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Cortrophin Gel
corticotropin
Adult Dosing .
Dosage forms: INJ (SC pre-filled syringe): 40 units per 0.5 mL, 80 units per mL; INJ (SC/IM vial): 80 units per mL
corticotropin-responsive conditions
- [40-80 units SC/IM q24-72h]
- Info: consider test dose before tx start; individualize dose, frequency based on condition, disease severity, initial tx response; use lowest effective dose; taper dose gradually to D/C
multiple sclerosis, acute exacerbation
- [80-120 units SC/IM qd x2-3wk]
- Info: consider test dose before tx start; individualize dose based on disease severity, initial tx response; use lowest effective dose; taper dose gradually to D/C
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ (SC pre-filled syringe): 40 units per 0.5 mL, 80 units per mL; INJ (SC/IM vial): 80 units per mL
corticotropin-responsive conditions
- [40-80 units SC/IM q24-72h]
- Info: consider test dose before tx start; individualize dose, frequency based on condition, disease severity, initial tx response; use lowest effective dose; taper dose gradually to D/C
infantile spasms (off-label)
- [high-dose tx, <2 yo]
- Dose: 150 units/m^2/day IM divided bid x2wk; Info: taper dose gradually over 2wk to D/C; may consider taper of 30 units/m^2/dose IM qam x3 days, then 15 units/m^2/dose IM qam x3 days, then 10 units/m^2/dose IM qam x3 days, then 10 units/m^2/dose IM every other am x6 days
- [low-dose tx, <2 yo]
- Dose: 20-30 units/m^2/dose IM qd; Info: taper dose gradually over 2wk to D/C
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to porcine protein
- IV use
- adrenal insufficiency
- adrenocortical hyperfunction
- scleroderma
- osteoporosis
- systemic fungal infection
- ocular HSV infection
- surgery, recent
- PUD, active
- PUD history
- CHF
- HTN, uncontrolled
- congenital infection, suspected (patients <2 yo)
- abrupt withdrawal (long-term use)
- caution: peds patients (long-term use)
- caution: renal impairment
- caution: cirrhosis
- caution: infection, active
- caution: TB infection, active
- caution: TB infection, latent
- caution: hypokalemia
- caution: HTN
- caution: hypothyroidism
- caution: osteoporosis risk
- caution: myasthenia gravis
- caution: GI bleeding
- caution: GI perforation risk
- caution: diverticulitis
- caution: intestinal anastomosis, recent
- caution: psychiatric disorder
- caution: diabetes mellitus
Drug Interactions .
Overview
corticotropin
ACTH analog
- affects growth hormone diagnostic test results
- GI mucosal injury/bleeding risk
- hyperglycemic effects
- hypernatremia
- hypertensive effects
- hypokalemia
- immunomodulatory effects
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- amphotericin
- cladribine oral
- etrasimod
- furosemide
- macimorelin
- midodrine
- natalizumab
- pimecrolimus topical
- rabies vaccine
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acebutolol
- acetazolamide
- afatinib
- albuterol
- albuterol inhaled
- alendronate
- aliskiren
- almotriptan
- aloe
- alogliptin
- amlodipine
- amphetamine
- angiotensin II
- anthrax vaccine
- aprocitentan
- arformoterol inhaled
- armodafinil
- arsenic trioxide
- asciminib
- asparaginase
- aspirin
- atenolol
- atogepant
- atomoxetine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- benzphetamine
- betamethasone
- betaxolol
- bevacizumab
- bexagliflozin
- bisoprolol
- brentuximab vedotin
- brexucabtagene autoleucel
- brigatinib
- budesonide
- bumetanide
- bupropion
- cabazitaxel
- cabozantinib
- caffeine
- caffeine citrate
- canagliflozin
- cannabis
- captopril
- carfilzomib
- carvedilol
- celecoxib
- ceritinib
- cetuximab
- chikungunya vaccine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cinacalcet
- cisplatin
- clevidipine
- clonidine
- cocaine
- colesevelam
- copanlisib
- cortisone
- COVID-19 vaccine
- crizotinib
- cyclosporine
- cysteamine
- danazol
- dapagliflozin
- darbepoetin alfa
- decitabine
- deflazacort
- desmopressin
- desvenlafaxine
- deuruxolitinib
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydroergotamine
