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Avlesco is used once daily for the prevention of asthma in patients 18 years and older. Starting dose (regardless of previous use of inhaled corticosteroid or bronchodilator) is 400 mcg once daily. Optimum range is 100 to 800 mcg per day. If 800mcg is used, it should be divided into 400mcg BID. The main ingredient (ciclesonide) inside the canister is in solution form so no shaking is necessary. Each canister contains 120 doses (100mcg or 200mcg) and should be primed, when new, by wasting 3 sprays. Once inhaled, ciclesonide is converted by esterases in the lungs to its active metabolite, 21 des-methylpropionyl-ciclesonide (M1), which is a potent glucocorticoid that binds to glucocorticoid receptors in the lung resulting in local pronounced anti-inflammatory activity.

If Alvesco is to be discontinued, it should be done gradually. Patients who are on drugs that suppress the immune system are more susceptible to infections than healthy individuals. Therapeutic dosages of inhaled corticosteroids may cause the appearance of C. albicans (thrush) in the mouth and throat. Patients may find it helpful to rinse and gargle with water after using Alvesco. Systemic effects of inhaled corticosteroids may occur, particularly at high doses prescribed for prolonged periods. These effects are much less likely to occur than with oral corticosteroids. Possible systemic effects include adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and increased intraocular pressure, with or without glaucoma. Therefore, it is important that the dose of inhaled corticosteroid is titrated to the lowest dose at which effective control of asthma is maintained.