What Is Ciclesonide?

Ciclesonide is a prescription inhaled corticosteroid (also called a glucocorticoid) used to treat persistent asthma and allergic rhinitis (seasonal and year-round allergies). It works by reducing inflammation in your airways and nasal passages, helping you breathe easier and reducing allergy symptoms like congestion, sneezing, and runny nose.

Ciclesonide is available under three brand names:

• Alvesco — A metered-dose inhaler (MDI) for asthma maintenance in adults and children aged 12 and older
• Omnaris — A nasal spray for allergic rhinitis in adults and children aged 6 and older
• Zetonna — A nasal aerosol for seasonal allergic rhinitis (limited availability)

Ciclesonide is manufactured by Covis Pharma. There is currently no generic version available in the United States.

What Does Ciclesonide Treat?

Ciclesonide is FDA-approved for the following conditions:

Persistent Asthma (Alvesco)

Alvesco is used as a daily maintenance treatment for persistent asthma in patients aged 12 and older. It is not a rescue inhaler — it won't help during an asthma attack. Instead, it works over time to reduce the inflammation that causes asthma symptoms like wheezing, shortness of breath, and chest tightness.

Seasonal Allergic Rhinitis (Omnaris and Zetonna)

Omnaris nasal spray is approved for seasonal allergic rhinitis in patients aged 6 and older. Zetonna nasal aerosol is approved for patients aged 12 and older. These treat symptoms like nasal congestion, sneezing, runny nose, and itchy nose caused by seasonal allergies (hay fever).

Perennial Allergic Rhinitis (Omnaris)

Omnaris is also approved for year-round (perennial) allergic rhinitis in patients aged 12 and older. This covers allergies to things like dust mites, pet dander, and mold that persist throughout the year.

How Is Ciclesonide Different from Other Inhaled Corticosteroids?

Ciclesonide has a unique feature: it's a prodrug. This means the medication you inhale is not yet active. It gets converted to its active form (called des-Ciclesonide) only after it reaches your lungs or nasal passages. This targeted activation has some advantages:

• Less oral thrush — Because the drug isn't active in your mouth and throat, there's a lower risk of yeast infections (candidiasis) compared to other inhaled corticosteroids.
• Less hoarseness — For the same reason, throat irritation is less common.
• Once-daily dosing — Many patients can use Ciclesonide just once a day, which is more convenient than twice-daily alternatives.

To learn more about how this works at a molecular level, read our guide on how Ciclesonide works.

How to Take Ciclesonide

Alvesco Inhaler (for Asthma)

• Dosage: 80 to 320 mcg twice daily, depending on your asthma severity and previous treatment
• Available strengths: 80 mcg/actuation and 160 mcg/actuation
• How to use: Prime the inhaler before first use. Exhale fully, then inhale slowly and deeply while pressing down on the canister. Hold your breath for about 10 seconds.
• Important: Rinse your mouth with water after each use and spit it out. This helps prevent oral thrush.

Omnaris Nasal Spray (for Allergies)

• Dosage: 2 sprays per nostril once daily (200 mcg total per day)
• How to use: Shake the bottle well. Blow your nose gently. Insert the tip into one nostril, close the other, and spray while breathing in gently. Repeat for the other nostril.
• Available strength: 50 mcg per spray (120 sprays per bottle)

Zetonna Nasal Aerosol

• Dosage: 1 spray per nostril once daily (74 mcg total per day)
• How to use: No shaking needed. Spray into each nostril once daily.
• Note: Zetonna has limited availability and may be difficult to find.

Important Things to Know Before Taking Ciclesonide

Who Should NOT Take Ciclesonide

• Anyone with a known allergy to Ciclesonide or any ingredient in the product
• Alvesco should not be used as the primary treatment for an asthma attack (status asthmaticus)
• Omnaris and Zetonna should not be used if you have an active, untreated infection in your nasal passages

Special Populations

• Pregnancy: Ciclesonide is Pregnancy Category C. Use only if the benefit outweighs the risk. Talk to your doctor.
• Children: Alvesco and Zetonna are approved for ages 12+. Omnaris is approved for ages 6+. Growth should be monitored in children using inhaled corticosteroids.
• Elderly patients: No specific dose adjustment, but monitoring for liver, kidney, or heart issues may be appropriate.

Drug Interactions

The biggest drug interaction concern with Ciclesonide is strong CYP3A4 inhibitors like Ketoconazole, which can significantly increase Ciclesonide levels in your body. For the full list, see our guide on Ciclesonide drug interactions.

Common Side Effects

Most side effects are mild:

• Headache
• Sore throat or stuffy nose
• Nosebleeds (nasal spray)
• Hoarseness (inhaler)
• Ear pain
• Unpleasant taste

For a complete breakdown of what to watch for, including serious side effects, read our detailed guide on Ciclesonide side effects.

How Much Does Ciclesonide Cost?

Because there's no generic, Ciclesonide can be expensive:

• Alvesco inhaler: $150 to $420, depending on pharmacy and dosage
• Omnaris nasal spray: $290 to $400

Insurance covers Alvesco in about 77% of plans, with typical copays of $15 to $75. Some plans may require prior authorization or step therapy (trying a cheaper medication first).

There are ways to save. The Alvesco Savings Card from Covis Pharma can bring your cost down to $0 if you have commercial insurance. There's also a patient assistance program for uninsured patients. Read our full guide on how to save money on Ciclesonide.

Is Ciclesonide Hard to Find?

Ciclesonide is not currently on the FDA drug shortage list, but because it's a single-source brand product, not all pharmacies stock it. If your pharmacy doesn't have it, they can usually order it in 1-2 days. You can also use MedFinder to check which pharmacies have Ciclesonide in stock near you.

Ciclesonide vs. Alternatives

If you're wondering how Ciclesonide compares to other options, here's a quick look:

• Fluticasone (Flovent/Flonase) — More widely available, Flonase is OTC. Generic available.
• Budesonide (Pulmicort/Rhinocort) — Available as generic, Rhinocort is OTC. Comes in nebulizer form too.
• Mometasone (Asmanex/Nasonex) — Nasonex is now OTC. Very effective for allergies.
• Beclomethasone (QVAR/Beconase) — Older option, widely available as generic.

Ciclesonide's main advantages are its prodrug design (fewer local side effects) and once-daily dosing convenience. Learn more in our alternatives guide.

Bottom Line

Ciclesonide is a well-established inhaled corticosteroid used for asthma and allergic rhinitis. Its prodrug design sets it apart by reducing common side effects like oral thrush and hoarseness. While it's only available as a brand-name product and can be pricey, savings programs exist to help. If your doctor has prescribed Ciclesonide, MedFinder can help you find it in stock at a pharmacy near you.