Generic Name

Ciclesonide

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Classification

FDA Approved Indications

• Asthma (inhalation)
• Nasal allergy symptoms (allergic rhinitis)

Mechanism of Action

Ciclesonide is a corticosteroid that exerts anti-inflammatory effects by inhibiting multiple types of inflammatory cells and decreasing the production of cytokines, leading to reduced airway inflammation and hypersensitivity.

Dosage and Administration

Adult: Inhalation for asthma: typically 160-320 mcg/day in divided doses. Nasal spray for allergic rhinitis: 2 sprays per nostril once daily.

Pediatric: Asthma: dosing based on age and severity, generally 80-160 mcg/day. Nasal spray: 1-2 sprays per nostril once daily for children ≥6 years.

Geriatric: Start at the lower end of dosing and titrate based on response.

Renal Impairment: Use with caution; no specific dose adjustment recommended.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Poorly absorbed; minimal systemic absorption after inhalation or intranasal administration.

Distribution: Widely distributed; high first-pass metabolism reduces systemic effects.

Metabolism: Primarily metabolized in the liver via CYP3A4.

Excretion: Metabolites excreted mainly in feces; minimal unchanged drug in urine.

Half Life: Approximately 2-5 hours; systemic effects depend on dose and formulation.

Contraindications

• Hypersensitivity to ciclesonide or other corticosteroids.

Precautions

• Use with caution in active infections of the respiratory tract, tuberculosis, or ocular herpes. Monitor for potential systemic corticosteroid side effects, especially with high doses or prolonged use. Use during pregnancy and lactation only if benefits outweigh risks.

Adverse Reactions - Common

• Nasal irritation, sore throat (Common)
• Headache (Common)
• Cough (Common)

Adverse Reactions - Serious

• Oral candidiasis (thrush) (Uncommon)
• Adrenal suppression (Rare)
• Immunosuppression, hypersensitivity reactions (Rare)

Drug-Drug Interactions

• CYP3A4 inhibitors (e.g., ketoconazole, itraconazole) may increase systemic corticosteroid effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use as directed; do not exceed prescribed dose.
• Rinse mouth after inhaler use to prevent oral thrush.
• Report any signs of infection, adrenal suppression, or unusual side effects.
• Proper inhalation technique is essential for effectiveness.

Special Considerations

Black Box Warnings:

• Potential for systemic corticosteroid effects with prolonged use at high doses.

Genetic Factors: No specific genetic considerations.

Lab Test Interference: May affect adrenal function tests in systemic corticosteroid use.

Overdose Management

Signs/Symptoms: Symptoms of corticosteroid overdose include hyperglycemia, hypertension, and signs of adrenal suppression.

Treatment: Discontinue corticosteroid, supportive measures, and monitor for adverse effects.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions until expiration date.