Learn How to Take Acthar

Acthar is an injection that can be given either under the skin (subcutaneously) or into the muscle (intramuscularly). It should never be injected into a vein (intravenously) or taken by mouth.

Acthar can be used when and where it is best for you. It can be self-injected or given to you by a friend, family member, or caregiver, as well as your healthcare provider.

Acthar is designed to provide a prolonged release of medication once it has been injected.

Your healthcare provider will describe how to correctly inject Acthar and tell you what dose is appropriate for you. You can also use the resources below for guidance throughout every step of your treatment process.

Videos on Taking Acthar

Watch these helpful videos to learn about taking Acthar.

Injecting Beneath the Skin

Watch subcutaneous (SC) injection videos.

Injecting under the skin1:22

Injecting Into the Muscle

Watch intramuscular (IM) injection videos.

Injecting into the muscle1:19

Services Available at No Cost

Watch a video on treatment support from HITS and A.S.A.P.

Learn How to Administer Acthar

The Acthar HITS program can teach you how to administer Acthar.

Watch this helpful video that explains Acthar HITS10:04

Support Throughout Treatment

Learn about long-term support from ActharPACT.

Learn about long-term support from ActharPACT9:46

Step-by-Step Brief Injection Guide

Start the Brief Injection Guide

Take a look at this 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
  • Your healthcare provider can request a licensed nurse to provide you with Home Injection Training Services to help you or your caregiver learn how to properly inject Acthar
  • If you still have questions about injecting, download the Step-by-Step Injection Guide

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

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

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)
  • 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

Choose Your Type of Injection

Choose the type of injection you need as well as the 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

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

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

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

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

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

Perform Your Injection

Showing 1 of 4 slides

  1. Wipe the top of the vial (the rubber stopper) with a new sterile alcohol wipe
  2. 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 23g or 25g needle and NOT the 20g needle
  3. 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
  4. If you're injecting into the muscle, stretch the skin at the injection site and insert the needle
  5. 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

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 (36°F-46°F; 2°C-8°C) between uses

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 should:

  • 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, and vials (once empty)
  • Throw the syringes, needles, and vials in household trash
  • Recycle syringes, needles, and 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

Download the Step-by-Step Injection Guide if you still have questions about injecting.

Important Safety Information

Who should not take Acthar?

You should not take Acthar if you have:

  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
  • Eye problems, such as ocular herpes simplex
  • Had recent surgery
  • Stomach ulcers or a history of ulcers
  • Heart problems
  • High blood pressure
  • Allergies to pig-derived proteins
  • Been recently given a vaccine or are about to take one
  • Suspected congenital infections (in children under 2 years of age)
  • A condition where your adrenal glands produce either too much of certain hormones (as with Cushing's syndrome), or not enough (adrenal insufficiency)

Tell your doctor if you have any of these conditions or any other health problems. Also, share with your doctor what medicines you are taking. Don't forget to mention nonprescription medicines, vitamins, and herbal supplements.

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

  • Never inject Acthar directly into a vein, and always take Acthar as prescribed by your doctor
  • Never stop treatment suddenly unless your doctor tells you to
  • Try not to miss any scheduled doctor's appointments, as it is important for the doctor to monitor you while taking Acthar

Acthar can cause side effects similar to those with steroid treatments. While taking Acthar, tell your doctor right away if you have any of the symptoms listed here:

  • Increased risk of infections. You may be more likely to get new infections. Also, old infections may become active. Before and during treatment, 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
  • Adrenal gland changes. When taking Acthar long term, your adrenal gland may produce too much of a hormone called cortisol, which may cause symptoms of Cushing's syndrome, such as upper body fat, rounded "moon" face, bruising easily, or muscle weakness
  • Sometimes when you stop taking Acthar long term, your body may not produce enough cortisol on its own. This is called "adrenal insufficiency." Your doctor may prescribe a steroid medicine to protect you until the adrenal gland recovers
  • Increased blood pressure, body salt, and fluid levels. Your doctor may check your blood pressure while you are being treated with Acthar. He or she may recommend some changes to your diet, such as eating less salt and taking certain supplements
  • Unpredictable response to vaccines. Talk to your doctor about which vaccines are safe to use when you are taking Acthar
  • Masking other conditions. 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 put you at increased risk for bleeding from the stomach or getting 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
  • Changes in mood or behavior. Taking Acthar can make you feel irritable or depressed. You may also have mood swings or trouble sleeping
  • Worsening of other medical conditions. If you have other conditions, such as diabetes or muscle weakness, you may find they get worse
  • Eye problems. It's possible that you may develop certain eye conditions, such as cataracts, glaucoma, or optic nerve damage
  • Allergic reactions. Your body may develop antibodies or become sensitive when Acthar is used long term. Signs of allergic reaction in children are:
    • Skin rash
    • Swelling of the face, tongue, lips, or throat
    • Trouble breathing
  • Problems with growth and physical development. Using Acthar long term can affect growth and physical development in children. This can be reversed when Acthar is no longer needed
  • Bone density loss. Acthar may cause osteoporosis at any age
  • Potential harm to unborn baby. 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
  • Changes in blood sugar
  • Increased 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
  • Increased blood pressure
  • Irritability
  • Symptoms of Cushing's syndrome
  • Cardiac hypertrophy (thickening of the heart muscle)
  • 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 [H P AK-thar jel]
(repository corticotropin injection)

