How to Inject Acthar

Acthar can be injected at home

Acthar can be injected when and where you and your doctor determine is best for you, including at home. You can self-inject Acthar, or a family member, friend, caregiver, or your doctor can help give Acthar to you.

Your doctor will advise you on how, and where on your body, to inject Acthar. He or she will choose a dose and how often you take Acthar based on your specific medical needs and condition.

Acthar can be injected in 2 ways*:

Subcutaneously (a short needle under the skin)
Intramuscularly (into a muscle)

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

For more information, please see the Acthar Injection Training Guide. There are also injection videos below to help you better understand the injection process.

Once you receive Acthar:

Check the vial to make sure that it’s Acthar.
Check the expiration date on the Acthar vial to make sure you are using it before the date listed.
Prior to each use, check for any signs of contamination (cloudiness, small flecks, etc).

Do not use if:
- The vial is expired
- Any signs of contamination are seen
Refrigerate Acthar as soon as you receive it and check that your refrigerator is set between 36°F and 46°F or 2°C and 8°C.
Read the entire instruction guide before your first injection.

Getting the right dose of Acthar

Each time you inject Acthar, before you start to prepare the medication in the syringe, you must check the dosage of Acthar that your doctor has prescribed for you. There are 2 key things you need to know:

The unit amount prescribed for you will need to be converted to milliliters, or mL (this is because syringes have an mL label, not a unit label).
This will be the amount of medication you will draw up in the syringe.

Typically, Acthar is prescribed in 20, 40, 60, or 80 units. But your doctor may have prescribed you a different dosage. So before you give yourself an injection of Acthar, talk with your doctor about how many mL you will need to draw up based on the number of units prescribed. This way you can be sure to take the correct amount of Acthar.

Use the Dose Conversion Chart below to figure out how much medication to draw up into the syringe. (You can download a copy of this chart here.)

Prescribed Units	Injection Amount (mL)
80 units	1 mL
60 units	0.75 mL
40 units	0.5 mL
20 units	0.25 mL

Keep in mind when taking Acthar:

It’s important to take Acthar exactly as directed by your doctor
Do not stop taking Acthar without first talking with your doctor
Your doctor may change your dose or tell you to stop taking Acthar if needed
If you miss a dose of Acthar, call your doctor

See how Acthar is injected

Watch one of the following videos to learn more about how to inject Acthar into a muscle or beneath the skin:

Select Chapter

Get Started

These steps included here should not replace the detailed instructions and training provided to you in person by your doctor or nurse. Keep in mind, your doctor or nurse is always the best source of advice.

Acthar is given by subcutaneous (under the skin) or intramuscular (into a muscle) injection. Acthar should never be given intravenously (into a vein) or by mouth.

You are also eligible to have a registered nurse visit you in the privacy of your home to provide Acthar Injection Training to help you or your caregiver learn how to inject Acthar. Learn more about Acthar Injection Training.

Please select your injection type and site

Things to Keep in Mind

Read the information below to learn about what to do before, during, and after your Acthar treatment.

Temperature considerations

Acthar requires special handling. Keep it refrigerated at 36°F to 46°F (2°C to 8°C) until you’re ready to use it. Do not inject Acthar directly after removing it from the refrigerator.

Before you inject, you should warm the vial of Acthar to room temperature. You can do this by rolling it between your hands or by holding it under your arm for a few minutes.

Suggestions for choosing where to inject:

Ask your doctor or nurse which injection areas may be best for you
When injecting yourself, the muscle along the upper-outer thigh may be best. If someone else is injecting, the muscle in the upper arm may be best
You can inject into the same area more than once a week, but rotate the injection sites in that area each time, keeping 1 inch between sites

For more information about injecting Acthar, including videos and downloadable instructions, go to Injecting Acthar.

Do not inject into:

The same site more than once a week
An area that has skin irritation or cuts
An area that has hardened or is sensitive to touch
Tattoos, warts, scars, or birthmarks
The stomach
The knee or groin area

Contact your doctor if you notice any injection-site reactions, including redness, pain, and swelling.

Things to remember while taking Acthar

What if I miss a dose of Acthar?

Talk with your doctor as soon as you realize that you missed a dose
Your doctor will let you know when to take the next dose
If you have questions about your Acthar dose, talk to your doctor

Can I take other medications while taking Acthar?

Continue taking your other treatments as prescribed by your doctor
Tell your doctor about any other health conditions you may have or medicines you are taking, including prescriptions, nonprescription medicines, vitamins, and herbal supplements

Do not do the following with any used supplies:

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

Learn more about sharps disposal.

Before ending Acthar treatment

Even if you’re feeling better, do not stop taking Acthar without consulting your doctor. If you consider ending treatment before your full course is over, be sure to talk with your doctor as well.

Your doctor will talk to you about when and how to stop treatment with Acthar. He or she may tell you how to gradually reduce the dose and frequency of injections. Do not suddenly stop taking Acthar without talking to your doctor first.

NEXT: Ongoing Support for You

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
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 H.P. Acthar^® Gel?

Acthar is a prescription medicine for flares or on a regular basis (maintenance) in people with dermatomyositis or polymyositis (DM-PM).

Acthar is a prescription medicine for flares or on a regular basis (maintenance) in people with systemic lupus erythematosus (lupus).

Acthar is a prescription add-on medicine for the short-term administration (to tide patients over an acute episode or exacerbation) in: psoriatic arthritis (PsA); rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy); ankylosing spondylitis.

Acthar is injected beneath the skin or into the muscle.

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.

Once you receive Acthar:

Getting the right dose of Acthar