Acthar Gel injection training

No-cost injection training for Acthar Gel

Licensed nurses are available throughout the country to provide in-home, online, and phone-based injection training to patients and their care partners.

Healthcare professionals may request injection training for their patients by completing the Acthar Gel Injection Training section of the Acthar Gel Referral Form or by calling the Acthar Hub at 1-888-435-2284 Monday through Friday from 8 AM to 9 PM ET and Saturday from 9 AM to 2 PM ET. Injection training for Acthar Gel is provided at no cost and made available through support from Mallinckrodt.


Educational videos

Step-by-step Acthar Gel injection videos are always available online.

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[JANE] Hi, I’m Jane. And I’m going to review with you what you need to know about Acthar. It can be injected at home or wherever works for you. I’ll show you the proper way to inject Acthar for yourself or for someone else, as well as how to store it and throw it away. Acthar can be given by a subcutaneous or SC injection as directed by or discussed with your doctor. That means the medication must be administered directly under the skin with a small needle.

Acthar should never be given intravenously, which is directly into a vein. This video provides instruction on subcutaneous or SC injection only. Please confirm that your prescription is for subcutaneous injections. You should have already received detailed instructions and training from your doctor or nurse at your doctor’s office, or from the nurse that was sent by Mallinckrodt’s home injection training service. So, what I’m about to show you is meant only as a review.

Now, if you’ve never received training on how to inject Acthar, do not attempt to inject yourself or another person. Please contact your doctor or nurse for further information. Prior to administering Acthar, please speak with your doctor about the potential side effects associated with Acthar. You can also refer to the full prescribing information included with this video. A summary of important safety information is included at the end of this video. Once you’ve received your prescription of Acthar, double-check the expiration date on the vial to make sure it hasn’t expired. If your Acthar vial has expired or if you see any signs of contamination, such as cloudiness or small flecks, do not inject yourself and contact your doctor immediately. This video provides instruction on subcutaneous or SC injection only. Please confirm that your prescription is for subcutaneous injections.

Remember to refrigerate Acthar as soon as you get it. Acthar must be kept refrigerated between 36 degrees to 46 degrees Fahrenheit or 2 degrees to 8 degrees Celsius. You should check your refrigerator to make sure it’s set at the right temperature.

Before you begin an injection, be sure to have all of your supplies in one place. You should have a vial of Acthar, one 23-gauge or 25-gauge needle and a syringe. Depending on the supply kit you’ve received, you may also have a larger 20-gauge needle. You may want to use the 20-gauge needle for ease of drawing the medication from the vial, however, the 23-gauge or 25-gauge needle may be more comfortable for injection. Please check the sterile packaging or needle cap to confirm the needle size.

You will also need alcohol swabs, gauze, adhesive bandages and a puncture-resistant container to safely dispose of syringes and needles after use. I’ll be referring to various components of the syringe throughout these instructions. You should be familiar with the syringe plunger, barrel, needle hub, needle and needle safety cap. You might also be interested in keeping a treatment journal. You can use the treatment journal included in your started kit to help you manage your treatment with Acthar by tracking injection areas and doctor appointments and recording any side effects you might experience on the calendars. Please contact your doctor or nose regarding side effects that may occur or if you have any questions or concerns.

Before you start to prepare the medication in the syringe, check the dosage of Acthar that your doctor has prescribed for you. The unit amount prescribed for you will need to be converted to milliliters, mLs, which will be the amount of medication you will draw up in the syringe. Look at that vial. It should indicate there are 80 USP units per one mL. To prepare to inject your medication, write down the number of units you were prescribed and how many mLs you need to inject. Let’s walk through an example.

If you were prescribed 80 units, you will need to inject one mL. If you’re prescribed 40 units, which is half of 80 units, you need to inject 0.5 mLs. The dosages uses here are only examples. Your doctor may have ordered a different dosage than the ones listed. If you have questions about the units or mLs prescribed to you, contact your doctor or nurse.

