Omnaris Dosing Recommendation
For patients aged 6 years and older with seasonal or perennial allergic rhinitis, administer Omnaris (ciclesonide) nasal spray as 2 sprays per nostril once daily (total 200 mcg/day). 1
Age-Specific Dosing
Children and Adolescents (6-11 years)
- Dose: 2 sprays (50 mcg/spray) per nostril once daily
- Total daily dose: 200 mcg
- Indication: Seasonal allergic rhinitis 2, 1
Adolescents and Adults (≥12 years)
- Dose: 2 sprays (50 mcg/spray) per nostril once daily
- Total daily dose: 200 mcg
- Indications: Both seasonal and perennial allergic rhinitis 2, 1
Important Dosing Considerations
Maximum dose: Do not exceed 2 sprays per nostril (200 mcg total) daily 1. Unlike some other intranasal corticosteroids that allow twice-daily dosing or dose escalation, Omnaris is specifically formulated for once-daily administration only.
Administration Instructions
Initial priming: Before first use, gently shake the bottle and prime the pump by actuating 8 times 1.
Repriming: If not used for 4 consecutive days, shake gently and reprime with 1 spray until a fine mist appears 1.
Timing: Administer once daily at the same time each day for optimal efficacy.
Clinical Context
Omnaris is formulated as a hypotonic aqueous suspension that optimizes intranasal absorption with lower spray volume compared to most other intranasal corticosteroids 3. The formulation lacks benzalkonium chloride and phenyl ethyl alcohol, excipients associated with reduced mucociliary transport and unpleasant sensory perceptions 3.
Common Side Effects
The most frequently reported adverse effects include epistaxis (4.9%), headache (6.0%), nasopharyngitis (3.7%), ear pain (2.2%), and pharyngolaryngeal pain 2, 1. These occur at rates only slightly higher than placebo and are generally mild to moderate in severity.
Safety Profile
Long-term studies up to 52 weeks demonstrate no cortisol suppression, no nasal septal perforation, and no nasal ulceration with recommended dosing 1, 3. The systemic exposure to ciclesonide and its active metabolite is minimal due to high protein binding (~99%) and rapid first-pass clearance 3, 4.
Important Limitation
Omnaris is NOT approved for children under 6 years of age for seasonal allergic rhinitis, though studies in children aged 2-5 years with perennial allergic rhinitis showed similar safety profiles 1. For younger children requiring intranasal corticosteroid therapy, consider alternatives like mometasone (approved ≥2 years) or fluticasone furoate (approved ≥2 years) 2.