Inhaled Ciclesonide

Aka: Inhaled Ciclesonide, Alvesco

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II. Indications

  1. Inhaled Corticosteroids are the most important agent in Asthma Management
  2. Indicated as daily maintenance agents in all persistent Asthma
    1. Mild Persistent Asthma
    2. Moderate Persistent Asthma
    3. Severe Persistent Asthma

III. Dosing: Ciclesonide HFA MDI (Alvesco)

  1. Use child dosing for age 6 to 11 years old
  2. Dose per puff
    1. U.S.: 80 or 160 mcg/puff (with 60 puffs per Inhaler)
    2. Canadian: 100 or 200/puff (with 120 puffs per Inhaler)
  3. Low dose
    1. Adult: 160 mcg/day (80 mcg Inhaler, 1 puff twice daily)
    2. Child: 80 mcg/day (80 mcg Inhaler, 1 puff daily)
  4. Medium dose
    1. Adult: 160 to 320 mcg/day (160 mcg Inhaler, 1 puff twice daily)
    2. Child: 80 to 160 mcg/day (80 mcg Inhaler, 1 puff twice daily)
  5. High dose
    1. Adult: >320 mcg/day (160 mcg Inhaler, 1-2 puffs twice daily)
    2. Child: >160 mcg/day (80 mcg Inhaler, 1-2 puffs twice daily)

IV. Adverse Effects

  1. See Inhaled Corticosteroid

V. Efficacy

  1. See Inhaled Corticosteroid

VI. Drug Interactions

  1. Strong CYP3A4 Inhibitors (e.g. Ketoconazole)
    1. May increase serum Ciclesonide levels (risk of adrenal suppression)

VII. Safety

  1. Pregnancy Category C
  2. Unknown Safety in Lactation

VIII. Resources

  1. Ciclesonide HFA MDI or Alvesco (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9f6112fb-78ef-43cf-8ae3-36370eb45468

IX. References

  1. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  2. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200

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