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Alvesco MDI (ciclesonide) is an inhaled corticosteroid used either alone or with other medications to manage symptoms of asthma over the long term. It does not provide fast-acting relief and should not be used in place of epinephrine, albuterol, or any other rescue inhaler.

Like all steroids, over time Alvesco MDI reduces inflammation in the airways and inhibits the immune system's response to allergens. This action reduces the frequency and severity of asthma attacks, but is unlikely to eliminate them altogether.

Long-Term Asthma Management

The MDI in this product's name stands for Metered Dose Inhaler, which means each puff delivers a precise amount of medication. It is available in two strengths:

• 80 mcg per puff
• 160 mcg per puff

The larger dose inhaler is convenient for patients who need to take more than 80 mcg in a dose, but it is not necessary; achieving 160 mcg through 2 puffs of an 80 mcg inhaler will provide the same benefit as receiving it through 1 puff of a 160 mcg inhaler.

Inhalers need to be primed before first use, which can be done by simply spraying the inhaler into the air 3 times prior to the first puff. Priming should be repeated any time the inhaler has gone unused for more than 10 days. Alvesco MDI does not need to be shaken before use.

Treatment is straightforward once the ideal dosage has been found:

• Start with 80 mcg, taken twice daily, for a total of 160 mcg.
• If after 4 weeks of treatment no significant improvements are noticed, increase each dose by 80 mcg for a total of 320 mcg.
• Do not exceed 320 mcg per day without explicit doctor approval.
• Spread daily doses as evenly apart as possible, and try to take doses at the same time each day.
• Missed doses may be taken as soon as remembered.

Patients who are transitioning from large doses of oral steroids, such as prednisone, may be temporarily prescribed significantly higher daily doses than those listed above.

It takes about 4 weeks for the full benefits of Alvesco MDI to be felt, though some individuals notice improvements within days of starting.

Treatment usually continues for as long as it remains effective, often spanning years or decades.

Precautions Before Use

Some things to keep in mind to ensure treatment is trouble-free:

• Alvesco MDI uses HFA propellent; asthmatics who are sensitive to HFA should consider other options.
• The medication should not be used in patients who have tuberculosis, or who have fungal or bacterial infections in the lungs or airways. Steroids inhibit the immune system and use may exacerbate the conditions.
• Treatment should be stopped immediately if there is any indication of infection in the mouth, nose, eyes, sinuses, throat or lungs. It is unlikely enough of the medication will be absorbed into the blood to affect other areas of the body.
• It is unlikely to harm unborn or nursing babies, but parents should speak with a trusted doctor about potential risks before use.
• The medication may interact with some antibiotics, antifungal treatments, certain antidepressants, and medications used to treat HIV.

Alvesco MDI should be used with caution in patients with:

• Hypothyroidism
• Eosinophilia
• Hypoprothrombinemia
• Liver issues
• Glaucoma
• Conditions which cause immune system suppression

It is not unusual for a range of side effects to be experienced when treatment with Alvesco MDI starts or when dosage is increased. These effects are usually mild and often stop after a few weeks of treatment, as the body adjusts. In general side effects are not cause for concern unless severe or persistent:

• Odd taste in mouth
• Dry mouth
• Mild burning or irritation in mouth or throat
• Headache
• Runny or stuffy nose
• Mild joint or back pain
• Hoarse voice

If side effects do become severe, discontinue use of Alvesco MDI until speaking with a doctor.