Ciclesonide

ALVESCO, OMNARIS

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Pronunciation: sye-KLES-oe-nide (al-VES-koe)

Ciclesonide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Ciclesonide ballicule

What it isInhaled glucocorticoid prodrug activated in the lung; maintenance treatment of asthma.

Why this onePulmonary activation and low oropharyngeal activity reduce thrush compared with many inhaled steroids.

What limits itStill requires mouth rinsing and is a controller, not a rescue inhaler.

Ciclesonide molecular structure (skeletal formula) — Molecular structure: Ciclesonide

Ciclesonide prescription history

Animated chart of estimated U.S. prescriptions per year, Asthma/COPD meds (1924–2026). Ciclesonide enters in 2008 (estimated).

FDA-approved for

asthma maintenance (2006)
allergic rhinitis

Principal riskOral candidiasis, less than other inhaled steroids

Classes and tags

Clinical profile

Therapeutic safety burden0 / 4

Overdose danger0 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Asthma maintenance — prior bronchodilators alone	≥12 yr	80 mcg BID	80 mcg BID	160 mcg BID
Asthma maintenance — prior inhaled corticosteroids	≥12 yr	80 mcg BID	80–320 mcg BID	320 mcg BID
Asthma maintenance — prior oral corticosteroids	≥12 yr	320 mcg BID	320 mcg BID	320 mcg BID

Renal Undefined

Hepatic Undefined

Instructions

Oral inhalation only
Prime before first use or when not used for >10 days (actuate 3 times)
Rinse mouth with water and spit out after each use (reduce oropharyngeal candidiasis)
When transferring from oral steroids: reduce prednisone gradually, no faster than 2.5 mg/day weekly, beginning after ≥1 week of Alvesco

Available strengths

inhaler 80, 160 mcg/inh
nasal spray 50 mcg/spray

Contraindications

Primary treatment of status asthmaticus or acute asthma episodes requiring intensive measures

Cautions

Oropharyngeal candidiasis — rinse mouth after use
Risk of impaired adrenal function when transferring from oral steroids; HPA suppression at high doses
Immunosuppression — more serious/fatal course of chickenpox/measles; worsening infections
Growth suppression in children; glaucoma, increased IOP, cataracts
Reduction in bone mineral density

Adverse reactions

Headache, nasopharyngitis, sinusitis, pharyngolaryngeal pain
Upper respiratory infection, nasal congestion
Arthralgia, back pain, pain in extremity

Pregnancy No human data; low systemic exposure at recommended dose — maintain asthma control

Lactation No human data; low systemic exposure — consider benefits vs. risks

Cost

Ciclesonide (ALVESCO, OMNARIS)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/unit	brand $/unit	CostPlus
80 mcg/inh	inhaler	per unit	—	$42.96/g	not offered
160 mcg/inh	inhaler	per unit	—	$42.97/g	not offered

Generic entry2028 est.

Active metabolites

Des-ciclesonide

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Self-check

Where is ciclesonide activated?
In the lung.
Does ciclesonide’s lower thrush risk remove the need to rinse?
No.