Alvesco (Ciclesonide) Dosing for a 12-Year-Old
For a 12-year-old patient with asthma, Alvesco (ciclesonide) should be dosed at 80 mcg twice daily initially, with a maximum recommended dose of 160 mcg twice daily depending on previous therapy and asthma severity. 1
Dosing Recommendations Based on Previous Therapy
The FDA-approved dosing for Alvesco in patients 12 years and older follows this pattern:
For patients previously on bronchodilators alone:
- Starting dose: 80 mcg twice daily
- Maximum recommended dose: 160 mcg twice daily
For patients previously on inhaled corticosteroids:
- Starting dose: 80 mcg twice daily
- Maximum recommended dose: 320 mcg twice daily
For patients previously on oral corticosteroids:
- Starting dose: 320 mcg twice daily
- Maximum recommended dose: 320 mcg twice daily 1
Administration Guidelines
- Alvesco is for oral inhalation only
- The inhaler must be primed before first use or when not used for more than 10 days
- Administer as twice daily dosing
- After administration, advise patient to rinse mouth to reduce risk of oral candidiasis 1
Important Considerations
Age Restrictions
Alvesco is FDA-approved only for patients 12 years of age and older. It is not indicated for use in children younger than 12 years. 1
Efficacy and Safety Profile
Clinical studies have demonstrated that ciclesonide once or twice daily is effective in improving lung function and asthma symptoms in patients with mild to moderate persistent asthma. 2, 3
Treatment Approach
For patients aged 12 years and older with mild persistent asthma, the 2020 National Asthma Education and Prevention Program guidelines conditionally recommend either:
- Daily low-dose ICS with as-needed SABA for quick-relief therapy, OR
- As-needed ICS and SABA used concomitantly 4
Safety Considerations
- Monitor for signs of oral Candida albicans infection
- Watch for potential adrenal suppression, especially when transferring from oral corticosteroids
- Growth should be routinely monitored in pediatric patients receiving Alvesco 1
Common Side Effects
The most common adverse reactions (≥3%) reported with Alvesco use include:
- Headache
- Nasopharyngitis
- Sinusitis
- Pharyngolaryngeal pain
- Upper respiratory infection
- Arthralgia
- Nasal congestion
- Pain in extremity
- Back pain 1
Ciclesonide has demonstrated a favorable safety profile regarding growth effects compared to some other inhaled corticosteroids, which may be an important consideration in pediatric patients. 3
Remember that Alvesco is indicated for maintenance treatment of asthma as prophylactic therapy and is not for relief of acute bronchospasm. Always ensure proper inhaler technique and adherence to the prescribed regimen for optimal therapeutic benefit.