- diltiazem
- dimethyl fumarate
- dinutuximab
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- diroximel fumarate
- dobutamine
- donepezil
- dopamine
- doxapram
- doxazosin
- dronabinol
- droxidopa
- dulaglutide
- ebola vaccine, live
- eletriptan
- emapalumab
- empagliflozin
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- erlotinib
- ertugliflozin
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- etelcalcetide
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethinyl estradiol (contraceptive)
- etodolac
- everolimus
- exenatide
- felodipine
- fenfluramine
- fenoprofen
- fingolimod
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- fosamprenavir
- foscarnet
- fosfomycin injection
- fosinopril
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galantamine
- galcanezumab
- gefitinib
- glimepiride
- glipizide
- glyburide
- guanfacine
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- hoodia
- human papillomavirus vaccine
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- ibandronate
- ibrutinib
- ibuprofen
- ibuprofen lysine
- imatinib
- imipramine
- indapamide
- indomethacin
- influenza H5N1 vaccine
- influenza vaccine
- insulin
- irbesartan
- isoproterenol
- Japanese encephalitis vaccine
- ketamine
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- lanthanum
- leflunomide
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levomilnacipran
- licorice
- linagliptin
- liraglutide
- lisdexamfetamine
- lisinopril
- lixisenatide
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- lutetium Lu 177 dotatate
- magnesium citrate
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- meningococcal vaccine
- metformin
- methamphetamine
- methazolamide
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- mifepristone
- miglitol
- milnacipran
- minoxidil
- mirabegron
- mitomycin
- modafinil
- monomethyl fumarate
- motixafortide
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- nadolol
- naproxen
- naratriptan
- nateglinide
- naxitamab
- nebivolol
- necitumumab
- niacin (vitamin B3)
- nicardipine
- nicotine
- nifedipine
- nilotinib
- nintedanib
- niraparib
- nisoldipine
- norepinephrine
- obinutuzumab
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- pamidronate
- panitumumab
- pasireotide
- pazopanib
- perphenazine
- pexidartinib
- phendimetrazine
- phentermine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- pioglitazone
- piroxicam
- pneumococcal vaccine
- poliovirus vaccine
- polyethylene glycol
- polyethylene glycol/electrolytes
- ponatinib
- ponesimod
- porfimer
- posaconazole
- pralsetinib
- pramlintide
- prazosin
- prednisolone
- prednisone
- propranolol
- protriptyline
- pseudoephedrine
- pyridostigmine
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- repaglinide
- respiratory syncytial virus vaccine
- rimegepant
- ripretinib
- risedronate
- rivastigmine
- rizatriptan
- ropinirole
- rosiglitazone
- sacituzumab govitecan
- salmeterol inhaled
- saxagliptin
- selinexor
- selpercatinib
- semaglutide
- siponimod
- sipuleucel-T
- sirolimus albumin-bound
- sitagliptin
- smallpox/mpox vaccine, live
- sodium acid phosphate
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- solriamfetol
- sorafenib
- spironolactone
- sulfate bowel prep
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tafasitamab
- tagraxofusp
- telmisartan
- temsirolimus
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tick-borne encephalitis vaccine
- timolol
- tirzepatide
- tivozanib
- tocilizumab
- tolmetin
- topiramate
- torsemide
- trametinib
- triamcinolone
- trifluoperazine
- typhoid vaccine
- ubrogepant
- upadacitinib
- vadadustat
- valsartan
- vamorolone
- vandetanib
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- willow bark
- yohimbe
- zavegepant
- ziv-aflibercept
- zolmitriptan
- zonisamide
Caution Advised
- abatacept
- abemaciclib
- abrocitinib
- acalabrutinib
- adalimumab
- afamitresgene autoleucel
- aldesleukin
- alemtuzumab
- anakinra
- anifrolumab
- anti-thymocyte globulin
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- baricitinib