Find a place that is clean and quiet to prepare and take your injection. It should be well-lit with access to water. The kitchen is often a great place. Gather all your supplies in one place so they’ll be easy to get to. Take the vial of Acthar out of the refrigerator and double-check the expiration date. Also check for signs of contamination like cloudiness or small flecks. Warm the vial to room temperature by rolling it between the palms of your hands for a few minutes. If you need an alternate method to warm the vial, talk with your doctor. Do not inject Acthar directly after removing it from the refrigerator. Wash your hands with soap and warm water for at least 15 seconds.

Remove the cap of the Acthar vial and use the alcohol swab to wipe the rubber stopper on top for 15 seconds. Attach either the wider 20-gauge needle or the thinner 23 or 25-gauge needle to the syringe. Check the dosage of Acthar that your doctor has prescribed for you. Before removing the cap of the needle, draw air into the syringe by pulling the syringe plunger to the exact amount your doctor has prescribed. Now remove the needle cap. Insert the needle through the rubber stopper and inject air into the upright vial by pushing down on the plunger until it cannot go any farther. While the syringe is still in the vial, turn the vial and syringe upside down. While keeping the needle tip in the gel, slowly pull back the plunger to the exact amount your doctor prescribed.

With the tip of the syringe upright, tap it with your finger until any air bubbles rise to the top. If bubbles are present, very slowly press the plunger until only the bubbles are pressed out of the syringe. Check that you still have the amount your doctor prescribed in the syringe. If not, place the needle tip in the gel. Draw in the amount you need and remove any bubbles again. If you used a 23 or 25-gauge, you are ready to inject. If you used a 20-gauge needle, replace the needle cap by scooping up the needle cap without touching it and attach the needle. Then attach the thinner 23 or 25-gauge needle and remove the needle cap before injecting.

Before injection, ensure that the needle remains sterile. For example, do not place on an unclear surface and keep the cap of the needle on until ready to inject. Good. You’ve made all the necessary preparations. Time to move on to the next step.

Let me tell you a few things to remember before you inject Acthar. First, ask your doctor or nurse which areas may be the most appropriate injection areas for you. The most common injection areas for a subcutaneous injection or an injection just under the sin include the upper arm, abdomen, or thigh When injecting yourself subcutaneously, the thigh and abdomen may be best. When injecting another person, the upper arm may be best. You may inject into the same area more than once in one week but rotate the injection sites in that area each time, keeping at least one inch between sites.

This is where a journal can come in handy. Whenever you inject, make sure not to inject into: The same site more than once a week; Any area that has skin irritation, including red, swollen, or painful areas; Any area that has hardened or is sensitive to touch; Any tattoos, warts, scars, or birthmarks; The belly button or the one-inch area around it. Contact your doctor or nurse if you notice any injection site reactions, including redness, pain and swelling. Now, let’s go over step by step how to inject the thigh. This is one area for patients who are self-injecting Acthar. First, find a sturdy chair. Sit comfortably with your feet on the floor to keep the thigh muscle relaxed. To locate the correct area, 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.

In addition to the thigh, the abdomen is another area that works well for patients who are self-injecting Acthar. First, find a sturdy chair and sit comfortably with your feet on the floor. To locate the correct area, place your hands on your lower ribs and draw an imaginary line below your hands. Injections should be done below this line in any area that has enough tissue to pinch. However, it is important to not inject into the belly button or the one-inch area around it.

The upper arm is a common area used when injecting another person. Injections can be given in either the side or the back of the upper arm. The following instructions are for the person giving the injection. First, we’ll review how to locate an area on the side of the upper arm. Start by running your fingers along the collarbone until you reach the shoulder bone at the outermost tip of the shoulder. Place four fingers of your hand just below the shoulder bone. Now place four fingers of your other hand on the elbow. You can inject anywhere on the side or back of the arm in the area between your hands if there is enough tissue to pinch.

