Adult Dosing
Maintenance treatment, Asthma
Prior bronchodilator alone
- Start 80 mcg INH bid
- Max: 160 mcg INH bid
Prior inhaled steroids
- Start 80 mcg INH bid
- Max: 320 mcg INH bid
Prior oral steroids
- Start 320 mcg INH bid
- Max: 320 mcg INH bid
Notes- Prime the product before using for the first time by actuating 3 times prior to using the first dose from a new canister or when the inhaler has not been used for more than 10 days
- Onset and degree of symptom relief will vary for individual patients
- Titrate dose to lowest effective dose after asthma stability has been achieved
- Provide higher dose in patients if adequate response does not occur after 4 wks of therapy
- Safety and efficacy when administered in excess of the highest recommended doses is not established
- Titrate to lowest effective dose and monitor patients for signs of asthma instability and adrenal insufficiency following discontinuation of oral steroid therapy. Advise patients to rinse mouth after use due to the risk of oral candidiasis
Pediatric Dosing
- Safety and effectiveness in pediatric patients <12 yrs have not been established
Maintenance treatment, Asthma
Prior bronchodilator alone
12 yrs: Start 80 mcg INH bid- Max: 160 mcg INH bid
Prior inhaled steroids
- 12 yrs: Start 80 mcg INH bid
- Max: 320 mcg INH bid
Prior oral steroids
- 12 yrs: Start 320 mcg INH bid
- Max: 320 mcg INH bid
Notes- Prime the product before using for the first time by actuating 3 times prior to using the first dose from a new canister or when the inhaler has not been used for more than 10 days
- Onset and degree of symptom relief will vary for individual patients
- Titrate dose to lowest effective dose after asthma stability has been achieved
- Provide higher dose in patients if adequate response does not occur after 4 wks of therapy
- Safety and efficacy when administered in excess of the highest recommended doses is not established
- Titrate to lowest effective dose and monitor patients for signs of asthma instability and adrenal insufficiency following discontinuation of oral steroid therapy. Advise patients to rinse mouth after use due to the risk of oral candidiasis
[Outline]
See Supplemental Patient Information
- May cause Candida albicans infection of the mouth and pharynx. Periodically monitor patients for signs of adverse effects.
- May cause increased risk of immunosuppression and infections; avoid exposure of patients who have not been exposed to chickenpox/measles or have not been properly immunized. Start prophylaxis with varicella zoster immune globulin (VZIG) if exposed to chickenpox and with pooled immunoglobulin (IG) if exposed to measles
- Impaired adrenal function has occurred when transferring from oral steroids to inhaled corticosteroids. Gradually taper dose while transferring from systemic corticosteroids to inhaled corticosteroids.
- Adrenal insufficiency and hypercorticism may occur at higher than recommended dosages or even at recommended dosages in susceptible individuals. Withdraw gradually to discontinue.
- Reduction in growth velocity may occur in pediatric patients; monitor periodically
- Corticosteroids cause development of glaucoma and/or cataracts. Monitor patients with history of increased IOP, glaucoma, and/or cataracts for changes in vision
- Bone mineral density (BMD) has decreased on prolonged use of inhaled corticosteroids
- On occurrence of bronchospasm, immediately treat with a fast-acting inhaled bronchodilator, discontinue ciclesonide and provide alternative treatment
Cautions: Use cautiously in
- Patients with a known hypersensitivity reaction
- Active or quiescent tuberculosis infections
- Untreated local or systemic fungal or bacterial infections
- Systemic viral or parasitic infections
- Ocular herpes simplex infections
- Measles or varicella exposure
- Glaucoma
- Cataracts
- Increased intra ocular pressure
- Adrenal insufficiency
- Adrenal suppression, hypercorticism
- Use of systemic steroid
- History or risk of decreased bone mineral density
- Vision changes
- Adolescent patients
- Pediatric patients
- Geriatrics
Supplemental Patient Information
- Advise patients to rinse mouth following inhalation
- Advise patients to contact their physician immediately if episodes of asthma are not responsive to their usual doses of bronchodilators during the course of treatment with inhaled ciclesonide
Pregnancy Category:C
Breastfeeding: Safety unknown; amount of corticosteriod absorbed into the blood and excreted in breast milk is too small to adversely affect breastfed infant. Inhaled corticosteriods are acceptable to use during breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 11 November 2010). Manufacturer advises caution
Pricing data from www.DrugStore.com in U.S.A.
- Alvesco 160 MCG/ACT AERS [Inhaler] (SUNOVION PHARMACEUTICALS)
6.1 act = $175.99
18.3 act = $493.97 - Alvesco 80 MCG/ACT AERS [Inhaler] (SUNOVION PHARMACEUTICALS)
6.1 act = $174.98
18.3 act = $480.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
