This product is taken via MDI (metered dose inhaler).
MDI (metered dose inhaler)
Why is it prescribed?
Ciclesonide is used to control the signs and symptoms of asthma that are responsive to orally inhaled corticosteroids in patients over 6 years of age. Ciclesonide is not presently recommended for those less than 6 years of age. It is also used as a nasal spray to relieve the symptoms that may occur with hay fever [seasonal allergic rhinitis (SAR)] or other year-round allergies [perennial allergic rhinitis (PAR)], including stuffiness/congestion in the nose, runny nose, itching and sneezing.
- Alvesco® MDI is an aerosol meant for inhalation by mouth only. Your doctor or pharmacist should have instructed you on the proper use and care of your Alvesco® MDI aerosol. It is advisable to have your technique reassessed by the pharmacist for the first 2 or 3 refills of your prescription.
- You do NOT need to shake the inhaler before each use. If the inhaler is new or has not been used for more than one week, three puffs should be released into the air prior to use to make sure the inhaler is ready for use.
- When 2 inhalations are required, wait at least half a minute between doses.
- Each canister contains 120 doses so it is important to keep a record of approximately when it should be replaced. To avoid problems, many people keep 2 inhalers on hand.
- Your inhaler should be stored at room temperature (between 15 to 30 degrees centigrade). The contents of the canister are under pressure and should never be punctured, used or stored near heat or open flame.It should also be protected from direct sunlight and frost.
- Alvesco® MDI aerosol has been developed for use without a spacer device but evidence suggests it is compatible with the Aerochamber®. Although these devices are not necessary, they have been shown to increase effectiveness and help people who are unable to coordinate inhalation with actuation of the inhaler.
- The inhaler should be cleaned and cared for according to the manufacturer's instructions. Rinsing the mouth and throat with water after each use will remove any remaining medication to help prevent local yeast (thrush) infections. Cleansing dentures has the same effect.
- Notify your doctor if a sore throat or mouth occurs or if you suspect a localized yeast infection.
- It may take up to 1 week of regular use before the ciclesonide will work.
- Do not use this medication to treat an acute asthma episode. Alvesco® MDI aerosol is not a rescue medication. It is very important that you use Alvesco® MDI aerosol regularly. If you miss a dose, skip the missed dose and take your next dose at the regularly scheduled time.
- For adults and adolescents (age over 12 years) the usual dose for ciclesonide ranges from 100 to 800 micrograms per day. Ciclesonide can be taken as 1 or 2 puffs once daily either in the morning or in the evening. Some patients with more severe asthma will require 800 micrograms daily, administered as 400 micrograms twice daily.
- For children aged 6 to 11, the recommended dosage range is 100 to 200 micrograms daily taken as 1 or 2 puffs once daily in the morning or the evening.
- Your doctor will tell you how much ciclesonide to take and how often. You should take ciclesonide daily.
Ciclesonide is a corticosteroid that possesses anti-inflammatory activity. It helps to control symptoms and prevent asthma attacks by decreasing inflammation in the lungs, thereby opening the airways and improving breathing. It is also used as a nasal spray for the treatment of seasonal allergic rhinitis, including hayfever, and perennial allergic rhinitis Whether inhaled through the nose or into the lungs, the effect of the drug is local (acting directly on the tissue it comes in contact with). The amount absorbed by the body is minimal and therefore the incidence of unwanted effects is low.
Along with its needed effects, ciclesonide may cause some unwanted or undesirable effects. Often, ciclesonide users who use their medication properly, never experience any unwanted effects. The severity and duration of these effects are dependant on many factors including duration of therapy, dose, route of administration and individual response. Possible unwanted effects include:
- difficulty speaking
- fungal infection in the mouth
- bad taste in the mouth
- throat pain
- throat irritation
- dry throat
- sudden wheeziness and chest pain or tightness
- swelling of eyelids, face, lips, tongue or throat
- lumpy skin rash or “hives” anywhere on the body
When used as a nasal spray, headache, nose-bleeds, and burning or irritation inside the nose can occur.
Use as directed. Never use a higher dose than what you have been prescribed. Using higher than recommended doses will cause greater absorption by the body and possibly lead to greater occurrence of unwanted effects. Optimal relief of symptoms may require a few days of continuous therapy. If symptoms do not improve or the condition worsens, the doctor should be contacted. Treatment with ciclesonide should never be stopped without first consulting your doctor. Discontinuation of ciclesonide may require gradual tapering or you may experience a flare-up of your condition.
Inadequate response can often be a result of improper use of the delivery device. Your doctor or pharmacist should instruct you on the correct use of these preparations. Each product comes with a package insert that should be read and then kept as a reference.
It is important that your doctors and pharmacists know that you are using or have used ciclesonide or any other corticosteroids as this may change the treatment plan. When you have been treated with oral corticosteroids (e.g. prednisone) for prolonged periods and are being transferred to orally inhaled ciclesonide, you may experience withdrawal symptoms (e.g. joint and/or muscular pain and depression). These symptoms should be reported to your doctor, especially if you have associated asthma or another condition in which too rapid a decrease in systemic steroids may cause a severe flare-up of symptoms.
Ciclesonide may mask some signs of infection and new infections may appear. The body tends to have a decreased resistance to infections while on this therapy so anything of this nature should be reported to the doctor.
Due to very low absorption at therapeutic doses, it is unlikely that there would be any important interactions. However, it is important to tell your doctor and pharmacist of any prescription or over-the-counter medications you are taking. In people with hypoprothrombinemia (deficiency of a clotting factor in the blood resulting in an increased tendency to bleed) ASA (e.g. Aspirin®) should be cautiously used in combination with corticosteroids. Drugs containing itraconazole (an azole antifungal), ritonavir or nelfinivir (drugs used in the treatment of HIV or AIDS) may interact with ciclesonide.
Use is not recommended in the following situations:
- Allergy to ciclesonide or any component of the preparation
- Untreated fungal, bacterial or tuberculosis infection of the respiratory tract
- Primary treatment of acute episodes of asthma
Caution is recommended in the following situations:
- eosinophilia (an increased level of certain blood cells in the blood)
- hypoprothrombinemia (difficiency of a clotting factor increasing tendancy to bleed)
- cirrhosis of the liver
- severe liver impairment
- suppressed immune system
- previous treatment for prolonged periods with oral corticosteroids (eg. prednisone)
Use in pregnancy and breastfeeding: Consult your doctor if you suspect you are pregnant or if you are breastfeeding. Ciclesonide should only be used in pregnancy or while breast feeding if the benefit to the mother outweighs the risk to the fetus or baby.