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INTRODUCTION

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ciclesonide (nasal) (si-kless-o-nide)

Omnaris

Classification

Therapeutic: allergy, cold, and cough remedies

Pharmacologic: corticosteroids

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Indications
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Symptomatic management of seasonal/perennial allergic rhinitis.

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Action
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Acts as a potent, locally acting anti-inflammatory and immune modifier. Therapeutic Effects: Decreased symptoms of allergic rhinitis.

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Adverse Reactions/Side Effects
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CNS: headache. EENT: ear pain, epistaxis, local stinging, nasopharyngitis. Endo: adrenal suppression (↑ dose, long-term therapy only).

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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.

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Patient/Client-Related Instruction
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  • 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).

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Pharmacokinetics
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Absorption: <1% systemically absorbed following intranasal administration.

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Distribution: Action is primarily local.

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Protein Binding: >99%.

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Metabolism and Excretion: Activated by enzymatic conversion to des-ciclesonide, which is the pharmacologically active drug. Small amounts absorbed are metabolized by the liver.

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Half-life: Unknown.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
intranasal 24–48 hr 1–5 wk unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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Use Cautiously in: Concurrent ketoconazole; OB/Lactation: Safe use in pregnancy or lactation not established; Pedi: Safe use in children <12 yr not established.

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Interactions
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Drug-Drug: Ketoconazole↑ blood levels; use cautiously.

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Route/Dosage
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PO (Adults): 2 sprays (50 mcg/spray) in each nostril once daily.

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Availability
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Aqueous suspension spray for nasal use: 50 mcg/actuation in 12.5-g bottles.

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