Acthar is a prescription medicine to be used as a short-term, add-on therapy in the event of symptoms suddenly worsening (flare) for rheumatoid arthritis, including juvenile rheumatoid arthritis. Some cases may require maintenance therapy.

Learn How to Take Acthar

Perhaps you and your doctor have decided that Acthar is a good option for you as an add-on treatment for worsening symptoms of RA. If so, Mallinckrodt offers you support in getting Acthar and learning how to use it properly. (See how Acthar is injected.)

Acthar can be injected at home by you or your care partner. This gives you the flexibility to inject on your own schedule—wherever and whenever is best.

Acthar is designed to provide a prolonged release of the medication after it is injected. The information at the bottom of this page will help you with the injection process.

Common side effects of Acthar may include fluid retention, changes in glucose tolerance, increased blood pressure, behavior or mood changes, increased appetite, or weight gain. These are not all of the possible side effects of Acthar. For more information, talk to your healthcare provider and please see the Important Safety Information and full Prescribing Information.

Two types of Acthar injections

Acthar can be injected:

  • Into a muscle (intramuscularly)
  • Beneath the skin (subcutaneously)

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

Your healthcare provider will advise on how to inject Acthar, where on the body you should inject it, and what the appropriate dose is for you.

Information about drawing up Acthar into a syringe

Acthar is usually injected every 1 to 3 days as directed by your healthcare provider on a short-term basis to help manage RA symptoms. In some cases, your healthcare provider may decide that you should take Acthar for a longer period of time. Your healthcare provider will show you how to inject Acthar and where on your body to inject it. There are also videos at the bottom of this page to help you better understand the injection process.

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:

  1. 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)
  2. 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

Examples only. Not intended to be a complete list of all possible prescribed dosing amounts. Always check with your doctor if you have questions about your prescribed dosage.

See how Acthar is injected

These educational videos will show you how to inject Acthar.

Injecting into the muscle

Intramuscular (IM) injection video

Watch Spanish version.

Injecting beneath the skin

Subcutaneous (SC) injection video

Watch Spanish version.

Step-by-step training materials

  • Start
  • Prepare Your Injection
  • Choose Your Type of Injection
  • Perform Your Injection
  • Complete Your Injection Process

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

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

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

  • 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 and where on your body to inject Acthar
Rolling Acthar vial in hands to warm it

Choose the type of injection you need as well as the 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

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
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

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

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

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
  • 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 23g or 25g needle and NOT the 20g needle
Drawing Acthar into the needle
  • 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
  • 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
  • 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
  • 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
Injecting Acthar
  • 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

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

Disposing used needle

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

Learn more about sharps disposal options.

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

See how Acthar is injected.

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ActharPACT: Registered nurses can answer your questions 24/7

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
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