Storing, Preparing and Injecting Acthar (SC)

Injection Preparation and Instructions for Subcutaneous (SC) Injection


Download Acthar Injection Instructions (Subcutaneous Administration) (PDF) »

The following sections provide easy step-by-step instructions on how to subcutaneously inject H.P. Acthar® Gel. They review all the items you will need when injecting, how to find areas on the body where Acthar can be injected, how to complete the injection itself, how to store Acthar, and how to throw it away.

Getting Started with Acthar

Acthar can be given by a subcutaneous (beneath the skin) injection. The steps included here are intended only to supplement the detailed instructions and training provided to you in person by your doctor or nurse. You also are eligible to have a licensed nurse visit you in the privacy of your home to provide Home Injection Training Services to help you or your care partner learn how to inject Acthar. If you are interested in these services, more information is available here.

Acthar bottle

Once you receive Acthar:

  1. Check the vial to make sure that it's Acthar
  2. Check the expiration date on the Acthar vial to make sure it is not outdated
  3. Refrigerate Acthar promptly and check that your refrigerator is set between 36°-46°F or 2°-8°C
  4. Read the entire instruction guide before your first injection

Items you will need when injecting Acthar:

Items you will need


A 23g or 25g needle can be used to draw Acthar into the syringe and it should be used to inject Acthar

  1. Vial of Acthar
  2. A 23g or 25g needle
    • Some packages may include a 20g needle, which can speed the process of drawing Acthar into the syringe (not for injection)
  3. Syringe
  4. Alcohol swabs
  5. Gauze pad
  6. Adhesive bandage
  7. Puncture-resistant container to safely dispose of syringe and needles after use
Acthar VialParts of a needle

Preparing to inject

  1. Gather all your needed supplies in one place that will be easy to access when injecting

  2. Step 2: Warm up vial between palms of hands Take the vial of Acthar out of the refrigerator. Recheck the expiration date to make sure the vial has not expired. Warm the vial to room temperature by rolling it between the palms of your hands or by holding it under your arm for a few minutes. Do not inject Acthar directly after removing it from the refrigerator

  3. Wash your hands with soap and warm water
  4. Remove the cap of the vial and use an alcohol swab to wipe the rubber stopper on top of the vial

  5. Step 5: Drawing air into the syringe Attach either the wider (20g) or the thinner (23g or 25g) needle to the syringe. 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

  6. Step 6: Inserting needle 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 be pushed farther

  7. Step 7: Turning vial and syringe upside down While the syringe is still in the vial, turn the vial and syringe upside down

  8. Step 8: Pulling back the plunger

    Keep needle tip in gel at all times

    While keeping the needle tip in the gel, slowly pull back the plunger to the exact amount your doctor prescribed

  9. Step 9: Tapping the syringe With the tip of syringe upright and the needle still in the vial, tap the syringe 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 and a droplet starts to form at the needle tip. Check that you still have the amount your doctor prescribed in the syringe. If not, place the needle tip in the gel and draw in the amount you need and remove bubbles again

  10. If using the wider (20g) needle to draw Acthar into the syringe, replace the needle cap, detach the needle, and attach the thinner (23g or 25g) needle; continue to pages 12-19 to find an injection site and learn how to inject Acthar

    If using the thinner (23g or 25g) needle to draw Acthar into the syringe, continue to the following sections to find an injection site and learn how to inject Acthar

A Few Things to Remember Before Injecting

  • Ask your doctor or nurse which injection areas may be best for you. Common areas include upper arm, abdomen, or thigh
  • When injecting yourself subcutaneously, the thigh and abdomen may be best. When injecting others, the upper arm may be best
  • You may 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

Do not inject into:

  • Same site more than once a week
  • A site that has skin irritation, including red, swollen, or painful areas
  • Tattoos, warts, scars, or birthmarks
  • Stomach
  • Knee or groin area
  • The belly button or the 1-inch area around it
Contact your doctor if you notice any injection site reactions, including redness, pain, and swelling

Injecting the Upper Thigh

The following instructions are for self-injections.

Injecting the upper thigh muscle You may inject into the same area more than once in a week, but rotate the injection sites in that area each time, keeping 1 inch between sites

  1. Sit comfortably on a firm chair to keep the thigh area relaxed

  2. Step 2: Drawing imaginary line down center front of thigh Step 2: Area between hands and from center of thigh to the outer side of leg 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

  3. See "How to inject" for additional instructions

Injecting the Abdomen

The following instructions are for self-injections.

  1. Sit comfortably on a firm chair

  2. Step 2: Placing hands on lower ribsThe area below hands and not in the 1-inch area around the belly button To locate the area, 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 to not inject the belly button or the 1-inch area around it

  3. See "How to inject" for additional instructions

Injecting the Upper Arm

The upper arm is a common area used when injecting another person. Injections can be given on either the side or the back of the upper arm. The person receiving the injection can either sit or lie down, whichever is more comfortable, with his or her arm relaxed. The following instructions are for the person giving the injection.

Side of the upper arm

  1. Step 1: Outermost tip of the shoulder Run your fingers along the collarbone until you reach the shoulder bone at the outermost tip of the shoulder

  2. Step 2: Fingers just below the shoulder bone Place 4 fingers of your hand just below the shoulder bone

  3. Step 3: Place 4 fingers of other hand on the elbowArea between imaginary lines and the hands 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

  4. See "How to inject" for additional instructions

Back of the arm

  1. Step 1: The shoulder bone Run your fingers along the collarbone until you reach the shoulder bone

  2. Step 2: Fingers behind the arm below the shoulder bone Place 4 fingers of your hand behind the arm just below the shoulder bone

  3. Step 3: Placing 4 fingers of other hand on the back side of elbowArea between imaginary lines and the hands 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 upper arm from shoulder to elbow. Injections can be given between these imaginary lines and your hands if there is enough tissue to pinch

  4. See "How to inject" for additional instructions

How to Inject

The steps are the same whether you are injecting yourself or someone else. The steps below should be done after 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 (see previous instructions for more information).

  1. Clean the area to be injected with an alcohol swab; let the alcohol dry before injecting

  2. Step 2: Pressing the plunger Press the plunger until a droplet forms at the tip of the needle

  3. Step 3: Pinching the skin around the injection site Pinch the skin around the injection site between the thumb and fingers of the hand that is not holding the syringe

  4. Step 4: Holding the needle at a 90° angle Hold the syringe like a pencil or dart with your right hand if you are right-handed and your left if you are left-handed. Using a quick motion, insert the needle at a 90° angle through the skin

  5. Step 5: Drawing back on the plunger to check for blood Once the needle is fully in, 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 no blood enters the syringe, slowly push the plunger in until the syringe is empty
    • If blood enters the syringe, withdraw the needle and, using a gauze pad, place pressure on the injection site. Start over with a new syringe and a new site for injection

  6. Step 6: Pulling the needle straight out Once the syringe is empty, pull the needle straight out. 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. Use an ice cube if you feel pain at the injection site

  7. If there is any blood, wipe it off and, if necessary, apply an adhesive bandage

  8. Step 8: Disposing of the used syringe, needle, and needle cap Dispose of the used syringe, needle, and needle cap in a puncture-resistant container. Do not replace the needle cap prior to disposal (see following section for more information about proper disposal of syringes, needles, and vials)

  9. Wash your hands with soap and warm water