To find an appropriate area for injections on the back of the arm, simply slide your hands from their current position to the back of the arm. Again, injections can be given anywhere between your hands if there’s enough tissue to pinch.

Now that you can find an injection site, let’s go over how to perform the injection. These steps are the same whether you are injecting yourself or someone else. Be sure the person receiving the injection has removed clothing around the area to be injected. An injection site has been found and the person receiving the injection is ready for the injection. Clean the area to be injected with an alcohol swab for 15 seconds. Allow the alcohol to dry completely before injecting. Pick up the syringe and gently press the plunger until a droplet begins to form at the tip of the needle. Pinch the skin around the injection site between the thumb and fingers of the hand that is not holding the syringe.

Hold the syringe like a pencil or a dart with your right hand if you are right-handed or your left if you are left-handed. Using a quick motion, insert the needle at a 90-degree angle through the skin. Follow your doctor’s instructions regarding how far the needle should go in. Please note that the following step may not be necessary for all injections. Ask your doctor or nurse if or when you should check for blood.

Once the needle is inserted, draw back on the plunger to check for blood. It is important to make sure you are not injecting into a vein and checking for blood will determine this. If blood enters the syringe, do not inject the Acthar. Withdraw the needle and using a gauze pad, please pressure on the injection site. Start over with a new syringe and anew site for injection. If no blood enters the syringe, slowly push the plunger in until the syringe is empty. Once the syringe is empty, pull the needle straight out. Then released the pinched skin. It may be helpful to hold a gauze pad over the injection site and use it to apply pressure once the needle has been removed.

If there is any blood, wipe it off and, if necessary, apply an adhesive bandage. Dispose of the used syringe and needle in a puncture-resistant or biohazard container. Do not replace the needle cap prior to disposal. Make sure to wash your hands with soap and warm water when you are finished.

It is important to follow state and local laws regarding proper disposal of used syringes, needles and vials. Your doctor, nurse, or pharmacist can provide instructions to you. Many states require that you use a heavy plastic container with a tight-fitting lid. It must be puncture-resistant and leak-proof. A Sharps container or laundry detergent bottle works well. Once you have your container, mark “Not for Recycling” on the container and reinforce the lid with heavy-duty tape once it is full. Store the container in a secure place out of reach from children or pets until it can safely be disposed of.

It is also important to remember do not: Reuse syringes and needles; Throw the syringes, needles and vials in household trash; Recycle syringes, needles and vials once empty; Or use a clear plastic or glass container.

Remember, in between injections, Acthar should be kept refrigerated at 36 degrees to 46 degrees Fahrenheit or 2 degrees to 8 degrees Celsius. If you have a question that was not answered here, please ask your doctor or nurse. You should call your doctor or nurse right away if you have any of the following: Problems that keep you from giving yourself the injection; Your medication is injected into the wrong area; Bleeding at the injection site that doesn’t stop; Rash or swelling at the injection site; A lot of pain; Shortness of breath; Fever or chills; An allergic reaction; Any other side effect or concern.

We have reviewed how to prepare and inject Acthar for subcutaneous injection. Remember to contact your doctor or nurse if you have any questions. You can also have a healthcare professional visit you at your home to provide home injection training services. This service is provided at no cost and is made available by support from Mallinckrodt ARD, Incorporated, the distributor of Acthar.

To find out more about these no-cost home injection training services for you or your care partner, please refer to the information contained within the Acthar Patient Starter Kit or visit You can also talk to a nurse from the ActharPACT Program, another service provided by the distributor of Acthar at no cost to you. A nurse coach will be there to support you as you begin your Acthar therapy and to answer questions and address common concerns throughout your treatment. Call an ActharPACT nurse available 24-7 to answer your questions at 1-877-546-PACT.

