Alvesco
Alvesco (ciclesonide) is a steroid inhaler used for the maintenance treatment of asthma in adults and children age 12 years and older. It's inhaled by mouth twice daily. When used regularly, Alvesco (ciclesonide) can lower the number and severity of asthma attacks. But it's not a rescue inhaler, so it won't help an asthma attack that has already started. Some common side effects this medication can cause include stuffy nose, sore throat, and headaches.
What is Alvesco (ciclesonide)?
What is Alvesco (ciclesonide) used for?
Maintenance treatment of asthma in people age 12 years and older
How Alvesco (ciclesonide) works
Alvesco (ciclesonide) is a corticosteroid. The exact way that it works to treat asthma isn't know. But it's thought to work directly in your lungs to lower the activities of many cell types and chemical signals that can trigger asthma. This helps control asthma and prevents asthma attacks.
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What are the side effects of Alvesco (ciclesonide)?
Common Side Effects
- Stuffy nose or swelling in the throat (7-11%)
- Headache (5-11%)
- Runny nose, cough, and other symptoms of an upper respiratory tract infection (4-9%)
- Sore throat (2-5%)
Other Side Effects
- Fungal infection in mouth
- Dry mouth or throat
- Joint pain
- Back pain and pain in the hands and feet
- Nausea
Serious Side Effects
- Serious allergic reaction: hives, swelling of your face, lips, or tongue, difficulty breathing
- Sudden narrowing of your airways: difficulty breathing, wheezing, chest pain or tightness, cough
- Changes to stress hormone levels: weight gain around your gut, puffiness of the face, muscle weakness in arms or legs, easy bruising, stretch marks around the belly, tiredness, mood changes, irregular menstrual periods, nausea, vomiting
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Body aches or pain
chills
difficulty in breathing
ear congestion
headache
loss of voice
muscle aches
pain or tenderness around eyes and cheekbones
shortness of breath or troubled breathing
stuffy or runny nose
tightness of chest or wheezing
unusual tiredness or weakness
Rare
Sore mouth or tongue
white patches in mouth and/or on tongue
Incidence not known
Blindness
blurred vision
creamy white, curd-like patches in mouth or throat
darkening of skin
decreased vision
dizziness
fainting
hoarseness
lack or slowing of normal growth in children
large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
lower back or side pain
mental depression
pain when eating or swallowing
painful or difficult urination
skin rash
tearing
vomiting
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Alvesco (ciclesonide)
Pros
Works well to prevent and lower asthma symptoms
Can be used with a spacer if you have trouble getting the full dose with the inhaler
Few known interactions with other medications
Cons
Doesn't replace your rescue inhaler and will not help your symptoms during an asthma attack
It can take up to a month or longer before you see symptoms improve
Can't be used in children under 12 years old
Might raise your risk for infections
Pharmacist tips for Alvesco (ciclesonide)
Use Alvesco (ciclesonide) twice daily at the same times every day. This medication works best if it's taken regularly every day.
If you have sudden trouble breathing during an asthma attack, use your rescue inhaler. Alvesco (ciclesonide) won't be able to relieve your asthma symptoms right away.
Make sure you know how to use your Alvesco (ciclesonide) inhaler. Doing so helps make sure it's working as best as possible to control your asthma. Carefully read the instructions on how to use your inhaler and ask your provider or pharmacist if you have any questions.
You don't need to shake your Alvesco (ciclesonide) inhaler before using it.
If you're using a new inhaler for the first time or if you haven't used it in more than 10 days, you'll need to prime your inhaler. To prime the inhaler, hold it upright and away from your face and spray 3 times.
After priming the inhaler, the dose counter on the back of the inhaler should read "60". Use the dose counter to track how many doses you have left so you know when to get a refill. The counter counts down by 10 and will move every 10th time you take a puff. When the display window shows a red zone, that means you only have 20 inhalations left and you should get a refill.
When the display window reads "0", throw your inhaler away, even if the canister isn't completely empty.
After each time you use the inhaler, hold your breath for up to 10 seconds or for as long as you comfortably can. This allows time for the medication to reach deep into your lungs.
Clean the mouthpiece of the inhaler using clean, dry tissues at least once weekly.
Call your provider if your breathing or peak flow meter results worsen. Also contact your provider if you're using your rescue inhaler more often than usual. These could be signs that your Alvesco (ciclesonide) dose is too low, or you need another long-acting medication to help manage your asthma.
Frequently asked questions about Alvesco (ciclesonide)
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What are the risks and warnings for Alvesco (ciclesonide)?
