ciclesonide (nasal)

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

History of ↑ intraocular pressure, glaucoma, or cataracts;
Immunosuppression;
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <6 yr (safety not established).

Adv. Reactions/Side Effects ⬆ ⬇

EENT: cataracts, ear pain, epistaxis, glaucoma, local stinging, nasal perforation, nasal ulceration, nasopharyngitis

Endo: adrenal suppression (long-term high-dose therapy only)

Neuro: headache

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

Ketoconazole↑ levels and risk of toxicity.

Availability ⬆ ⬇

Nasal spray: 50 mcg/actuation in 12.5-g bottle (delivers 120 metered sprays)

Route/Dosage ⬆ ⬇

(Adults and Children ≥12 yr): 2 sprays in each nostril once daily (not to exceed 2 sprays in each nostril/day).
(Adults and Children ≥6 yr): 2 sprays in each nostril once daily (not to exceed 2 sprays in each nostril/day).

US Brand Names ⬆ ⬇

Omnaris, ~~Zetonna~~

Action ⬆ ⬇

Acts as a potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects:

Decreased symptoms of allergic rhinitis.

Classifications ⬆ ⬇

Therapeutic Classification: allergy, cold and cough remedies

Pharmacologic Classification: corticosteroids

Pharmacokinetics ⬆ ⬇

Absorption: <1% systemically absorbed following intranasal administration.

Distribution: Action is primarily local.

Protein Binding: >99%.

Metabolism/Excretion: Activated by enzymatic conversion to des-ciclesonide, the pharmacologically active drug. Small amounts absorbed are metabolized by the liver.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
intranasal	24–48 hr	1–5 wk	unknown

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Medication should be used at regular intervals for best effect.
Caution patient not to exceed maximal daily dose.
Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Instruct patient to read patient information sheet prior to use. Warn patient that temporary nasal stinging may occur.
Inform patient that there is an ↑ risk of nosebleeding while using ciclesonide.
Advise patients on immunosuppressive doses of corticosteroids to avoid exposure to infectious diseases (chickenpox, measles). If exposed, contact health care professional.
Inform patient that glaucoma and cataracts may occur with intranasal steroids. Advise patient to have regular eye exams and to notify health care professional if changes in vision occur during use.
Instruct patient to notify health care professional if symptoms do not improve within 1–2 wk for seasonal allergic rhinitis or 5 wk in perennial allergic rhinitis, or if nasal discharge becomes purulent or nasal sores occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Pedi: Advise caregiver to have child's growth monitored routinely during therapy.

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Indications ⬇

Contraind./Precautions ⬆ ⬇