Maximum Recommended Dose of Alvesco (Ciclesonide)
The maximum recommended dose of Alvesco (ciclesonide) is 320 mcg twice daily (640 mcg total daily dose) for patients 12 years of age and older. 1
Dosage Guidelines by Patient Population
Adults and Adolescents ≥12 years:
Starting dose recommendations:
- Patients previously on bronchodilators alone: 80 mcg twice daily
- Patients previously on inhaled corticosteroids: 80 mcg twice daily
- Patients previously on oral corticosteroids: 320 mcg twice daily 1
Maximum recommended doses:
- Patients previously on bronchodilators alone: 160 mcg twice daily
- Patients previously on inhaled corticosteroids: 320 mcg twice daily
- Patients previously on oral corticosteroids: 320 mcg twice daily 1
Children <12 years:
- Alvesco is not indicated for use in pediatric patients less than 12 years of age 1
Administration Guidelines
- Alvesco is for oral inhalation use only
- The inhaler must be primed before first use or when not used for more than 10 days 1
- Administer as directed, typically twice daily
- Patients should rinse their mouth after inhalation to reduce the risk of oral candidiasis 1
Clinical Efficacy at Different Doses
Clinical studies have demonstrated that:
- Once-daily administration of ciclesonide at doses of 100,200, or 400 mcg was effective in adults with mild to moderate asthma 2
- Ciclesonide 160 mcg once daily was as effective as fluticasone propionate 88 mcg twice daily in improving lung function and asthma symptoms 3
- In children with asthma, ciclesonide 160 mcg once daily showed comparable efficacy to budesonide 400 mcg once daily 4
Safety Considerations
Common adverse reactions (≥3%) include headache, nasopharyngitis, sinusitis, pharyngolaryngeal pain, upper respiratory infection, arthralgia, nasal congestion, pain in extremity, and back pain 1
Potential safety concerns:
- Candida albicans infection of the mouth and pharynx
- Potential worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infections
- Risk of impaired adrenal function when transferring from oral steroids
- Possibility of hypercorticism and HPA axis suppression at very high doses
- Potential growth suppression in children (monitor growth routinely)
- Risk of glaucoma, increased intraocular pressure, and posterior subcapsular cataracts 1
Important Monitoring Parameters
- Monitor for signs of oral candidiasis
- For patients transferring from oral corticosteroids, taper oral prednisone gradually (no faster than 2.5 mg/day on a weekly basis)
- Monitor for signs of adrenal insufficiency during steroid taper
- In pediatric patients, monitor growth routinely
- Monitor patients with a history of increased intraocular pressure, glaucoma, or cataracts 1
Contraindications
- Status asthmaticus or other acute episodes of asthma where intensive measures are required
- Known hypersensitivity to ciclesonide or any ingredients of Alvesco 1
Clinical Pearl
When prescribing Alvesco at the maximum dose (320 mcg twice daily), be aware that this is typically reserved for patients with more severe asthma or those transitioning from oral corticosteroids. For most patients with mild to moderate asthma, lower doses are often sufficient to maintain control while minimizing potential adverse effects.