Ciclesonide
ALVESCO, OMNARIS
Pronunciation: sye-KLES-oe-nide (al-VES-koe)
What it isInhaled glucocorticoid prodrug activated in the lung; maintenance treatment of asthma.
Why this onePulmonary activation and low oropharyngeal activity reduce thrush compared with many inhaled steroids.
What limits itIt still requires mouth rinsing and is a controller, not a rescue inhaler.
FDA-approved for
- asthma maintenance (2006)
- allergic rhinitis
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Asthma maintenance — prior bronchodilators alone | ≥12 yr | 80 mcg BID | 80 mcg BID | 160 mcg BID |
| Asthma maintenance — prior inhaled corticosteroids | ≥12 yr | 80 mcg BID | 80–320 mcg BID | 320 mcg BID |
| Asthma maintenance — prior oral corticosteroids | ≥12 yr | 320 mcg BID | 320 mcg BID | 320 mcg BID |
Renal Undefined
Hepatic Undefined
Instructions
- Oral inhalation only
- Prime before first use or when not used for >10 days (actuate 3 times)
- Rinse mouth with water and spit out after each use (reduce oropharyngeal candidiasis)
- When transferring from oral steroids: reduce prednisone gradually, no faster than 2.5 mg/day weekly, beginning after ≥1 week of Alvesco
Available strengths
- inhaler 80, 160 mcg/inh
- nasal spray 50 mcg/spray
Contraindications
- Primary treatment of status asthmaticus or acute asthma episodes requiring intensive measures
Cautions
- Oropharyngeal candidiasis — rinse mouth after use
- Risk of impaired adrenal function when transferring from oral steroids; HPA suppression at high doses
- Immunosuppression — more serious/fatal course of chickenpox/measles; worsening infections
- Growth suppression in children; glaucoma, increased IOP, cataracts
- Reduction in bone mineral density
Adverse reactions
- Headache, nasopharyngitis, sinusitis, pharyngolaryngeal pain
- Upper respiratory infection, nasal congestion
- Arthralgia, back pain, pain in extremity
Pregnancy No human data; low systemic exposure at recommended dose — maintain asthma control
Lactation No human data; low systemic exposure — consider benefits vs. risks
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 80 mcg/inh | inhaler | per unit | — | $42.96/g | not offered |
| 160 mcg/inh | inhaler | per unit | — | $42.97/g | not offered |
Generic entry2028 est.
NO BOXED WARNINGS
Principal riskOral candidiasis, less than other inhaled steroids
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.