ciclesonide (nasal) (si-kless-o-nide)
Therapeutic: allergy, cold, and cough remedies
Symptomatic management of seasonal/perennial allergic rhinitis.
Acts as a potent, locally acting anti-inflammatory and immune modifier. Therapeutic Effects: Decreased symptoms of allergic rhinitis.
Adverse Reactions/Side Effects
CNS: headache. EENT: ear pain, epistaxis, local stinging, nasopharyngitis. Endo: adrenal suppression (↑ dose, long-term therapy only).
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.
Monitor symptoms of allergic rhinitis (nasopharyngeal pain, inflammation, itching, mucous discharge) to help document whether this drug is successful in managing these symptoms.
Advise patient not to exceed the recommended dose or frequency of intranasal applications.
Advise patients on long-term treatment to consult physician before stopping this medication. Stopping the medication suddenly may result in adrenocortical shock (severe hypotension, hypoglycemia, weakness, vomiting). If these signs appear, notify physician immediately; may be life threatening.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, ear pain, or nasal problems (inflammation, nosebleeds, local pain/stinging).
Absorption: <1% systemically absorbed following intranasal administration.
Distribution: Action is primarily local.
Metabolism and Excretion: Activated by enzymatic conversion to des-ciclesonide, which is the pharmacologically active drug. Small amounts absorbed are metabolized by the liver.
Contraindicated in: Hypersensitivity.
Use Cautiously in: Concurrent ketoconazole; OB/Lactation: Safe use in pregnancy or lactation not established; Pedi: Safe use in children <12 yr not established.
Drug-Drug: Ketoconazole↑ blood levels; use cautiously.
PO (Adults): 2 sprays (50 mcg/spray) in each nostril once daily.
Aqueous suspension spray for nasal use: 50 mcg/actuation in 12.5-g bottles.