Interactions - summary

ACTH +

Amphotericin B -  
 depletes potassium and enhance the potassium wasting effect  of  corticotropin. Also decrease adrenocortical responsiveness to  corticotropin. Closely monitor serum potassium

Antidiabetic agents
increased requirements for insulin or oral hypoglycemic agents in diabetic occured in patients taking ACTH 
                                                

Diuretics-  Pot depleting
that deplete  potassium enhance the potassium wasting effect of orticotropin.  Closely monitor serum potassium
                                            

 Indomethicin / Salicylates
 use aspirin cautiously in conjunction with corticotropin  Corticosteroids  increase the  renal clearance of salicylate  and salicylate toxicity occur

Diagnostic testing of adrenocortical function

Infections- pneumonia, abcess and septic infection and GI and GU infectons ( more frequent with higher doses )

Fluid and electrolyte disturbances - sodium and potassium retention, potassium and calcium loss hypokalemic alkalosis

Musculoskeletal - muscle weakness, steroid myopathy, loss of muscle mass, osteoporosos, vertibral, compression fractures, pathologic fracture of leg bones, aseptic necrosis of femoral and humeral heads

GI - pancreatitis, ulcerative esophagitis, abdominal distention, peptic ulcer and perforation and haemorrhage

Dermatologic- impaired wound healing, increaserd sweating, hyperpigmentation, thin fragile skin

Cardiovascular - hypertension, CHF , necrotizing angitis

CNS - convulsions, vertigo, headache, increased cranial pressure

Endocrine - menstrual irregularities, suppression of growth in children,manifestation of latent diabetes

Opthalmic- posterior capsule cataract, increased ocular pressure, glaucoma with possible damage to optic nerve. Metabolic - negative nitrogen balance

Hypersenstivity - dizziness, nausea, vomiting, shock, skin reactions

Miscellaneous- prolonged use may result in antibody production and subsequent loss of stimulatory effect of ACTH

Scleroderma, osteoporosis, systemic fungal infections,

ocular herpes simplex recent surgery, history of presence of peptic ulcer,

congestive heart failure

Warnings-

Do not administer until adrenal responsiveness has been verified with route of admin. IM or SC which will be used during treatment.

Rise in urinary and plasma corticosteroid old value provides direct evidence of stimulatory effect. Chronic admin. may lead to irreversible adverse effects.

ACTH may suppress signs and symptoms of chronic disease witout having altering the natural course of the disease

Prolonged use increase risk of hypersensitivity freactions and may produce posterior subcapsular cataracts and glaucoma with possiblev damage to optic nerve.

Stress - in patients who receive prolonged corticotropin therapy, use additional rapidly acting corticosteroids during and after an unusally stressful condition

Infection- ACTH may mask signs of infection including fungal or viral infections that may appear during its use. When infection is present administer appropioate anti-infective therapy

Tuberculosis - observe patients with latent tuberculosis or tuberculin reactivity who receive ACTH

During prolonged ACTH therapy administer chemopropylaxis

Imunosuppression- perform imunization procedures with caution especially when high doses are administered, because of possible hazard of neurological complications and lack of antibody response

Electrolyte- corticotropin can elevate blood pressure , cause salt or water retention and increase potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necesary

Pregnancy- use in pregnancy only when clearly needed and when benefits outweigh potential hazards to the fetus

Lactation- Because of potential for serious adverse reactions in nursing infants from ACTH, decide whether to discontinue nursing or to continue the drug.

Children- prolonged use of corticotropin in children will inhibit skeletal growth. If use is necessary give intermittantly and carefully observe the child.

Precautions- Concomittant therapy- since maximal corticotropin of the adrenals may be limited during the first few days of treatment, administer a rapidly acting corticosterone ( eg hydrocorticosone ) when immediate therapeutic effects is desirable.

ACTH should be adjunctive and mot the sole therapy Use the lowest dose to control condition, when reduction in dosage should be gradual

Sensitivity - perform skin testing prior to treatment in patients with suspected senssitivity to procaine proteins.

Hypothyroidsm and cirrhosis - an enhanced effect of corticotropin may occur

Use with caution in patients with diabetes, abcess, pyogenic infections

Drug abuse and dependence - although drug dependence does not occur, sudeden withdrawal of corticotropin may lead to recurrent symptoms which make it difficult to stop.

Necessary to taper dose and increase the injection interval to gradually disconiue the medication

Indication-

Diagnostic testing of adrenocortical function

Dosage-

Standard tests for verification of adrenal responsiveness to corticotropin may utilize as much as 80 units as a single injection or more injections of lesser dosage

1. ACTH may mask signs of infection. There may be decreased resistence and inability to localize infection

2. Avoid immunizations with live vaccines

3. Diabetes may have increased requirements for insulin oral hypoglycemics

4. Notify physician if marked fluid retention, musclev weakness, abdominal pain, seizures, or headache occurs

Pregnancy-

Use in pregnancy only when clearly needed and when benefits outweigh potential hazards to the fetus

Lactation-

Because of potential for serious adverse reactions in nursing infants from ACTH, decide whether to discontinue nursing or to continue the drug.

Children-

Prolonged use of corticotropin in children will inhibit skeletal growth. If use is necessary give intermittantly and carefully observe the child.