What is the recommended dosage and treatment plan for Alvesco (ciclesonide) in patients with asthma?

From the Guidelines

Alvesco (ciclesonide) should be prescribed at an initial dose of 80-160 mcg once daily for mild asthma, and 160-320 mcg once daily for moderate to severe asthma, with a maximum recommended daily dose of 320 mcg, as supported by the most recent guidelines 1. The treatment plan for Alvesco (ciclesonide) in patients with asthma involves administering the medication via oral inhalation, preferably in the evening, and rinsing the mouth after each use to prevent oral thrush.

• Key considerations for treatment include:
  • Initial dose: 80-160 mcg once daily for mild asthma, and 160-320 mcg once daily for moderate to severe asthma
  • Maximum recommended daily dose: 320 mcg
  • Administration: oral inhalation, preferably in the evening
  • Mouth rinsing: after each use to prevent oral thrush
• For patients transitioning from oral corticosteroids, a higher starting dose of 320 mcg twice daily may be appropriate, with gradual tapering of the oral steroid, as recommended by guidelines 1.
• Improvement in symptoms typically begins within 24 hours, though maximum benefit may take 1-4 weeks, and the dose should be adjusted to the lowest effective amount once asthma control is achieved, as indicated by studies 1.
• Patients should be instructed on proper inhaler technique and advised not to stop treatment abruptly, even when feeling better, to maintain optimal asthma control and minimize the risk of exacerbations, as emphasized by recent guidelines 1.

From the FDA Drug Label

The recommended starting dosage and the highest recommended dosage of ALVESCO are listed in Table 1 Table 1: Recommended Dosages for Adults and Pediatric Patients 12 Years and Older Previous Therapy Recommended Starting Dosage Highest Recommended Dosage Patients ≥ 12 years who received bronchodilators alone 80 mcg twice daily 160 mcg twice daily Patients ≥ 12 years who received inhaled corticosteroids 80 mcg twice daily 320 mcg twice daily Patients ≥ 12 years who received oral corticosteroids1 320 mcg twice daily 320 mcg twice daily

The recommended dosage of Alvesco (ciclesonide) for patients with asthma is as follows:

• For patients 12 years and older who received bronchodilators alone, the recommended starting dose is 80 mcg twice daily, with a highest recommended dose of 160 mcg twice daily.
• For patients 12 years and older who received inhaled corticosteroids, the recommended starting dose is 80 mcg twice daily, with a highest recommended dose of 320 mcg twice daily.
• For patients 12 years and older who received oral corticosteroids, the recommended starting dose is 320 mcg twice daily, with a highest recommended dose of 320 mcg twice daily 2. Key points to consider:
• The dose should be titrated to the lowest effective dosage to reduce the possibility of side effects.
• Patients should not exceed the highest recommended dosage per day.
• Asthma stability should be achieved before reducing the dose.
• Patients should be carefully monitored for signs of asthma instability and adrenal insufficiency during steroid taper and following discontinuation of oral corticosteroid therapy.

From the Research

Recommended Dosage and Treatment Plan for Alvesco (Ciclesonide)

The recommended dosage and treatment plan for Alvesco (ciclesonide) in patients with asthma vary depending on the severity of the disease and the patient's response to treatment.

• The usual dosage of ciclesonide for adults and adolescents with asthma is 80-160 micrograms once daily or 80 micrograms twice daily 3.
• Ciclesonide has been shown to be effective in improving lung function and reducing asthma symptoms and rescue medication use in adults and adolescents with asthma of varying severity 4.
• The drug is generally well tolerated, with a low potential for systemic adverse events due to its low systemic bioavailability 4.

Efficacy and Safety of Ciclesonide

• Ciclesonide has been compared to other inhaled corticosteroids, such as budesonide and fluticasone, in several studies, and has been shown to be non-inferior in terms of efficacy 5.
• However, the doses of ciclesonide used in these studies were often higher than the standard doses, which may have favored ciclesonide 5.
• A systematic review suggested that ciclesonide does not have a better adverse effect profile than other inhaled corticosteroids used at equivalent doses 5.
• Ciclesonide has been shown to be effective in maintaining asthma control in patients with mild-to-moderate persistent asthma previously treated with inhaled corticosteroids or inhaled corticosteroids/long-acting beta2-agonists 3.

Fixed-Dose Combination Therapy

• The fixed-dose combination of inhaled corticosteroid and long-acting beta2-agonist therapy has been approved for the treatment of persistent asthma in adults 6.
• This combination therapy has been shown to be more effective in asthma control than inhaled corticosteroid monotherapy, and reduces the daily dosage of inhaled corticosteroid and asthma exacerbation 6.
• The efficacy of each individual combination on asthma treatment is generally similar, and clinical experience, ease of use, cost, and side effects of medication should guide the clinician's preferences 6.