ciclesonide: clinical use

Prescribing considerations

• Confirm persistent asthma and that the patient is within the licensed age group.
• Not for status asthmaticus or acute symptoms.
• Check technique, adherence, symptom control and access to an appropriate reliever.
• Consider AeroChamber Plus when actuation and inspiration are difficult to coordinate.
• Take particular care when transferring from systemic corticosteroids because impaired adrenal reserve may persist.

Contraindications and cautions

• Hypersensitivity to ciclesonide or an excipient.
• Use cautiously in active or quiescent pulmonary tuberculosis and treated fungal, viral or bacterial respiratory infection.
• Severe hepatic impairment may increase systemic exposure.
• Avoid potent CYP3A4 inhibitors unless the expected benefit outweighs the systemic corticosteroid risk.

Monitoring

• Asthma symptoms, reliever use and pulmonary function where appropriate.
• Inhaler technique.
• Signs of systemic corticosteroid exposure.
• Adrenal function when clinically indicated, particularly during or after transfer from systemic corticosteroids.
• Growth in adolescents receiving prolonged treatment.
• Visual symptoms, with ophthalmology assessment when indicated.

Clinical pharmacology

Lung esterases hydrolyse ciclesonide to an active anti-inflammatory metabolite. Oral bioavailability is negligible. Further metabolism is mainly CYP3A4-mediated, with elimination predominantly through faeces.

Formulation and product differences

• Clear, colourless pressurised inhalation solution containing HFA-134a propellant and ethanol.
• Shaking is unnecessary because it is a solution aerosol.
• The named compatible spacer is AeroChamber Plus.
• Clean the mouthpiece with a dry tissue or cloth; do not place it in water.
• Protect the pressurised container from excessive heat; do not puncture or burn it.

Inhaled preparation

Route: Inhaled

Strengths: 80 micrograms/metered dose, 160 micrograms/metered dose