What is H.P. Acthar Gel?

Acthar is a prescription medicine for the reduction of proteinuria in people with nephrotic syndrome of the idiopathic type (unknown origin) without uremia (accumulation of urea in the blood due to malfunctioning kidneys) or that due to lupus erythematosus (lupus).

Acthar is injected beneath the skin or into the muscle.

Important Safety Information

Who should not take Acthar?

You should not take Acthar if you have:

  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
  • Eye problems, such as ocular herpes simplex
  • Had recent surgery
  • Stomach ulcers or a history of ulcers
  • Heart problems
  • High blood pressure
  • Allergies to pig-derived proteins
  • Been recently given a vaccine or are about to take one
  • Suspected congenital infections (in children under 2 years of age)
  • A condition where your adrenal glands produce either too much of certain hormones (as with Cushing's syndrome), or not enough (adrenal insufficiency)

Tell your doctor if you have any of these conditions or any other health problems. Also, share with your doctor what medicines you are taking. Don't forget to mention nonprescription medicines, vitamins, and herbal supplements.

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

  • Never inject Acthar directly into a vein, and always take Acthar as prescribed by your doctor
  • Never stop treatment suddenly unless your doctor tells you to
  • Try not to miss any scheduled doctor's appointments, as it is important for the doctor to monitor you while taking Acthar

Acthar can cause side effects similar to those with steroid treatments. While taking Acthar, tell your doctor right away if you have any of the symptoms listed here:

  • Increased risk of infections. You may be more likely to get new infections. Also, old infections may become active. Before and during treatment, 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
  • Adrenal gland changes. When taking Acthar long term, your adrenal gland may produce too much of a hormone called cortisol, which may cause symptoms of Cushing's syndrome, such as upper body fat, rounded "moon" face, bruising easily, or muscle weakness
  • Sometimes when you stop taking Acthar long term, your body may not produce enough cortisol on its own. This is called "adrenal insufficiency." Your doctor may prescribe a steroid medicine to protect you until the adrenal gland recovers
  • Increased blood pressure, body salt, and fluid levels. Your doctor may check your blood pressure while you are being treated with Acthar. He or she may recommend some changes to your diet, such as eating less salt and taking certain supplements
  • Unpredictable response to vaccines. Talk to your doctor about which vaccines are safe to use when you are taking Acthar
  • Masking other conditions. 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 put you at increased risk for bleeding from the stomach or getting 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
  • Changes in mood or behavior. Taking Acthar can make you feel irritable or depressed. You may also have mood swings or trouble sleeping
  • Worsening of other medical conditions. If you have other conditions, such as diabetes or muscle weakness, you may find they get worse
  • Eye problems. It's possible that you may develop certain eye conditions, such as cataracts, glaucoma, or optic nerve damage
  • Allergic reactions. Your body may develop antibodies or become sensitive when Acthar is used long term. Signs of allergic reaction in children are:
    • Skin rash
    • Swelling of the face, tongue, lips, or throat
    • Trouble breathing
  • Problems with growth and physical development. Using Acthar long term can affect growth and physical development in children. This can be reversed when Acthar is no longer needed
  • Bone density loss. Acthar may cause osteoporosis at any age
  • Potential harm to unborn baby. 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
  • Changes in blood sugar
  • Increased 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
  • Increased blood pressure
  • Irritability
  • Symptoms of Cushing's syndrome
  • Cardiac hypertrophy (thickening of the heart muscle)
  • 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 [H P AK-thar jel]
(repository corticotropin injection)

What is H.P. Acthar Gel?

Acthar is a prescription medicine for the reduction of proteinuria in people with nephrotic syndrome of the idiopathic type (unknown origin) without uremia (accumulation of urea in the blood due to malfunctioning kidneys) or that due to lupus erythematosus (lupus).

Acthar is injected beneath the skin or into the muscle.