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- bimekizumab
- blinatumomab
- bortezomib
- brodalumab
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- canakinumab
- carboplatin
- carmustine
- certolizumab pegol
- chlorambucil
- ciltacabtagene autoleucel
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- coccidioides immitis skin test antigen
- crovalimab
- cyclophosphamide
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- deferasirox
- delgocitinib topical
- deucravacitinib
- dexamethasone ophthalmic
- difluprednate ophthalmic
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- epcoritamab
- epirubicin
- eribulin
- etanercept
- etoposide
- etuvetidigene autotemcel
- floxuridine
- fludarabine
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- gemtuzumab ozogamicin
- glofitamab
- golimumab
- guselkumab
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- icotrokinra
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- lifileucel
- linvoseltamab
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methacholine inhaled
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- mosunetuzumab
- nadofaragene firadenovec intravesical
- narsoplimab
- nelarabine
- nipocalimab
- obecabtagene autoleucel
- ocrelizumab
- ofatumumab
- oxaliplatin
- paclitaxel
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- pozelimab
- prednisolone ophthalmic
- procarbazine
- quizartinib
- ravulizumab
- relacorilant
- rilonacept
- rilzabrutinib
- risankizumab
- ritlecitinib
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- ruxolitinib topical
- salsalate
- sarilumab
- satralizumab
- secukinumab
- sibeprenlimab
- siltuximab
- sirolimus
- spesolimab
- sulfasalazine
- sutimlimab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- tofacitinib
- topotecan
- trabectedin
- tralokinumab
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- HPA axis suppression
- adrenal insufficiency after abrupt D/C (long-term use)
- Cushing syndrome
- diabetes mellitus
- hypokalemic alkalosis
- infection, serious
- myocardial hypertrophy
- CHF
- atrial fibrillation
- ICP incr.
- pseudotumor cerebri
- intracranial hemorrhage
- seizures
- GI perforation
- GI ulcer
- GI bleeding
- pancreatitis
- depression
- psychosis
- steroid myopathy
- osteoporosis
- osteonecrosis
- vertebral compression fracture (infants)
- cataracts (long-term use)
- glaucoma (long-term use)
- optic nerve damage (long-term use)
- growth suppression (long-term use in peds patients)
Common Reactions
- infection
- Cushing syndrome
- irritability
- HTN
- acne
- diarrhea
- seizures
- rash
- fever
- constipation
- appetite changes
- vomiting
- nasal congestion
- myocardial hypertrophy
- weight gain
- behavior changes
- sodium retention
- fluid retention
- hypokalemia
- hyperglycemia
- injection site reaction
Safety/Monitoring .
Monitoring Parameters
electrolytes including Ca; glucose; BP; weight; height (peds) if prolonged tx; BMD if prolonged tx; ophthalmic exam if prolonged tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially in 1st trimester; inadequate human data available, though possible risk of orofacial cleft based on conflicting human data with other systemic corticosteroids; possible risk of low birth wt and premature birth based on limited human data with other systemic corticosteroids; possible risk of fetal adrenal suppression based on drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for corticotropin: unknown; CYP450: unknown
Excretion: for corticotropin: unknown; Half-life: 15min
Subclass: Corticosteroids, Systemic
Mechanism of Action
for corticotropin: in infantile spasms, exact mechanism of action unknown; in multiple sclerosis and corticotropin-responsive conditions, stimulates the adrenal cortex, secreting cortisol, corticosterone, aldosterone, and other weakly androgenic substances; binds melanocortin receptors, producing anti-inflammatory and immunosuppressive effects
Formulary .
No Formulary Selected
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