Current Ciclesonide Availability

Ciclesonide — sold as Alvesco (inhaler), Omnaris (nasal spray), and Zetonna (nasal aerosol) — is a single-source brand medication manufactured by Covis Pharma. Without generic competition, supply fluctuations hit patients harder than they would for widely genericized medications like Fluticasone or Budesonide.

As of early 2026, Ciclesonide is not on the FDA's formal drug shortage list, but many patients report difficulty finding it in stock at their local pharmacies. The problem is particularly acute for Alvesco inhalers and Zetonna, while Omnaris nasal spray tends to be more consistently available.

This guide gives you a practical, step-by-step workflow for helping patients access Ciclesonide — or transition to alternatives when necessary.

Why Patients Can't Find Ciclesonide

Several factors converge to make Ciclesonide harder to find than other inhaled corticosteroids:

• Single manufacturer: Covis Pharma is the sole supplier. Any production or distribution issue affects the entire market.
• No generic available: Pharmacies cannot substitute a generic version, and many stock only what they can reliably sell.
• Low pharmacy demand: Because Ciclesonide is prescribed less frequently than Fluticasone or Budesonide, pharmacies may not keep it on the shelf, ordering it only when a prescription arrives.
• Insurance barriers: Step therapy requirements and prior authorization delays mean some patients give up before filling.
• Regional variation: Distributor allocation can vary by region, creating pockets of availability and scarcity.

For a patient-facing explanation, see: Why Is Ciclesonide So Hard to Find?

What Providers Can Do: 5 Steps

Step 1: Verify Stock Before Prescribing

The single most effective thing you can do is check availability before sending the prescription. Use MedFinder for Providers to see real-time stock data at pharmacies near your patient. This prevents the frustrating cycle of patients driving to a pharmacy only to learn the medication is out of stock.

If your e-prescribing system shows pharmacy inventory, use that as well — but be aware that these systems are not always current.

Step 2: Expand the Pharmacy Search Radius

If the patient's usual pharmacy is out of stock, broaden the search. Ciclesonide may be available at:

• A different location of the same chain (e.g., a CVS across town may have stock when the nearest one doesn't)
• Independent pharmacies, which sometimes have different wholesaler relationships
• Specialty pharmacies that stock less common medications
• Mail-order pharmacies, which often have larger inventory pools

Direct patients to How to Check If a Pharmacy Has Ciclesonide in Stock so they can search independently.

Step 3: Contact the Pharmacy Directly

When a patient reports difficulty, a call from the prescriber's office can be more effective than patient self-advocacy. Ask the pharmacy:

• Can they order Ciclesonide from their wholesaler? (Many pharmacies can special-order within 1-2 business days.)
• Is the issue a temporary stockout or a longer-term supply problem?
• Can they check other locations within their chain?

Step 4: Prepare Prior Authorization Documentation

If insurance requires prior authorization, have your documentation ready. Key elements to include:

• Diagnosis and severity
• History of failed alternatives (with specific adverse events documented)
• Clinical rationale for Ciclesonide specifically (prodrug mechanism, lower oral candidiasis risk, etc.)
• Duration of current therapy if already established

Proactive prior authorization can prevent gaps in therapy that lead to emergency visits.

Step 5: Have an Alternative Plan Ready

For every patient on Ciclesonide, document a backup plan in the chart. If Ciclesonide becomes unavailable, you and the patient should already know the next option. Common alternatives include:

• Fluticasone Propionate: Flovent (inhaler), Flonase (nasal spray, OTC) — most widely available
• Budesonide: Pulmicort (inhaler/nebulizer), Rhinocort (nasal spray, OTC) — generic available
• Mometasone Furoate: Asmanex (inhaler), Nasonex (nasal spray, now OTC)
• Beclomethasone Dipropionate: QVAR (inhaler), Beconase AQ (nasal spray) — generic available

See our full comparison: Alternatives to Ciclesonide If You Can't Fill Your Prescription.

Alternatives: A Quick Clinical Comparison

All inhaled corticosteroids work through glucocorticoid receptor activation to reduce airway inflammation. The key differences relevant to a Ciclesonide switch:

• Local activation: Ciclesonide is unique as a prodrug. Fluticasone and Budesonide are active on contact.
• Oral candidiasis risk: Ciclesonide's prodrug mechanism may reduce oral thrush risk compared to Fluticasone.
• Device type: Alvesco uses an MDI. Pulmicort offers a nebulizer option. QVAR uses an MDI with HFA propellant.
• Availability: Fluticasone and Budesonide are far more available and affordable than Ciclesonide.

When switching, match the device type to the patient's technique and preference when possible.

Workflow Tips for Your Practice

• Flag Ciclesonide patients in your EHR: Create a patient list or flag so you can proactively contact patients if you learn of a supply issue.
• Bookmark medfinder.com/providers: Make it part of your prescribing workflow for any medication with known availability challenges.
• Include availability in patient instructions: When prescribing Ciclesonide, add a note: "If your pharmacy doesn't have this in stock, check medfinder.com or call our office."
• Batch prior authorizations: If multiple patients need Ciclesonide PAs, batch the work to improve efficiency.
• Share patient resources: Point patients to How to Find Ciclesonide in Stock Near You and How to Save Money on Ciclesonide.

Final Thoughts

Helping patients find Ciclesonide requires a proactive approach. The combination of single-source manufacturing, no generic competition, and variable insurance coverage means that standard prescribing workflows often aren't enough.

By verifying stock before prescribing, expanding pharmacy search options, preparing prior authorization documentation in advance, and maintaining a documented alternative plan, you can significantly reduce the burden on your patients and your practice.

For a broader overview of the supply situation, see: Ciclesonide Shortage: What Providers and Prescribers Need to Know in 2026.