Corticotropin

(core-tih-koe-TROE-pin)

  Action:
Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

  Indications:
Diagnostic testing of adrenocortical function; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic and GI diseases. Unlabeled use(s): Treatment of infantile spasms.

  Contraindications:
Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

  Route/Dosage:

Rapid-acting Injection

Adults:
IM/SC 20 U qid.

Diagnostic tests:
IV 10 to 25 U dissolved in 500 mL of D5W infused over 8 hr.

Acute exacerbations of multiple sclerosis:
IM 80 to 120 U/day for 2 to 3 wk.

infantile spasms:
IM 20 to 40 U qd or 80 U qo for 3 mo or 1 mo after seizures stop.

Repository Injection
IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

  Interactions:

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis.

Barbiturates: May decrease effects of corticotropin.

  Lab Test Interferences:
May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

  Adverse Reactions:

CV:

Hypertension; CHF; necrotizing angiitis.

CNS:

Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri.

DERM:

Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne.

EENT:

Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos.

GI:

Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer.

META:

Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use.

OTHER:

Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

  Precautions:

Pregnancy: Category C.

Lactation: Undetermined.

Children: Because prolonged use inhibits skeletal growth, careful monitoring is necessary.

Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention and increase potassium and calcium excretion.

Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin.

Infection: Drug may mask signs of infection; resistance to infection may be decreased.

Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects.

Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration.

Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during and after stressful situations.

  Administration/Storage:

• Medication may be given via IV, IM or SC route. Do not use IV route except in treatment of idiopathic purpura or diagnostic testing of adrenocortical function.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin for Injection

• Check product label to be certain that medication is for IV use.
• Reconstitute powder in Sterile Water for Injection or Sterile Sodium Chloride for Injection. Use only enough diluent so that dose is contained in 1 to 2 mL of solution.
• Rotate vial while drawing into syringe.
• Refrigerate reconstituted solution and use within 24 hr.

Corticotropin Repository Injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient's vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms, which may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention, muscle weakness, abdominal pain, seizures or headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

  Patient/Family Education:

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures or headaches.
• Instruct patient not to take otc medications without consulting health care provider.

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