ACTHAR: Uses, Dosage, Demographic, Side Effects, Interactions, and Generic Options Acthar Gel, also known as repository corticotropin injection, is a complex formulation containing adrenocorticotropic hormone (ACTH). It is a natural hormone produced in the pituitary gland that stimulates the adrenal cortex to produce steroid hormones. The drug is available in the form of a gel or an injectable suspension. In this article, we will discuss the uses, dosage, demographic, side effects, interactions, and generic options of Acthar. Uses of Acthar Acthar is primarily indicated for several conditions, including: 1. Multiple Sclerosis: Acthar is approved as monotherapy or adjunctive therapy for the treatment of multiple sclerosis (MS) in adults. The drug is used for acute exacerbations of the disease, but not for the long-term management of MS. 2. Rheumatoid Arthritis: Acthar is indicated for the treatment of selected cases of rheumatoid arthritis when alternative therapies have failed. 3. Nephrotic Syndrome: Acthar is used in the management of nephrotic syndrome in combination with other immunosuppressive agents. 4. Dermatologic Diseases: Acthar is also used for the treatment of dermatologic diseases like pemphigus, bullous dermatitis herpetiformis, and severe erythema multiforme. Dosage and Administration of Acthar Acthar is prescribed by a licensed practitioner and administered via subcutaneous or intramuscular injection. The dosage is highly variable and depends on the indication, age, body weight, and clinical response of the patient. It is essential to carefully follow the prescribed dose, as Acthar overdose may result in serious adverse reactions. The recommended dosage range for the indications are: 1. Multiple Sclerosis: 80-120 units per day for 3 to 5 consecutive days. The drug can be repeated as needed. 2. Rheumatoid Arthritis: 40-80 units per day for a minimum of 2 to 3 weeks, followed by a gradual taper. 3. Nephrotic Syndrome: The dosage is determined by the severity of the condition and may range from 40-80 units per day. 4. Dermatologic Diseases: The dosage may be 40-120 units per day, depending on the severity and response to the treatment. Demographic Information Acthar is indicated for use in adults, and the safety and efficacy have not been established in children. The drug is not recommended for pregnant or lactating women, as the safety profile is unknown. The use of Acthar in geriatric patients requires caution, as they may be more susceptible to adverse reactions. Acthar Side Effects The most common side effects associated with Acthar use include hypertension, fluid retention, mood changes, stomach upset, and elevated blood glucose levels. Other potential side effects include osteoporosis, thrombosis, adrenal suppression, and increased susceptibility to infections. Long-term use of Acthar may also result in Cushing's syndrome and diabetes mellitus. Interactions Acthar may interact with other medications, including anticoagulants, antidiabetic agents, and immunosuppressive agents. Concurrent use of Acthar and other corticosteroids may increase the risk of adverse reactions. Generic Options A generic version of Acthar is not currently available. Adoption of the 2019 rule change by CMS established a new reimbursement rate, which may lead to other generic options becoming available. In conclusion, Acthar is a complex formulation containing adrenocorticotropic hormone indicated for a range of medical conditions, including multiple sclerosis, rheumatoid arthritis, nephrotic syndrome, and dermatologic diseases. The drug is administered via subcutaneous or intramuscular injection and requires careful dosage management under the guidance of a licensed practitioner. The safety and efficacy of the drug have not been established in children and pregnant or lactating women. The most common side effects associated with Acthar include hypertension, fluid retention, mood changes, and elevated blood glucose levels. The drug may interact with other medications, and a generic version of Acthar is not currently available.