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Alvesco
ciclesonide inhaled
Adult Dosing .
Dosage forms: MDI: 80 mcg per actuation, 160 mcg per actuation
asthma, maintenance tx
- [Dose: 1-2 puffs (80 mcg or 160 mcg per actuation) inhaled bid]
- Start: varies by disease severity and current asthma tx, may incr. dose after 4wk; Max: 640 mcg/day; Info: taper to lowest effective dose; search 'asthma' for epocrates Asthma Long-Term Management NIH/NHLBI decision tools
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: MDI: 80 mcg per actuation, 160 mcg per actuation
asthma, maintenance tx
- [12 yo and older]
- Dose: Dose: 1-2 puffs (80 mcg or 160 mcg per actuation) inhaled bid; Start: varies by disease severity and current asthma tx, may incr. dose after 4wk; Max: 640 mcg/day; Info: taper to lowest effective dose; search 'asthma' for epocrates Asthma Long-Term Management NIH/NHLBI decision tools
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- status asthmaticus
- asthma, acute
- bronchospasm, acute
- abrupt withdrawal
- caution: hypersensitivity to corticosteroids
- caution: peds patients
- caution: adolescent patients
- caution: long-term systemic corticosteroid use, recent
- caution: immunosuppressed patients
- caution: infection, active
- caution: TB infection, active
- caution: TB infection, latent
- caution: measles exposure
- caution: varicella exposure
- caution: ocular HSV infection
- caution: cataract
- caution: glaucoma
- caution: IOP incr.
- caution: osteoporosis
- caution: osteoporosis risk
Drug Interactions .
Overview
ciclesonide
corticosteroid
- CYP3A4 substrate
- interferes w/ ACTH analog test
Contraindicated
- desmopressin
- mifepristone
Avoid/Use Alternative
- cobicistat
- darunavir
- lopinavir/ritonavir
- ritonavir
Monitor/Modify Tx
- cosyntropin
- metyrapone
Caution Advised
- adagrasib
- atazanavir
- ceritinib
- chloramphenicol
- clarithromycin
- idelalisib
- itraconazole
- ketoconazole
- levoketoconazole
- lonafarnib
- methacholine inhaled
- nefazodone
- nelfinavir
- posaconazole
- ribociclib
- tipranavir
- tucatinib
- voriconazole
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- angioedema
- bronchospasm
- adrenal suppression (high-dose use)
- hypercorticism (high-dose use)
- glaucoma (long-term use)
- cataracts (long-term use)
- immunosuppression (long-term use)
- growth suppression (long-term use in peds patients)
Common Reactions
- headache
- nasopharyngitis
- URI
- sinusitis
- nasal congestion
- pharyngolaryngeal pain
- arthralgia
- extremity pain
- back pain
- hoarseness
- candidiasis, oral
- influenza
- pneumonia
- musculoskeletal chest pain
- urticaria
- dizziness
- gastroenteritis
- facial edema
- fatigue
- conjunctivitis
Safety/Monitoring .
Monitoring Parameters
BMD at baseline if osteoporosis risk factors, then periodically; height in children/adolescents; oral cavity exam periodically; consider ophthalmic exam if long-term use, change in vision, IOP/glaucoma/cataracts history
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; no human data available, though risk of fetal harm not expected based on minimal systemic absorption; no known risk of fetal harm based on animal data with inhaled route at 15x MRHD; possible risk of fetal harm, including cleft palate, incomplete ossification, and low birth wt, based on animal data with SC route at 0.76x MRHD
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm and adverse effects on milk production not expected based on minimal systemic absorption in breastfeeding patients and drug properties
Pharmacology .
Metabolism: for ciclesonide: liver extensively; CYP450: 2D6, 3A4 (primary) substrate; Info: minimal systemic absorption
Excretion: for ciclesonide: bile/feces 66%, urine <20%; Half-life: 0.71h (parent drug), 6-7h (active metabolite)
Subclass: Corticosteroids, Inhaled
Mechanism of Action
for ciclesonide: prodrug converted to active metabolite; exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Formulary .
No Formulary Selected
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