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  • Generic Name: repository corticotropin injection
  • Brand Name: H.P. Acthar Gel
Last updated on MDtodate: 10/6/2022


The following clinically significant adverse reactions are described elsewhere in the labeling:

  • Infections.
  • Cushing’s Syndrome and Adrenal Insufficiency Upon Withdrawal.
  • Elevated Blood Pressure, Salt and Water Retention, and Hypokalemia.
  • Masking Symptoms of Other Diseases.
  • Gastrointestinal Perforation and Bleeding.
  • Behavioral and Mood Disturbances.
  • Ophthalmic Effects.
  • Immunogenicity Potential.
  • Negative Effects on Growth and Physical Development.
  • Decrease in Bone Density.

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adverse Reactions In Infants And Children Under 2 Years Of Age

While the types of adverse reactions seen in infants and children under age 2 treated for infantile spasms are similar to those seen in older patients, their frequency and severity may be different due to the very young age of the infant, the underlying disorder, the duration of therapy and the dosage regimen. Below is a summary of adverse reactions specifically tabulated from source data derived from retrospective chart reviews and clinical trials in children under 2 years of age treated for infantile spasms. The number of patients in controlled trials at the recommended dose was too few to provide meaningful incidence rates or to permit a meaningful comparison to the control groups. The most common adverse reactions (5% or greater in the recommended twice daily dosing group) for the treatment of infantile spasms are increased risk of infections, convulsions, hypertension, irritability, and pyrexia.

TABLE: Incidence (%) of Adverse Reactions Occurring in ≥2% of Infants and Children Under 2 Years of Age Treated with Acthar Gel

Adverse Reactions Recommended
75 U/m² twice daily
n=122, (%)
150 U/m² once daily
n=37 (%)
Cardiac disorders
Cardiac Hypertrophy 3 0
Endocrine disorders
Cushingoid 3 22
Gastrointestinal disorders
Diarrhea 3 14
Vomiting 3 5
Constipation 0 5
General disorders and administration site conditions
Irritability 7 19
Pyrexia 5 8
Infections and infestations
Infection* 20 46
Weight gain 1 3
Metabolism and nutrition disorders
Increased appetite 0 5
Decreased appetite 3 3
Nervous system disorders
Convulsion† 12 3
Respiratory, thoracic and mediastinal disorders
Nasal Congestion 1 5
Skin and subcutaneous tissue disorders
Acne 0 14
Rash 0 8
Vascular disorders
Hypertension 11 19
*Specific infections that occurred at ≥ 2% were candidiasis, otitis media, pneumonia and upper respiratory tract infections.
†In the treatment of infantile spasms, other types of seizures/convulsions may occur because some patients with infantile spasms progress to other forms of seizures (for example, Lennox-Gastaut Syndrome). Additionally, the spasms sometimes mask other seizures and once the spasms resolve after treatment, the other seizures may become visible.


These adverse reactions may also be seen in adults and children over 2 years of age when treated for other purposes and with different doses and regimens.

Postmarketing Experience

The following adverse reactions have been identified during post approval use of Acthar Gel.

Because adverse reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Allergic Reactions

Allergic responses have presented as dizziness, nausea, and anaphylaxis (anaphylactic shock, hypotension, respiratory compromise, urticaria, edema).


Necrotizing angitis (adults only), congestive heart failure, atrial fibrillation, and palpitations.


Skin thinning (adults only), facial erythema, and increased sweating (adults only).


Decreased carbohydrate tolerance (infants only), hirsutism, and menstrual irregularities.


Pancreatitis (adults only), abdominal distention, and ulcerative esophagitis.

General Disorders And Administration Site Conditions

Injection site reaction and asthenic conditions (including fatigue, malaise, asthenia, and lethargy).

Infections And Infestations



Blood glucose increased.


Hypokalemic alkalosis (infants only) and fluid retention (including peripheral swelling).


Muscle weakness and vertebral compression fractures (infants only).


Headache (adults only), vertigo (adults only), subdural hematoma, intracranial hemorrhage (adults only), and reversible brain shrinkage (usually secondary to hypertension) (infants only).

Psychiatric Disorders


Possible Additional Steroidogenic Effects

Based on steroidogenic effects of Acthar Gel certain adverse events may be expected due to the pharmacological effects of corticosteroids. The adverse events that may occur but have not been reported for Acthar Gel are:


Impaired wound healing, petechiae and ecchymoses, and suppression of skin test reactions.


Negative nitrogen balance due to protein catabolism and alteration in glucose tolerance.


Loss of muscle mass and aseptic necrosis of femoral and humeral heads.


Increased intracranial pressure with papilledema, (pseudo-tumor cerebri) usually after treatment, and subdural effusion.





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