Dose of ACTH in infantile spasm

The dose of adrenocorticotropic hormone (ACTH) for infantile spasms:

Infants and Children <2 years:

High dose: Body-surface area (BSA) directed dosing: Vial: IM: 75 units/m2/dose twice daily or 150 units/m2/dose once daily for 2 weeks, followed by a 2-week taper: 30 units/m2/dose once daily in the morning for 3 days, followed by 15 units/m2/dose once daily in the morning for 3 days, followed by 10 units/m2/dose once daily in the morning for 3 days and 10 units/m2/dose every other morning for 6 days. In practice, some centers have used maximum doses of 80 units/dose twice daily or 160 units/dose once daily based on currently available dosage forms.

Low dose: Fixed dosing: Vial: IM: Initial: 20 units/day for 2 weeks; if patient responds, taper and discontinue over a 1-week period; if patient does not respond, increase dose to 30 units/day for 4 weeks then taper and discontinue over a 1-week period. Dosing based on a prospective, single-blind study which reported no major difference in effectiveness between high-dose long-duration versus low-dose short-duration ACTH therapy.

Trade Names:

USA & Europe: H.P. Acthar Gel (Repository Corticotropin Injection)

Other regions: Synacthen Depot (Tetracosactide) – a synthetic ACTH analog, sometimes used when Acthar Gel is unavailable.

Tetracosactide dose

For infantile spasms

By intramuscular injection using depot injection

Child 1–23 months

500 micrograms once daily on alternate days for 2 weeks; increased if necessary up to 750 micrograms once daily on alternate days, increased dose to be used if spasms continue or recur after the first 7 days.