Ciclesonide (Nasal)

INTRODUCTION

Indications

Symptomatic management of seasonal/perennial allergic rhinitis.

Action

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.

Patient/Client-Related Instruction

• 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).

Pharmacokinetics

Absorption: <1% systemically absorbed following intranasal administration.

Distribution: Action is primarily local.

Protein Binding: >99%.

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

Half-life: Unknown.

Contraindications/Precautions

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.

Interactions

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

Route/Dosage

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

Availability

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