At a glance
| Hormone | ACTH |
|---|---|
| Example product | Acthar Gel |
| Key pediatric use | Infantile spasms under age 2 |
| Other labeled use | Adult MS exacerbations |
| Major risk domain | Corticosteroid effects |
Overview
Repository corticotropin injection, such as Acthar Gel, is a pharmaceutical ACTH-based preparation with specific indications and formulation requirements. Its label includes monotherapy for infantile spasms in children under two and treatment of adult multiple-sclerosis exacerbations, as well as selected rheumatic, dermatologic, ophthalmic and other disorders. These indications do not make corticotropin a general adrenal-support product. It is also distinct from cosyntropin, the shorter synthetic ACTH fragment used primarily for diagnostic adrenal stimulation. The same hormonal pathway can be used therapeutically or diagnostically, with very different exposure and risk.
How it works
ACTH stimulates the adrenal cortex to produce corticosteroids, including cortisol, through melanocortin-2 receptor signaling. Corticotropin preparations may interact with additional melanocortin pathways, but the mechanism for every therapeutic indication is not fully established. Increased endogenous steroid exposure explains many recognized effects, including immune suppression, fluid retention, glucose disturbance and suppression of the hypothalamic-pituitary-adrenal axis during prolonged treatment.
Indication and formulation matter
Infantile-spasm treatment uses the specifically labeled preparation and route; the adult self-injector presentation is not labeled for this pediatric use. The wide historical indication list still requires a disease-specific rationale rather than assuming benefit for any inflammatory symptom.
Supporting sources [1]
Evidence in infantile spasms
A small randomized blinded study assessed both cessation of spasms and resolution of the characteristic EEG abnormality. ACTH outperformed the prednisone regimen used in that study. The comparison is regimen-specific and should not be generalized to all modern steroid approaches.
Supporting sources [2]
Infection and metabolic risks
The label warns about increased susceptibility to infection, Cushing-like effects, hypertension, fluid retention, low potassium, gastrointestinal bleeding, mood changes and worsening diabetes. Prolonged therapy can suppress adrenal function, with risk after withdrawal.
Supporting sources [1]
Important contraindications
Examples include systemic fungal infection, uncontrolled hypertension, heart failure, primary adrenal insufficiency and certain other conditions. Live vaccines are contraindicated during immunosuppressive exposure. Porcine-protein sensitivity and serious hypersensitivity to the product also matter.
Supporting sources [1]
Therapy versus a diagnostic ACTH test
Therapeutic repository corticotropin creates sustained hormonal exposure. A cosyntropin stimulation test uses a different molecule and purpose to assess adrenal reserve. Evidence and safety from a short diagnostic test cannot be transferred to repeated corticotropin treatment.
Supporting sources [1]
Reading this profile
Jurisdiction: United States — FDA-approved prescription medicine; indication and formulation restrictions apply.. Molecular class: Adrenocorticotropic hormone-based peptide preparation.
This profile was written with AI-assisted research and checked against the linked sources. It has not been represented as a clinician’s review. Evidence summaries describe the cited studies and products; they do not establish that a separately purchased preparation is equivalent.
Sources & references
Follow the original material. Product labels define specific formulations and uses; trial registration describes a study and does not by itself establish benefit.
- Acthar Gel current prescribing information, October 2026 ↗Regulatory source · Checked 2026-10-27
- Randomized ACTH versus prednisone trial in infantile spasms ↗Original research · Checked 2026-10-27