Section 04 · Monograph
Corticotropin (ACTH)
Reviewed Nov 2026FDA label
Acthar GelHormone (ACTH)
- Forms
- Inj: 80 units/mL (5mL vial)
- Dose
- 80-120 units/day IM/SC x2-3 weeks (MS exacerbation)
- MOA
- Stimulates adrenal steroidogenesis
Indications
- Infantile spasms in patients under 2 years of age (monotherapy)FDA-labeled
- Acute exacerbations of multiple sclerosis in adultsFDA-labeled
- Rheumatic, collagen, dermatologic, allergic, ophthalmic, respiratory and edematous conditionsFDA-labeled
Mechanism of Action
- Stimulates the adrenal cortex to release cortisol, corticosterone, aldosterone and androgens
- Also acts at melanocortin receptors with possible direct anti-inflammatory and neuromodulatory effects
Full Dosing
Adult / usual
- Infantile spasms: 150 units/m²/day IM divided twice daily (75 units/m² BID) for 2 weeks, then taper over 2 weeks
- MS exacerbation: 80-120 units/day IM or SC for 2-3 weeks, then taper per label
- Refrigerate; the gel is viscous and requires an appropriate needle
Contraindications
- Scleroderma, osteoporosis, systemic fungal infections
- Ocular herpes simplex, recent surgery
- Congestive heart failure, uncontrolled hypertension
- Sensitivity to porcine proteins
- Live vaccines; infants with suspected congenital infection (for infantile spasms use)
Drug Interactions
- Live vaccines are contraindicated
- Diuretics increase hypokalemia
- NSAIDs increase GI bleeding risk
Adverse Effects
- Hypertension, fluid retention, hypokalemia
- Hyperglycemia
- Irritability and insomnia in infants; cardiac hypertrophy in infants
- Immunosuppression and infection
- Adrenal suppression
Monitoring Parameters
- Blood pressure, glucose, electrolytes
- Infants: echocardiography, weight, infection surveillance
- Taper and adrenal function after treatment
Pregnancy & Lactation
- Possible embryo-fetal toxicity; use only if benefit justifies risk
- Lactation data limited