Ciclesonide

Indications

Ciclesonide is used for: Asthma, seasonal allergic rhinitis, perennial allergic rhinitis

Adult Dose

Inhalation Asthma Adult: Usual dose 160 mcg once daily, preferably in the evening from a metered-dose inhaler; reduced to 80 mcg once daily for maintenance. May increase to 160 mcg twice daily Nasal Spray: 1 spray (50 micrograms/spray) in each nostril once a day. The maximum total daily dosage should not exceed 2 sprays in each nostril (200 micrograms/day).

Child Dose

Inhalation Asthma Child: >12 yr: Usual dose 160 mcg once daily, preferably in the evening from a metered-dose inhaler; reduced to 80 mcg once daily for maintenance. May increase to 160 mcg twice daily Nasal Spray: 1 spray (50 micrograms/spray) in each nostril once a day. The maximum total daily dosage should not exceed 2 sprays in each nostril (200 micrograms/day).

Renal Dose

Administration

Gently shake and prime nasal spray by actuating 3 times before using for the first time or when not in use for 4 consecutive days

Contra Indications

Not for status asthmaticus or severe acute asthma where intensive measures are needed. Ciclesonide nasal spray is contraindicated in patients with a hypersensitivity to any of its ingredients.

Precautions

Active or quiescent pulmonary TB, fungal, viral or bacterial infections, unless adequately treated. Severe hepatic impairment. Monitor height of children and adolescents on long term treatment with inhaled corticosteroids; reduce dose if growth is slow. Pregnancy, lactation. Ciclesonide nasal spray should be used with caution in patients with active or quiescent tuberculosis infection of the respiratory tract or in patients with untreated fungal, bacterial or systemic viral infections or ocular herpes simplex. Rare instances of nasal septal perforation, cataract, and glaucoma have been reported following intranasal application. Development of localized infections of the nose and pharynx with Candida albcans has rarely occurred. Although systemic effects have been minimal with recommended doses of Ciclesonide nasal spray, potential risk increases with larger doses. Therefore, larger than recommended doses of Ciclesonide nasal spray should be avoided. Lactation: Not known if excreted in breast milk, use caution

Pregnancy-Lactation

Pregnancy Category: C Lactation: Not known if excreted in breast milk, use caution

Interactions

Increased ciclesonide concentrations with concomitant ketoconazole, itraconazole, ritonavir, nelfinavir or other potent CYP3A4 inhibitors.

Adverse Effects

Side effects of Ciclesonide : Inhalation >10% Headache (11%), Nasopharyngitis (11%) 1-10% Epistaxis (4.9%), Ear pain (2.2%), Facial edema (3%), Urticaria (3%), Oral candidiasis (3%), Back pain (3%), Extremety pain (3%), Conjunctivitis (3%), Upper respiratory infection (9%), Gastroenteritis (3%), Sinusitis (3%) Nasal spray 1-10% Headache (3.1-6.6%), Epistaxis (2.9-6%), Nasopharyngitis (3.7%), Nasal discomfort (3.2%), Ear pain (2.2%)

Mechanism of Action

Ciclesonide, an inhaled corticosteriod, is converted by esterases in the lungs to the active metabolite, desisobutyryl-ciclesonide, which has anti-inflammatory activity.