How does it work?
Alvesco CFC-free aerosol inhaler contains the active ingredient ciclesonide, which is a type of medicine known as a corticosteroid.
Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many important functions, including control of inflammatory responses. Ciclesonide is a synthetic corticosteroid and is used to decrease inflammation in the lungs. (NB. Corticosteroids are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.)
When ciclesonide is inhaled into the lungs it is absorbed into the cells of the lungs and airways. Here the medicine becomes activated. It works by preventing the release of certain chemicals from the cells. These chemicals are important in the immune system and are normally involved in producing immune and allergic responses that result in inflammation. By decreasing the release of these chemicals in the lungs and airways, inflammation is reduced.
In asthma, the airways tighten due to inflammation and can also be blocked by mucus. This makes it difficult for air to get in and out of the lungs. By preventing the inflammation and excess mucus formation, ciclesonide makes it easier to breathe and helps prevent asthma attacks.
Ciclesonide is taken using an inhaler device to treat asthma. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects occurring in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.
Ciclesonide taken by inhaler is known as a preventer. This is because it is taken regularly to reduce the inflammation in the lungs and prevent asthma attacks. Symptoms usually start to get better about 24 hours after starting treatment. However, it is important to continue using this medicine regularly, even after your asthma symptoms have improved, in order to prevent them coming back.
What is it used for?
- Follow the instructions in the leaflet provided with this medicine carefully. If you have any questions about using the inhaler consult your doctor, pharmacist or asthma nurse.
- This medicine is known as a preventer and it should be taken regularly to prevent asthma attacks. It should not be used to relieve an asthma attack, as it will not work for this purpose. An asthma attack needs to be treated with a medicine that quickly opens the airways, such as salbutamol or terbutaline. These are known as relievers, and you should make sure you carry your reliever inhaler with you at all times to relieve an asthma attack if it happens. Consult your doctor if you need to use your reliever more frequently than normal, or if it becomes less effective at treating attacks, as this may indicate that your asthma is getting worse and your doctor may need to prescribe you another medicine.
- Do not exceed the dose of this medicine that your doctor has prescribed for you.
- You should not suddenly stop taking this medicine unless your doctor tells you otherwise, as your asthma symptoms are likely to return.
- Inhalers may cause an unexpected increase in wheezing and difficulty breathing (paradoxical bronchospasm) straight after using them. If this happens, don't use the inhaler again, use your reliever inhaler to open your airways and consult your doctor immediately.
- Inhaled corticosteroids can sometimes cause a fungal infection in the mouth called oral thrush. To minimise the chances of this you should rinse your mouth with water or clean your teeth after inhaling each dose. Using a spacer device (AeroChamber Plus) may also help avoid this problem.
- Inhaled corticosteroids have considerably fewer side effects than steroids taken by mouth. However, when taken for long periods of time at high doses, inhaled steroids do have the potential to cause side effects such as glaucoma, cataracts, thinning of the bones (osteoporosis), slowed growth in children and adolescents, and to suppress the functioning of the adrenal glands (glands that produce natural steroid hormones). For this reason your doctor will prescribe the lowest effective dose to control your symptoms, and monitor for these side effects. Do not exceed the dose of this medicine that your doctor has prescribed for you. It is recommended that children receiving long-term treatment with corticosteroids have their growth monitored. If a child's growth appears to be slowed your doctor may refer them to a paediatrician. For further information talk to your doctor or pharmacist.
- People with severe asthma should have regular blood tests to monitor the amount of potassium in their blood. This is because low oxygen levels in the blood (hypoxia) and various asthma medicines can potentially lower blood potassium levels.
Use with caution in
- Active or inactive (dormant) tuberculosis infection of the lungs.
- Other lung infections.
- Severely decreased liver function.
Not to be used in
- Children under 12 years of age.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should be used with caution during pregnancy and only if the benefits outweigh any risks to the foetus. However, it is important that asthma is well controlled in pregnant women. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. In general, the amount of corticosteroid that passes into breast milk after using an inhaler is negligable. You should seek medical advice from your doctor before breastfeeding while using this medicine.
- Do not stop taking this medication except on your doctor's advice.
- Follow the printed instructions you have been given with this medication.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Unexpected narrowing of the airways (paradoxical bronchospasm).
- Bad taste.
- Throat irritation.
- Dry mouth or throat.
- Systemic effects (eg, Cushing's syndrome, adrenal suppression, slowed growth in children and adolescents, decreased bone mineral density, cataract and glaucoma) may occur after high doses for prolonged periods - see warning above.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
The following medicines may theoretically increase the amount of this medicine in the blood:
Ciclesonide may potentially decrease the amount of potassium in the blood. If it is taken in combination with any of the following medicines, which can also lower potassium in the blood, the risk of a low blood potassium level (hypokalaemia) is increased:
- beta 2 agonists, such as salbutamol and salmeterol
- oral corticosteroids, such as prednisolone
- xanthine derivates, such as theophylline or aminophylline
- diuretics, such as bendroflumethiazide and furosemide.
A low blood potassium level can have serious effects, which is why people with severe asthma, who may be taking several of these medicines, should have their blood potassium level monitored regularly.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain ciclesonide as the active ingredient.