ACTH and IV steroids aren't ordinarily used together. However, high-dose IV steroids (in 1-gram daily doses) could be used for a 3- to 5-day period in patients who have especially severe attacks to reduce swelling in the optic nerve or spinal cord, with ACTH added to maintain adrenal function (since steroids suppress the adrenal glands) and thereby obtain the benefit of the other actions of ACTH. This would also provide the neuroprotective effect of ACTH.
Although you may ask why not continue the highdose IV steroids, it is important to realize that highdose steroids damage myosin, which is the main protein in muscle that is responsible for muscle contraction. Prolonged use of intravenous steroids may result in serious muscle damage, sometimes referred to as "intensive care unit paralysis." This is yet another reason why it is unwise to continue high-dose steroids for longer periods.
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