Alvesco (ciclesonide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Fungal infection in the mouth
Risk factor: Not rinsing and spitting after using Alvesco (ciclesonide) | Weakened immune system from medical conditions or medications
Alvesco (ciclesonide) is a steroid medication. When inhaled through the mouth, it can cause a fungal infection in your mouth and throat called thrush. To lower your risk for thrush, make sure to rinse your mouth with water and spit after each inhalation of Alvesco (ciclesonide). If you've thrush, your provider might prescribe you medication to treat this condition. Let your provider know if you notice symptoms of thrush, such as white patches in your mouth, cotton-like feeling in your mouth, pain while eating or swallowing, or loss of taste.
Narrowing of your airways (bronchospasm)
Inhaled medications, including Alvesco (ciclesonide), can sometimes cause a muscle spasm in your lungs (bronchospasm). This can lead to difficulty breathing, wheezing, cough, and chest discomfort. If you have a hard time breathing after inhaling Alvesco (ciclesonide), use your rescue inhaler and get medical attention right away.
Higher risk of infections
Like all corticosteroids, it's possible for Alvesco (ciclesonide) to weaken your immune system and raise your risk for infections. Your risk is higher if you're also taking other medications that can weaken your immune system. If you're currently being treated for a serious infection, such as tuberculosis, let your provider know. They might need to consider a different medication for your asthma. Let your provider know right away if you have symptoms of infections, such as fever, chills, body aches.
Altered stress hormone levels
Risk factors: Using Alvesco (ciclesonide) for a long time | Using too much Alvesco (ciclesonide)
Using Alvesco (ciclesonide) for long periods of time or at a dose that's higher than recommended can cause more medication to be absorbed into the body. This can affect your body in different ways since the medication acts similar to cortisol (a natural stress hormone made by your body). You might experience symptoms of too much cortisol (called Cushing's disease), such as weight gain around your gut, puffiness of your face, and muscle weakness in the arms and legs.
On the other hand, Alvesco (ciclesonide) can also cause your body to make less natural cortisol. Symptoms of low cortisol include long-lasting fatigue, loss of appetite, nausea, and vomiting. If either problem is severe enough, you might need additional medical treatment.
Use Alvesco (ciclesonide) only as directed. Don't use more than the maximum number of inhalations each day. Use the lowest dose possible for the shortest amount of time.
Delayed growth in children
It's possible for children to experience a delay in growth during treatment with Alvesco (ciclesonide). There isn't enough information available to know what the long-term effects of Alvesco (ciclesonide) are on children's growth. Children should use the lowest dose for the shortest amount of time needed. If you're concerned about how Alvesco (ciclesonide) might affect your child's growth, discuss with your child's provider to see if this medication is right for them.
Eye and vision problems
Risk factors: History of glaucoma or cataracts
Though rare, people taking Alvesco (ciclesonide) have reported having higher pressure in the eyes, glaucoma, and cataracts. Talk to your eye provider before using Alvesco (ciclesonide) if you have glaucoma or cataracts because they might ask you to come in more often for eye exams. Also speak with them if you notice any changes to your vision while using the medication.
Alvesco (ciclesonide) dosage forms
Typical dosing for Alvesco (ciclesonide)
Alvesco (ciclesonide) is available as inhalers with either 80 mcg or 160 mcg of ciclesonide in each inhalation.
The typical dose is either 80 mcg, 160 mcg, or 320 mcg inhaled twice daily.
Your provider will pick a starting dose based on which other asthma medications you were previously taking before starting Alvesco (ciclesonide). After starting Alvesco (ciclesonide), your provider will adjust your dose based on how well the medication is controlling your asthma symptoms and if you're having side effects.
Interactions between Alvesco (ciclesonide) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Bemiparin
- Lutetium Lu 177 Dotatate
- Macimorelin
- Nadroparin
- Ritonavir
- Sargramostim
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Auranofin
How much does Alvesco (ciclesonide) cost?
Alvesco (ciclesonide) contraindications
Treatment of sudden asthma attack
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References
Best studies we foundAmerican Lung Association. (2023). Measuring your peak flow rate.
Centers for Disease Control and Prevention. (2021). Candida infections of the mouth, throat, and esophagus.
Covis Pharma US, Inc. (2023). ALVESCO- ciclesonide aerosol, metered. DailyMed.
Erlem D. J., et al. (2014). The cell biology of asthma. Journal of Cell Biology.
Global Initiative for Asthma. (2022). Global strategy for asthma management and prevention.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Symptoms & causes of adrenal insufficiency & Addison’s Disease.
White, M. (1999). Mediators of inflammation and the inflammatory process. The Journal of Allergy and Clinical Immunology.
You and Your Hormones. (2020). Cushing’s disease.
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