Ciclesonide

Ciclesonide Brand Names

Alvesco | Omnaris | Zetonna

What is Ciclesonide

Ciclesonide is a non-halogenated glucocorticoid which is beneficial in treating inflammatory conditions such as allergic rhinitis and asthma.

Data from controlled trials suggest it may also be beneficial in the treatment of COPD.

Ciclesonide is used off-label for prevention of of exercise-induced bronchoconstriction (EIB); it may be a first-line choice for a controller agent to be added to an inhaled short-acting beta-2 agonist (SABA) to control EIB symptoms in patients who cannot be controlled by an inhaled SABA alone.

The drug has a low systemic bioavailability following intranasal or oral inhalational administration, which aids in limiting systemic effects such as cortisol suppression.

Ciclesonide is a prodrug with an active metabolite which is 100—120 times more potent than the parent compound, and a similar relative potency to beclomethasone and budesonide.

In October 2006, ciclesonide nasal spray (Omnaris) received FDA approval for the treatment of nasal symptoms associated with seasonal and perennial allergic rhinitis.

In January 2008, ciclesonide oral inhalation (Alvesco) was approved by the FDA for the maintenance treatment of asthma as prophylactic therapy.

In January 2012, a ciclesonide nasal aerosol (Zetonna) FDA approved for the treatment of symptoms associated with seasonal and perennial allergic rhinitis.

All dosage forms are approved in adult and pediatric patients 12 years of age and older.

Indications

• allergic rhinitis
• asthma
• exercise-induced bronchospasm prophylaxis
• perennial allergies
• seasonal allergies

For the management of symptoms of perennial allergies and seasonal allergies, including allergic rhinitis

Side Effects

1. abdominal pain
2. angioedema
3. arthralgia
4. back pain
5. bronchospasm
6. candidiasis
7. cataracts
8. contact dermatitis
9. cough
10. dysphonia
11. epistaxis
12. growth inhibition
13. headache
14. hypothalamic-pituitary-adrenal (HPA) suppression
15. infection
16. influenza
17. nasal congestion
18. nasal irritation
19. nasal septum perforation
20. nausea
21. osteopenia
22. otalgia
23. pharyngitis
24. rhinitis
25. sinusitis
26. xerostomia

Monitoring Parameters

• pulmonary function tests (PFTs)

Contraindications

• acute bronchospasm
• adrenal insufficiency
• breast-feeding
• cataracts
• children
• corticosteroid hypersensitivity
• Cushing’s syndrome
• fungal infection
• geriatric
• glaucoma
• growth inhibition
• herpes infection
• hypothalamic-pituitary-adrenal (HPA) suppression
• increased intracranial pressure
• increased intraocular pressure
• infants
• infection
• measles
• nasal septal perforation
• nasal surgery
• nasal trauma
• neonates
• osteoporosis
• pregnancy
• status asthmaticus
• tuberculosis
• vaccination
• varicella
• viral infection

Interactions

• Abatacept
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• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
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