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Severe Allergic and Inflammatory Eye Conditions

Acthar is a prescription medicine for people with severe acute and chronic allergic and inflammatory conditions affecting different parts of the eye. This can include the front part of the eye such as the cornea and iris, or the back part of the eye such as the optic nerve and retina. Acthar is injected beneath the skin or into the muscle.

Acthar is a prescription medicine for people with severe acute and chronic allergic and inflammatory conditions affecting different parts of the eye. This can include the front part of the eye such as the cornea and iris, or the back part of the eye such as the optic nerve and retina. Acthar is injected beneath the skin or into the muscle.

Learn How to Take Acthar

If you and your doctor decide that Acthar is a good option for treating your uveitis, Mallinckrodt offers you support in getting Acthar and learning how to use it properly.

Acthar can be injected by you or your care partner.

The information on this page will help you with the injection process.

See how Acthar is injected

These educational videos will show you how to inject:

Beneath the skin

Subcutaneous (SC) injection video

Into the muscle

Intramuscular (IM) injection video

Two types of Acthar injections

Acthar can be injected:

Acthar should never be given intravenously (into a vein) or by mouth.

Your healthcare provider will advise on how to inject Acthar and what the appropriate dose is for you.

Step-by-step training materials

  • Start
  • Prepare
  • Choose
  • Perform
  • Complete

Start

Take a look at this brief guide for a quick overview of how to properly inject Acthar.

Please note:

  • This quick reference is not intended to replace the injection training that you received from your doctor or nurse
  • Your doctor or nurse is always the best source of advice
  • See the injection instruction videos and additional information below
  • After you and/or your care partner receive injection training, a nurse coach from ActharPACT can review the steps with you and provide helpful tips over the phone. Learn more about the services offered by ActharPACT

Prior to injecting Acthar, please refer to the Important Safety Information about Acthar.

Speak with your healthcare provider about the potential side effects associated with Acthar, including possible injection site reactions.

Next step: Prepare Your Injection

Prepare Your Injection

  • Gather all of the Acthar injection materials in one place
    • Remove the vial of Acthar from the refrigerator. (Do not open the vial or pry off the rubber stopper cap)
Acthar injection supplies
  • Warm Acthar by rolling the vial between the palms of your hands for a few minutes
  • Wash your hands
  • Your healthcare provider will advise you on how to inject Acthar
Rolling Acthar vial in hands to warm it
Next step: Choose Your Type of Injection

Choose Your Type of Injection

Choose the type of injection you need as well as the injection site:

Upper Thigh subcutaneous injection site
Upper Thigh subcutaneous injection site

Inject beneath the skin (subcutaneous): upper thigh

  • Sit comfortably on a firm chair to keep the thigh area relaxed
  • Place one hand on your knee and one hand on your upper thigh near your hip. Draw an imaginary line down the center front of your thigh from hip to knee. The area between your hands and from the center of your thigh to the outer side of the leg is the area that should be injected
Abdomen subcutaneous injection site
Abdomen subcutaneous injection site

Inject beneath the skin (subcutaneous): abdomen

  • Sit comfortably on a firm chair
  • Place your hands on your lower ribs. Injections should be done below where your hands are in any area that has enough tissue to pinch. However, it is important not to inject the belly button or the 1-inch area around it
Side of upper arm subcutaneous injection site
Side of upper arm subcutaneous injection site

Inject beneath the skin (subcutaneous): side of upper arm

The following instructions are for the person giving the injection:

  • Run your fingers along the collarbone until you reach the shoulder bone at the outermost tip of the shoulder
  • Place 4 fingers of your hand just below the shoulder bone
  • Now place 4 fingers of your other hand on the elbow. Draw an imaginary line down the center front and down the outer side of the upper arm from shoulder to elbow. Injections can be given between these imaginary lines and your hands if there is enough tissue to pinch
Back of upper arm subcutaneous injection site
Back of upper arm subcutaneous injection site

Inject beneath the skin (subcutaneous): back of upper arm

The following instructions are for the person giving the injection:

  • Run your fingers along the collarbone until you reach the shoulder bone
  • Place 4 fingers of your hand just below the shoulder bone
  • Now place 4 fingers of your other hand on the back side of the elbow. Draw an imaginary line down the center back and down the outer side of the back of the upper arm from shoulder to elbow. Injections can be given between these imaginary lines and your hands if there is enough tissue to pinch
Upper arm intramuscular injection site
Upper arm intramuscular injection site

