium supplements may be necessary.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if corticotropin or cosyntropin appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Prolonged use of corticotropin in children inhibits skeletal bone growth. If use is necessary, the drug should be given intermittently at the lowest effective dose and the child should be closely watched.

Side Effects:

very drug is capable of producing side effects. Many corticotropin users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects of corticotropin include:

Fluid and Electrolyte 'Disturbances: Sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis.

Digostive Tract: Nausea; vomiting, ulceration of esophagus, inflammation of the pancreas, peptic ulcer, stomach bloating.

Norvous System: Vertigo (feeling of whirling motion); headache, euphoria, sleeplessness, mood swings, depression, seizures, dizziness, psychic symptoms, increased intra cranial pressure with papilledema.

Circulatory System: High blood pressure; congestive heart failure.

Skin: Impaired wound healing; increased sweating; excessive pigmentation of skin; thin, fragile skin; facial redness; acne; excessive body hair growth; rash; unusual bruising; Suppression of skin test reactions; facial swelling; small red spots under the skin.

Other: Infection, menstrual irregularities, Suppression of growth in children, cataracts, glaucoma, muscle weakness, loss of muscle mass, osteoporosis (brittle bones), abscess, increased intra ocular pressure, shock, aseptic necrosis of femoral and humeral heads, vertebral compression fractures, pathologic fracture of long bones, secondary aristocratically and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, development of Cushingoid state, increased requirements for insulin or blood-sugar-Iowering agents in diabetic patients, protrusion of one or both eyeballs, negative nitrogen balance due to protein breakdown.

Guidelines for Use:

Corticotropin -

• Dosage will be individualized according to the condition being treated and the general medical condition of the patient. The usual dosage of repository corticotrophin is 40 to 80 units given intramuscularly (IM) or subcutaneous (SC) every 24 to 72 hours. In the treatment of multiple sclerosis, daily IM doses of 80 to 120 units for 2 to 3 weeks may be administered.

• For IM or SC use only; intravenous (IV) administration is contra­indicated.

• If self-administering, carefully follow the preparation, administration, and disposal techniques taught to you by your health care provider.

• Warm to room temperature before using.

• Treatment for acute gouty arthritis should be limited to a few days. Since rebound attacks may occur when corticotrophin is discontinued, conventional concomitant anti gout therapy should be administered during corticotrophin treatment and for several days after it is stopped.

• Corticotropin may mask signs of infection. There may be decreased resistance and inability to localize infection when corticotropin is used.

• Diabetics: Insulin or oral blood-sugar-Iowering agent requirements may increase.

• Notify your doctor if marked fluid retention, muscle weakness, abdominal pain, seizures, headache, dizziness, nausea, vomiting, shock, or skin reactions occur.

• Avoid immunization with live vaccines (eg, MMR) when receiving corticotropin.

• Sudden withdrawal after prolonged use may lead to recurrent disease symptoms which make it difficult to withdraw the medication. It may be necessary to slowly lower the dose and increase the injection interval to gradually discontinue the medication.

• Lab tests or exams may be required to monitor therapy. Be sure to keep appointments .

• Store in the refrigerator (36° to 46°F).

• Cosyntropin - Cosyntropin will be administered by your health care provider. It is for IV or IM use only as a diagnostic agent.