the jobs [1%:20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections. Select surgical patients on long-term, high-dose, inhaled corticosteroid (ICS), should be given stress doses of hydrocortisone intravenously during the surgical period and the dose reduced rapidly within 24 hours after surgery (NAEPP 2007). Bronchospasm: May occur with wheezing after inhalation; if this occurs, stop steroid and treat with a fast-acting bronchodilator. Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox and measles should be avoided; use caution in patients with active or quiescent TB infections or in patients with ocular herpes. Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered. Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Preexisting psychiatric conditions may be exacerbated by corticosteroid use. Thrush: Candida albicans infections (mostly mild to moderate) of the mouth and pharynx may occur with orally inhaled corticosteroid use; interruption of therapy may be necessary at times while antifungal therapy is employed; advise patients to rinse mouth after use. Vasculitis: Rare cases of vasculitis (eosinophilic granulomatosis with polyangiitis [formerly known as Churg-Strauss]) or other eosinophilic conditions (eg, vasculitic rash, decreased pulmonary function, cardiac complications) can occur. Disease-related concerns: Asthma: Supplemental steroids (oral or parenteral) may be needed during stress or severe asthma attacks. Not to be used in status asthmaticus or for the relief of acute bronchospasm. Cardiovascular disease: Use with caution following acute MI; corticosteroids have been associated with myocardial rupture. Use with caution in patients with HF; long-term use has been associated with fluid retention and hypertension. Diabetes: Use with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia. Hepatic impairment: Systemic exposure to the active metabolite is increased in moderate to severe impairment; however, dosage adjustments are not recommended in hepatic impairment; monitor for increased systemic effects, particularly in patients with severe hepatic impairment, including cirrhosis. Myasthenia gravis: Use with caution in patients with myasthenia gravis; exacerbation of symptoms has occurred with corticosteroids especially during initial treatment. Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Consider routine eye exams in chronic users. Osteoporosis: Use with caution in patients with osteoporosis; high doses and/or long-term use of corticosteroids have been associated with increased bone loss and osteoporotic fractures. Renal impairment: Use in renally impaired patients has not been studied; however, 20% of drug is eliminated renally. Seizure disorders: Use with caution in patients with a history of seizure disorder; seizures have been reported with adrenal crisis. Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid ones. Special populations: Elderly: Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in elderly patients in the smallest possible effective dose for the shortest duration. Pediatric: Orally inhaled corticosteroids may cause a reduction in growth velocity in pediatric patients (~1 cm per year [range: 0.3 to 1.8 cm per year] and related to dose and duration of exposure). To minimize the systemic effects of orally inhaled corticosteroids, each patient should be titrated to the lowest effective dose. Growth should be routinely monitored in pediatric patients. Other warnings/precautions: Discontinuation of therapy: Withdraw systemic therapy with gradual tapering of dose. There have been reports of systemic corticosteroid withdrawal symptoms (eg, joint/muscle pain, lassitude, depression) when withdrawing oral inhalation therapy. Monitoring Parameters Growth (adolescents and children via stadiometry) signs/symptoms of HPA axis suppression/adrenal insufficiency; ocular effects (eg, cataracts, increased intraocular pressure, glaucoma); bone mineral density; signs/symptoms of oral candidiasis; FEV 1 , peak flow, and/or other pulmonary function tests Pregnancy Risk Factor C Pregnancy Considerations Adverse events were observed in some animal reproduction studies. Hypoadrenalism may occur in infants born to mothers receiving corticosteroids during pregnancy. Based on available data, an overall increased risk of congenital malformations or a decrease in fetal growth has not been associated with maternal use of inhaled corticosteroids during pregnancy (Bakhireva 2005; NAEPP 2005; Namazy 2004). Uncontrolled asthma is associated with adverse events in pregnancy (increased risk of perinatal mortality, pre-eclampsia, preterm birth, low birth weight infants). Inhaled corticosteroids are recommended for the treatment of asthma during pregnancy (most information available using budesonide) (ACOG 2008; NAEPP 2005). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience headache, rhinitis, pharyngitis, sinus pain, common cold symptoms, back pain, or painful extremities. Have patient report immediately to prescriber signs of infection, signs of adrenal gland problems (severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss), signs of Cushing s disease (weight gain in upper back or abdomen; moon face; severe headache; or slow healing), difficulty breathing, wheezing, cough, severe loss of strength and energy, irritability, tremors, tachycardia, confusion, dizziness, sweating, thrush, angina, bone pain, joint pain, or vision changes (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about ciclesonide Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group En Español 15 Reviews Add your own review/rating Drug class: inhaled corticosteroids Consumer resources Ciclesonide inhalation Ciclesonide (Oral Inhalation) Ciclesonide Inhalation (Advanced Reading) Professional resources Ciclesonide (Systemic, Oral Inhalation) (AHFS Monograph) Other brands: Alvesco Related treatment guides Asthma Asthma, Maintenance] Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Ciclesonide Rating 15 User Reviews 7.4 /10 15 User Reviews 7.4 Rate it! Drug Class Inhaled corticosteroids Related Drugs inhaled corticosteroids fluticasone , budesonide , mometasone , Qvar , Flovent , Flovent HFA Asthma, Maintenance Symbicort , albuterol , fluticasone , montelukast , ProAir HFA , Singulair , Advair Diskus , budesonide , Breo Ellipta , Ventolin , Medrol , methylprednisolone , More... Asthma prednisone , triamcinolone , montelukast , Singulair , ipratropium , Breo Ellipta , Medrol , dexamethasone , methylprednisolone , Dulera , Medrol Dosepak , Xopenex , More... a chosen
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