Inject into the muscle (intramuscular): upper arm

The following instructions are for the person giving the injection:

  • Run your fingers along the collarbone until you reach the shoulder bone at the outermost tip of the shoulder
  • Inject in the area 3 fingertip widths directly below the shoulder bone
Upper outer thigh intramuscular injection site
Upper outer thigh intramuscular injection site

Inject into the muscle (intramuscular): upper-outer thigh

  • Sit comfortably on a firm chair to keep the muscle relaxed
  • Place your fingertips on the middle of the thigh and gently press down to locate the thigh bone. The muscle that runs along the upper-outer edge of the thigh bone is the muscle that should be injected
  • It is best to inject into the middle third of that muscle. To find the middle third, place the fingertips of one hand on your knee and rest the palm of that hand on your thigh. Place the fingertips of your other hand behind the first hand. The outer area under your second hand is the area to inject
Next step: Perform Your Injection

Perform Your Injection

  • Since the syringe, needle, and vial are small, it might be a good idea to have a care partner help you with this step
  • Wipe the top of the vial (the rubber stopper) with a new sterile alcohol wipe
  • Prepare the syringe and a new sterile needle to draw up the amount of Acthar that your doctor has told you to use. Make sure to inject with ONLY a 23-g or 25-g needle and NOT the 20-g needle
Drawing Acthar into the needle
  • The prescribed amount of Acthar will need to be converted to milliliters (mL). This is the amount of medication you will draw up in the syringe
    • The vial of Acthar should indicate that there are 80 USP units per 1 mL
    • Use the chart below to convert the amount prescribed to you to the amount you should draw up into the syringe
Prescribed Units Injection Amount (mL)
80 units 1 mL
60 units 0.75 mL
40 units 0.5 mL
20 units 0.25 mL
  • Remember:
    • This is meant only as an example. It is not a complete list of possible prescribed units of Acthar
    • Always check with your doctor about your prescribed dose of Acthar
  • If you’re injecting beneath the skin, pinch the skin around the injection site between the thumb and fingers of the hand that is not holding the syringe. Then, insert the needle

Pinching the skin around subcutaneous injection site
  • If you’re injecting into the muscle, stretch the skin at the injection site and insert the needle

Stretching the skin around intramuscular injection site
  • Draw back syringe plunger slightly
    • If blood appears, withdraw needle and begin again
    • If no blood appears, inject all of the Acthar slowly and then pull the needle straight out
Injecting Acthar
Next step: Complete Your Injection Process

Complete Your Injection Process

  • Dispose of used syringe, needle, and needle cap
  • Place vial of Acthar back in the refrigerator. Acthar should be kept refrigerated (36ºF-46ºF; 2ºC-8ºC) between uses
Disposing used needle

Remember: If you are using a journal to keep track of your treatment schedule, be sure to fill it out now before you forget.

Many states require that you:

  • Place used supplies in a heavy plastic or metal container with a tight-fitting lid that is puncture-resistant and leak-proof; you can ask your pharmacist for a sharps container or you can use a laundry detergent bottle
  • Mark “Not For Recycling” on the container
    • Reinforce the lid with heavy-duty tape
    • Store the container in a secure place out of reach of children or pets

You should not:

  • Reuse syringes, needles, or vials
  • Throw the syringes, needles, or vials in household trash
  • Recycle syringes, needles, or vials
  • Use a clear plastic or glass container for disposal

Keep in mind:

  • This quick reference is not intended to replace the injection training that you received from your doctor or nurse
  • Your doctor or nurse is always the best source of advice
  • If you still have questions about injecting technique after reviewing the Step-by-Step Injection Guide, a nurse coach from ActharPACT can review the steps with you and provide helpful tips over the phone. Learn more about the services offered by ActharPACT
Next: Make the Most of Your Treatment

Get personalized injection reminders

IMPORTANT SAFETY INFORMATION

DO NOT take Acthar until you have talked to your doctor if you have any of the following conditions:

  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
Expand

IMPORTANT SAFETY INFORMATION

DO NOT take Acthar until you have talked to your doctor if you have any of the following conditions:

CLOSE
  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
  • Eye infections, such as ocular herpes simplex
  • Had recent surgery
  • Stomach ulcers or a history of stomach ulcers
  • Heart failure
  • Uncontrolled high blood pressure
  • Allergies to pig-derived proteins
  • Have been given or are about to receive a live or live attenuated vaccine
  • Suspected congenital infections (in children under 2 years of age)
  • If you have been told that you have Cushing’s syndrome or Addison’s disease

Tell your doctor about any other health problems that you have. Give your doctor a complete list of medicines you are taking. Include all nonprescription medicines, vitamins, and herbal supplements that you are taking.

