Ciclesonide is a synthetic corticosteroid designed to mimic hormones produced by the body’s adrenal glands. Its primary function is as a potent anti-inflammatory agent formulated to target the respiratory system. It works by decreasing swelling and irritation in the airways, offering a localized approach to managing conditions that affect breathing and nasal passages.
Medical Uses of Ciclesonide
Ciclesonide’s application is specific to inflammatory respiratory conditions, with its formulation determining its use. For the long-term management of asthma in adults and children 12 years of age and older, it is administered via an oral inhaler like Alvesco. This form is intended to prevent and reduce symptoms like wheezing and shortness of breath by controlling inflammation in the lungs’ airways. It is designed for regular, preventative use to maintain control over asthma.
A different formulation is available as a nasal spray to treat symptoms of allergic rhinitis, also known as hay fever. This version, marketed under brand names like Omnaris and Zetonna, alleviates nasal symptoms such as congestion, sneezing, and a runny nose by reducing inflammation in the nasal passages. Similar to the asthma formulation, the nasal spray is meant for consistent use to manage and control allergy symptoms.
How Ciclesonide Works
Ciclesonide functions as a prodrug, meaning it is administered in an inactive state and activated only after it reaches its target. When inhaled or sprayed into the nasal passages, enzymes called esterases convert ciclesonide into its active form, des-ciclesonide. This localized conversion is a key aspect of its design, concentrating the medication in the respiratory tract.
Once activated, des-ciclesonide binds to glucocorticoid receptors inside airway cells. This action suppresses multiple pro-inflammatory genes, stopping cells from producing substances that promote inflammation, such as cytokines and prostaglandins. By inhibiting these pathways, the medication reduces swelling, decreases mucus production, and calms irritation in the airways, which makes breathing easier.
Ciclesonide is a controller medication for long-term maintenance, not for providing immediate relief. Its mechanism prevents the onset of symptoms over time, so it is not effective for stopping an asthma attack that has already begun. Patients are prescribed a separate, short-acting rescue inhaler for sudden episodes. The full benefit of ciclesonide may take four weeks or longer to become apparent as it gradually brings airway inflammation under control.
Administration and Dosage
For the oral inhaler used for asthma, such as Alvesco, the device does not need to be shaken. If the inhaler is new or has not been used for more than a week, it should be primed by spraying it three times into the air, away from the face. To use it, breathe out fully, place the mouthpiece in your mouth with lips sealed around it, and press down on the canister while inhaling slowly and deeply. Holding your breath for about 10 seconds after inhalation helps the medication settle in the lungs.
To prevent oral side effects like hoarseness or yeast infections, rinse your mouth with water and spit it out after each use. The inhaler’s mouthpiece should be cleaned regularly. Dosage is determined by a physician based on the patient’s condition. If a prescribed dose involves two puffs, patients should wait at least one minute between each puff.
Nasal spray formulations, like Omnaris or Zetonna, must be primed before first use or after a period of non-use by shaking the bottle and spraying it into the air until a fine mist appears. To administer the dose, gently blow your nose to clear the nostrils, shake the bottle, and insert the tip into one nostril. While pointing the spray tip away from the nasal septum and blocking the other nostril, spray the medication while breathing in gently through the nose. Repeat for the other nostril as prescribed.
Potential Side Effects and Precautions
Potential Side Effects
Side effects from ciclesonide are often localized. Common side effects for the inhaled form include headache, sore throat, irritation in the nose and throat, and hoarseness. Painful white patches in the mouth or throat, which can indicate a fungal infection, may also occur. For the nasal spray, common effects include headache, nosebleeds, and irritation of the nasal passages and throat.
More significant side effects can arise that require medical attention. These can include signs of an infection, as corticosteroids can mask or worsen existing infections. Changes in vision, such as blurred vision or the development of glaucoma or cataracts, have been associated with long-term use and warrant consultation with a healthcare provider. Any worsening of breathing problems after using the medication should be reported to a doctor immediately.
Precautions and Warnings
Before starting treatment, patients should inform their healthcare provider of their complete medical history. It is important to mention any active or past infections, especially tuberculosis. The presence of eye conditions like glaucoma, cataracts, or ocular herpes requires careful consideration. Patients who have had recent nasal surgery, injury, or ulcers should also disclose this, as corticosteroids can affect healing.
Individuals who are pregnant, planning to become pregnant, or breastfeeding should discuss using ciclesonide with their doctor. Long-term use of corticosteroids may affect bone strength, so factors like smoking or a family history of osteoporosis should be discussed. In children, long-term use may temporarily slow growth, though poorly controlled asthma can also impact growth. Regular medical check-ups are important to monitor for any adverse effects.