Storing, Preparing and Injecting Acthar (IM)

Injection Preparation and Instructions for Intramuscular (IM) Injection

Download Acthar Injection Instructions (Intramuscular Adminstration) (PDF) »

The following sections provide easy step-by-step instructions on how to 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 is given by an intramuscular (into the muscle) 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 under Home Injection Training Services on page 23 of the full guide (download above).

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 Check the expiration date on the Acthar vial to make sure it is not outdated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:

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

Preparing to inject

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

2. 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. 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. 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. While the syringe is still in the vial, turn the vial and syringe upside down

8. 

   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. 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 or thigh
• When injecting yourself, the muscle along the upper-outer thigh may be best. When injecting others, the muscle in the upper arm may be best

Do not inject into:

• Same site (small area of the muscle) 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

Injecting the Upper-Outer Thigh Muscle

The following instructions are for self-injections.

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

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

2. To locate the correct muscle, 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

3. 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

4. See "How to inject" for additional instructions

Injecting the Upper-Arm Muscle

NOTE: In some patients, the muscle may not be well developed and would not be a suitable area for injections. Consult your doctor or nurse for further guidance. 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.

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

2. 
   Inject in the area 3 fingertip widths directly below the shoulder bone
3. 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. Press the plunger until a droplet forms at the tip of the needle

3. Stretch and hold the skin around the injection site between the thumb and fingers of the hand that is not holding the syringe

4. 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. Once the needle is fully in (about 1/8" of the needle should still be visible above the skin), 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. 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. 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