What is the most important information I should know about Acthar?

  • Never inject Acthar directly into a vein
  • Always inject Acthar beneath the skin or into the muscle
  • Follow your doctor’s instructions for injecting Acthar
  • Never stop treatment suddenly unless your doctor tells you to do so
  • Try not to miss any scheduled doctor’s appointments. It is important for the doctor to monitor you while taking Acthar

Acthar and corticosteroids have similar side effects.

  • You may be more likely to get new infections. Also, old infections may become active. Tell your doctor if you see any signs of an infection. Contact your doctor at the first sign of an infection or fever. Signs of infection are fever, cough, vomiting, or diarrhea. Other signs may be flu or any open cuts or sores
  • When taking Acthar long term, your adrenal gland may produce too much of a hormone called cortisol. This can result in symptoms of Cushing’s syndrome. This may cause increased upper body fat, a rounded “moon” face, bruising easily, or muscle weakness
  • Sometimes when you stop taking Acthar long term, your body may not produce enough natural cortisol. This is called “adrenal insufficiency.” Your doctor may prescribe a steroid medicine to protect you until the adrenal gland recovers
  • You might develop high blood pressure, or retain too much fluid. As a result of this, your doctor may recommend some changes to your diet, such as eating less salt and taking certain supplements
  • Vaccines may not work well when you are on Acthar. Talk to your doctor about which vaccines are safe to use when you are taking Acthar
  • Acthar may hide symptoms of other diseases. This can make it more difficult for your doctor to make a diagnosis if something else is going on
  • Stomach or intestinal problems. Acthar may increase the risk of bleeding stomach ulcers. Tell your doctor if you have stomach pains, bloody vomit, bloody or black stools, excessive tiredness, increased thirst, difficulty breathing, or increased heart rate
  • Taking Acthar can make you feel irritable or depressed. You may also have mood swings or trouble sleeping
  • If you have other conditions, such as diabetes or muscle weakness, you may find they get worse
  • You might develop certain eye conditions, such as cataracts, glaucoma, or optic nerve damage
  • Your body may develop allergies to Acthar. Signs of allergic reaction are:
    • Skin rash and itching
    • Swelling of the face, tongue, lips, or throat
    • Trouble breathing
  • Long-term Acthar use can affect growth and physical development in children. This can be reversed when Acthar is no longer needed
  • Acthar may cause osteoporosis (weak bones)
  • Acthar might harm an unborn baby. Therefore, tell your doctor if you are pregnant or plan on becoming pregnant

What are the most common side effects of Acthar?

The most common side effects of Acthar are similar to those of steroids. They include:

  • Fluid retention
  • High blood sugar
  • High blood pressure
  • Behavior and mood changes
  • Changes in appetite and weight

Specific side effects in children under 2 years of age include:

  • Increased risk of infections
  • High blood pressure
  • Irritability
  • Symptoms of Cushing’s syndrome
  • Thickening of the heart muscle (cardiac hypertrophy)
  • Weight gain

The above side effects may also be seen in adults and children over 2 years of age.

These are not all of the possible side effects of Acthar.

Tell your doctor about any side effect that bothers you, or that does not go away. Call your doctor or pharmacist for medical advice about side effects. You may report side effects to the FDA. Call 1-800-FDA-1088 or visit www.fda.gov/medwatch. You may also report side effects by calling 1-800-778-7898.

Please see full Prescribing Information.

H.P. Acthar® Gel
(repository corticotropin injection) [H P AK-thar jel]

What is H.P. Acthar Gel?

Acthar is a prescription medicine for people with severe acute and chronic allergic and inflammatory conditions affecting different parts of the eye. This can include the front part of the eye such as the cornea and iris, or the back part of the eye such as the optic nerve and retina.

Acthar is injected beneath the skin or into the muscle.