See full


Acthar® Gel (repository corticotropin injection) is indicated for severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: keratitis, iritis, iridocyclitis, diffuse posterior uveitis and choroiditis, optic neuritis, chorioretinitis, anterior segment inflammation.

Important Safety information


  • Acthar should never be administered intravenously
  • Administration of live or live attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of Acthar
  • Acthar is contraindicated where congenital infections are suspected in infants


Acthar® Gel (repository corticotropin injection) is indicated for severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: keratitis, iritis, iridocyclitis, diffuse posterior uveitis and choroiditis, optic neuritis, chorioretinitis, anterior segment inflammation.

Important Safety information


  • Acthar should never be administered intravenously
  • Administration of live or live attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of Acthar
  • Acthar is contraindicated where congenital infections are suspected in infants
  • Acthar is contraindicated in patients with scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, recent surgery, history of or the presence of a peptic ulcer, congestive heart failure, uncontrolled hypertension, primary adrenocortical insufficiency, adrenocortical hyperfunction or sensitivity to proteins of porcine origins

Warnings and Precautions

  • The adverse effects of Acthar are related primarily to its steroidogenic effects
  • Acthar may increase susceptibility to new infection or reactivation of latent infections
  • Suppression of the hypothalamic-pituitary-axis (HPA) may occur following prolonged therapy with the potential for adrenal insufficiency after withdrawal of the medication. Adrenal insufficiency may be minimized by tapering of the dose when discontinuing treatment. During recovery of the adrenal gland patients should be protected from the stress (e.g. trauma or surgery) by the use of corticosteroids. Monitor patients for effects of HPA suppression after stopping treatment
  • Cushing’s syndrome may occur during therapy but generally resolves after therapy is stopped. Monitor patients for signs and symptoms
  • Acthar can cause elevation of blood pressure, salt and water retention, and hypokalemia. Blood pressure, sodium and potassium levels may need to be monitored
  • Acthar often acts by masking symptoms of other diseases/disorders. Monitor patients carefully during and for a period following discontinuation of therapy
  • Acthar can cause GI bleeding and gastric ulcer. There is also an increased risk for perforation in patients with certain gastrointestinal disorders. Monitor for signs of bleeding
  • Acthar may be associated with central nervous system effects ranging from euphoria, insomnia, irritability, mood swings, personality changes, and severe depression, and psychosis. Existing conditions may be aggravated
  • Patients with comorbid disease may have that disease worsened. Caution should be used when prescribing Acthar in patients with diabetes and myasthenia gravis
  • Prolonged use of Acthar may produce cataracts, glaucoma and secondary ocular infections. Monitor for signs and symptoms
  • Acthar is immunogenic and prolonged administration of Acthar may increase the risk of hypersensitivity reactions. Neutralizing antibodies with chronic administration may lead to loss of endogenous ACTH activity
  • There is an enhanced effect in patients with hypothyroidism and in those with cirrhosis of the liver
  • Long-term use may have negative effects on growth and physical development in children. Monitor pediatric patients
  • Decrease in bone density may occur. Bone density should be monitored for patients on long-term therapy
  • Pregnancy Class C: Acthar has been shown to have an embryocidal effect and should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus

Adverse Reactions

  • Common adverse reactions for Acthar are similar to those of corticosteroids and include fluid retention, alteration in glucose tolerance, elevation in blood pressure, behavioral and mood changes, increased appetite and weight gain
  • Specific adverse reactions reported in IS clinical trials in infants and children under 2 years of age included: infection, hypertension, irritability, Cushingoid symptoms, constipation, diarrhea, vomiting, pyrexia, weight gain, increased appetite, decreased appetite, nasal congestion, acne, rash, and cardiac hypertrophy. Convulsions were also reported, but these may actually be occurring because some IS patients progress to other forms of seizures and IS sometimes mask other seizures, which become visible once the clinical spasms from IS resolve

Other adverse events reported are included in the full Prescribing Information.

Please see full Prescribing Information.