Onset of action of ciclesonide in the treatment of seasonal allergic rhinitis: 6 hours

Ciclesonide is an intranasal corticosteroid (INS) approved for the treatment of allergic rhinitis (AR) in adults and children 6 years of age and older. The trade name in the U.S. is Omnaris.

Ciclesonide seems to have no significant effect on hypothalamic-pituitary-adrenal axis.

Why ciclesonide has no significant effect on hypothalamic-pituitary-adrenal axis?

The medication is "activated" locally in the lungs. Carboxylesterases in bronchial epithelial cells convert ciclesonide to des-CIC in the lungs. Low systemic levels of des-CIC are a result of the high metabolic clearance by the liver following CIC inhalation.

In a double-blind, randomized, placebo-controlled study, 509 adults with at least a 2-year history of SAR completed 1 to 5 priming sessions of ragweed pollen exposure. Patients with successful priming visits received a single dose of intranasal ciclesonide, 200 microg or placebo.

The change from baseline in TNSSs between the ciclesonide and placebo groups was measured hourly 1 to 12 hours.

The authors concluded that intranasal ciclesonide, 200 microg/d, has an onset of action of 6 hours in patients with SAR.

Ciclesonide is marketed under the brand name Alvesco for asthma and Omnaris/Omniair for hayfever in the US and Canada.

Treatment Options for Allergic Rhinitis (click to enlarge the image).

Ciclesonide mnemonic

Converted to active form (des-CIC)
Carboxyl-esterases in bronchial epithelial cells
Clearance by liver


Onset of action of ciclesonide once daily in the treatment of seasonal allergic rhinitis. Couroux P, Kunjibettu S, Hall N, Wingertzahn MA. Ann Allergy Asthma Immunol. 2009 Jan;102(1):62-8.

New Dry Nasal Spray are on the Horizon for Perennial Allergic Rhinitis - Medscape, 2011.

Ciclesonide Aerosol (Alvesco) Approved for Asthma Treatment

Mind Maps: Allergic Rhinitis

Images source: Wikipedia, a free GNU license and public domain.

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