Question

What client assessments are imperative for an individual taking corticotropin therapy who is also taking digitalis and an oral Glucophage?

Answer 1

Corticotropin (ACTH or adrenocorticotropic hormone) is a polypeptide hormone produced and secreted by the pituitary gland. It is an important player in the hypothalamic-pituitary-adrenal axis.
For use as a diagnostic agent in the screening of patients presumed to have adrenocortical insufficiency.

POLICY

• Corticotropin therapy for the treatment of infantile spasms (West syndrome) is considered medically necessary if the medical appropriateness criteria are met
• Corticotropin therapy for diagnostic testing of adrenocortical function is considered not medically necessary.
• Corticotropin therapy for the treatment of other conditions/diseases is considered investigational.  

MEDICAL APPROPRIATENESS

INITIAL APPROVAL

• Corticotropin therapy is considered medically appropriate if ALL of the following are met:

·

• Diagnosis of infantile spasms (West syndrome) is clinically documented
• Individual is 2 years of age or younger
• Documentation that individual is free from suspected congenital infection
• Treatment must be as monotherapy

RENEWAL CRITERIA

• Corticotropin therapy is considered medically appropriate for renewal for one month if ALL of the following criteria are met:
  • All original criteria for approval are met
  • Disease response is indicated by improvement or resolution of symptoms and/or normalization of laboratory tests
  • Absence of unacceptable toxicity from the e.g., GI bleeding; gastric ulcer; hypertension; hypokalemia; severe depression; frank psychotic manifestations; posterior subcapsular cataracts; glaucoma; new onset seizures; pancreatitis

INDICATION(S)	DOSAGE & ADMINISTRATION
Infantile spasms	75 units/m² intramuscularly given twice daily for 2 weeks, then taper the dose over a 2 week period (e.g., 30 units/m2 in the morning for 3 days; 15 units/m2 in the morning for 3 days; 10 units/m2 in the morning for 3 days; and 10 units/m2 every other morning for 6 days)
Use of repository corticotropin injection for indications including, but not limited to, those additionally listed in the product labeling are not supported by substantial clinical evidence.

While taking care of patient under Corticotropin therapy, nurses must keep in mind for those patient taking Digitalis and Glucophage.

Digitalis increases myocardial contractility in patients with heart failure and reduces the ventricular rate in those with atrial fibrillation. Cardiac complications can result from therapeutic or toxic effects of digitalis, primarily due to inhibition of membrane Na⁺,K⁺-ATPase.

Glucophage is usually prescribed as a treatment for people with type 2 diabetes who are overweight or obese When diet and exercise fail to adequately control blood glucose levels, Glucophage is prescribed.