ciclesonide (inhalation)

Contraindicated in:

Hypersensitivity to ciclesonide or any other ingredients in the formulation;
Acute asthma/status asthmaticus.

Use Cautiously in:

Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <12 yr (safety and effectiveness not established).
Geri: Consider age-related ↓ in cardiac, renal and hepatic function, concurrent disease state and drug therapy; consider lower initial dose.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: nasal congestion, nasopharyngitis, ↑intraocular pressure, candida infection of mouth and pharynx, cataracts, pharyngolaryngeal pain

Endo: ↓growth (children), adrenal suppression (↑ dose, long term therapy)

MS: arthralgia, back pain, extremity pain, ↓bone mineral density (↑ dose, long term therapy)

Neuro: headache

Misc: worsening of infections

Interactions ⬆ ⬇

Drug-drug:

None noted.

Availability ⬆ ⬇

Inhalation aerosol (contains HFA-134A as a propellant): 80 mcg/actuation in 6.1–g canisters of 60 actuations; 160 mcg/actuation in 6.1–g canisters of 60 actuations

Route/Dosage ⬆ ⬇

Inhaln (Adults and Children ≥12 yr): Previous therapy with bronchodilators alone: 80 mcg twice daily, may be ↑ to 160 mcg twice daily; Previous therapy with inhaled corticosteroids: 80 mcg twice daily, may be ↑ to 320 mcg twice daily; Previous therapy with oral corticosteroids: 320 mcg twice daily.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects:

↓frequency and severity of asthma attacks; improved asthma symptoms.

Classifications ⬆ ⬇

Therapeutic Classification: antiasthmatics

Pharmacologic Classification: corticosteroids (inhalation)

Pharmacokinetics ⬆ ⬇

Absorption: Negligible oral bioavailability, action is primarily local.

Distribution: Unknown.

Metabolism/Excretion: Converted by esterases to des-ciclesonide, the active drug, which is subsequently metabolized by the liver. Some further metabolites may be pharmacologically active. Mostly eliminated in feces via biliary excretion; <20% of des-ciclesonide is excreted in urine.

Half-Life: Ciclesonide: 0.7 hr; Des-ciclesonide: 6–7 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Inhaln	within 24 hr	1–4 wk‡	unknown

‡Improvement in pulmonary function, ↓ airway responsiveness may take longer.

Patient/Family Teaching ⬆ ⬇

Instruct patient to use inhaler at regular intervals as directed. If a dose is missed, omit and take next regularly scheduled dose. Advise patient not to ↑ dose or discontinue medication, even if feeling better, without consulting health care professional; gradual ↓ is required. If asthma symptoms worsen, contact health care professional. Instruct patient to read Patient Leaflet before use.
Advise patient to follow instructions supplied. Before first-time use or if inhaler has not been used for more than 10 days, prime unit by actuating 3 times prior to dose. Do not shake inhaler. When dose indicator display window shows a red zone, 20 inhalations are left and refill is required; discard when indicator shows zero. Do not use actuator with other medications. Clean mouthpiece weekly with a clean dry tissue; do not wash or put any part of the inhaler in water.
Advise patients using inhalation corticosteroids and bronchodilator to use bronchodilator first and to allow 5 min to elapse before administering the corticosteroid, unless otherwise directed by health care professional.
Advise patient that inhalation corticosteroids should not be used to treat an acute asthma attack but should be continued even if other inhalation agents are used.
Instruct patient to notify health care professional if asthma worsens or if signs of adrenal insufficiency occur.
Patients using inhalation corticosteroids to control asthma may require systemic corticosteroids for acute attacks. Advise patient to use regular peak flow monitoring to determine respiratory status.
Advise patient to rinse mouth with water after treatment to ↓ risk of developing local candidiasis.
Caution patient to avoid smoking, known allergens, and other respiratory irritants.
Advise patient to notify health care professional if sore throat or mouth occurs or if exposed to anyone with chicken pox or measles.
Instruct patient to consult health care professional before taking other Rx, OTC, or herbal products.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators.

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Indications ⬇

Contraind./Precautions ⬆ ⬇