1 What is Alvesco?

Brand: Alvesco

Generic: Ciclesonide

Alvesco is an inhalational steroid which utilizes a novel approach to improve topical/systemic activity ratio. It is a prodrug that is cleaved by esterases in the bronchial epithelium in order to release the active moiety. 

Although it is absorbed from the lungs, there is oral bioavailability accounting <1%. In the circulation, Ciclesonide is extensively bound to plasma proteins resulting in minimized exposure of tissue cells to the free and active drug. Such inhaled steroids are safe during pregnancy.

2 What To Know Before Using

Before using Alvesco, you must know all about the risks and complications associated with it.Inhaled steroids are glucocorticoids with high topical and low systemic activity due to poor absorption and/or marked first pass metabolism. 

Beclomethasone, budesonide and fluticasone are the inhalational steroid having similar properties. Ciclesonide is the newer addition. 

Asthma is primarily an inflammatory disorder which, if not controlled, accentuates with time, and the availability of inhaled steroids that produce few adverse effects has led to early introduction and more extensive use of glucocorticoids in asthma. 

Although glucocorticoids are not bronchodilators, they benefit by reducing bronchial hyperactivity, mucosal edema and by suppressing inflammatory response.

Corticosteroids afford more complete and sustained symptomatic relief than bronchodilators or cromoglycate; improve airflow, reduce asthma exacerbations and may influence airway remodeling, retarding disease progression. 

They also increase airway smooth muscle responsiveness to beta-2 agonists and reverse refractoriness to these drugs. Inhaled corticosteroids have thus markedly changed the outlook on asthma therapy. 

Because airway inflammation is present in early mild disease as well, and bronchial remodeling starts developing from the beginning, it has been advocated that inhaled steroids should be the ‘step one’ for all asthma patients. 

However, currently inhaled steroids are not considered necessary for patients with mild and episodic asthma. They are indicated in all cases of persistent asthma when inhaled beta-2 agonists are required almost daily or the disease in not only episodic. 

The airway inflammation in COPD is not very responsive to corticosteroids. As such, only high dose inhaled steroids are beneficial in advanced COPD with frequent exacerbations; should not be used in early/mild cases. There is no proof that they slow disease progression. 

3 Proper Usage

If you are about to start Alvesco, speak with your doctor about what you need to know. Inhaled steroids suppress bronchial inflammation, increase peak expiratory flow rate, reduce need for rescue beta-2 agonist inhalations and prevent episodes of acute asthma. However, they have no role during an attack or in status asthmaticus. 

Peak effect is seen after 4–7 days of instituting inhaled steroids and benefit persists for a week after discontinuation. They can be started in patients who in the past have required oral steroids as well as in those with no such history. 

Patients who are to be switched over from oral steroid should receive inhaled steroid in addition for 1–2 weeks before oral steroid is tapered, otherwise steroid withdrawal may manifest (precipitation of asthma, muscular pain, lassitude, depression, hypotension). 

This confirms lack of systemic activity of inhaled steroids (at doses <600 microgram/day). Long-term experience has shown that efficacy of inhaled steroids is seldom needed. 

Short courses of oral steroids may be added during periods of exacerbation. Some patients who remain well controlled for long periods can even stop inhaled steroids without worsening of asthma.

In order to combat asthma, adults should start with 100-200 mcg once daily, preferably in the evening from a metered-dose inhaler. The dose can be reduced to 80 mcg once daily for maintenance.

4 Precautions To Take

In using Alvesco, you must be careful and take some precautions as advised by your doctor.

Choosing an appropriate drug is the most important matter in order to treat a disease effectively. This decision is recommended to be taken by a health professional with your active participation. 

The risk: benefit ratio should be considered before starting a drug therapy. If you have had any allergic reactions to any medicine then you must inform your doctor about that. 

You should visit your doctor routinely to make sure this drug is working properly or not. You should take this medicine exactly as directed by your doctor. Never try to increase either the frequency of drug administration or the dosage of the drug. 

You will make yourself more prone to infections. Some important measures should be taken if you feel any discomfort following this drug therapy. You are advised not to stop taking the drug abruptly. 

Monitor height of children and adolescents on long-term treatment with inhaled corticosteroids. If growth is hampered, it is recommended to discontinue the therapy. Ciclesonide is not given for status asthmaticus or severe acute asthma where intensive measures are needed.  

Some drug interactions are noticed when ciclsonide is used concurrently with ketoconazole, itraconazole, ritonavir and nelfinavir. 

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

5 Potential Side Effects

Alvesco comes with few or more unwanted adverse effects. Ciclosonide is also responsible for some potential side effects such as hoarseness of voice, dysphonia, sore throat, asymptomatic, or symptomatic oropharyngeal candidiasis etc. 

These effects are considered as the most common side effects. The use of a spacer, gargling after every dose to wash off the drug deposited on oral and pharyngeal mucosa helps one to get rid of those undesirable effects. 

In addition, topical nystatin or clotrimazole is prescribed for prevention of such hazards, and for treatment also. There is no evidence of mucosal damage or increased incidence of chest infections even after long-term therapy.

Long-term inhaled glucocorticoids only at doses >600 microgram/day may cause some systemic side effects like mood changes, osteoporosis, growth retardation in children, bruising, petechiae, hyperglycaemia, and pituitary-adrenal suppression. There are several reports of adrenal crisis, especially in children and during stress of an infection. 

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