Names and pronunciation
(si-cleh′son-ide) Alvesco, Omnaris, Zetonna
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Drug reference
(si-cleh′son-ide) Alvesco, Omnaris, Zetonna
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Func. class.: Corticosteroid
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ACTION: Inhibits inflammation in asthma by inhibiting leukotrienes
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USES: Prevention of asthma during maintenance treatment, perennial/sea- sonal allergic rhinitis
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CONTRAINDICATIONS: Hyper- sensitivity, nasal septic ulcers, nasal sur- gery, nasal trauma Precautions: Children, TB, immuno- suppression
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SIDE EFFECTS CNS: Headache EENT: Ear pain, sinusitis, nasal con- gestion, nosebleed META: Growth retardation if used long- term MS: Arthralgia, back pain
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INTERACTIONS Increase: hyperglycemia—ceritinib Increase: effect of desmopressin, avoid using together Increase: effect of CYP3A4 inhibitors
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DOSAGE AND ROUTES Prevention of asthma (Alvesco) • Adult and child ≥12 yr in those previ- ously taking bronchodilators alone: INH 80 mcg bid, increase to max of 160 mcg bid after 4 wk, if needed • Adult and child ≥12 in those previ- ously taking inhaled corticosteroids: INH 80 mcg bid, increase to 320 mcg bid after 4 wk if needed • Adult and child ≥12 yr in those previ- ously taking oral corticosteroids: INH 320 mcg bid Perennial allergic rhinitis • Adult and child ≥12 yr: Nasal 2 sprays in each nostril daily (Omnaris) or 1 actuation (Zetonna) in each nostril daily Seasonal allergic rhinitis • Adult and child ≥12 yr: Nasal 1 actua- tion (Zetonna) in each nostril daily • Adult and child ≥6 yr: Nasal 2 sprays (Omnaris) in each nostril daily
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Available forms: Nasal aerosol solu- tion 37 mcg/metered spray; nasal sus- pension 50 mcg/metered spray; oral inhalation aerosol 80 mcg, 160 mcg
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Administer: • Prime the inhaler before the initial use by releasing 3 sprays into the air away from the face and other people • If the inhaler is not used for more than 10 consecutive days, it should be primed by releasing 3 sprays into the air • The canister contains a dose counter. The inhaler should be discarded after the counter reads zero; although the canister is still operational and may contain med- ication, the accuracy of medication deliv- ery cannot be assured • When the dose indicator shows a red zone, approximately 20 inhalations are left, and a refill is required • Instruct patient on proper inhalation technique • To avoid the spread of infection, do not use the inhaler for more than 1 person Intranasal inhalation administration Omnaris: • For intranasal use only • Before the first use, shake the inhaler gently and prime the pump by actuating eight times • If not used in 4 consecutive days, shake gently and prime with 1 spray or until fine mist appears • Product should be discarded after 120 sprays following initial priming, or 4 mo after removal from pouch • Blow nose gently if needed. Insert spray tip into nostril, and close the other nostril with finger. With head slightly tilted forward and bottle upright, press pump quickly and firmly while inhaling through nose. Avoid spraying into eyes and directly onto the nasal septum. After administration, wipe the applicator tip with a clean tissue and replace dust cap. If applicator is clogged or needs further cleaning, remove nasal applicator and rinse with warm water • Dry and replace applicator and prime the unit with one spray or until a fine mist appears, then replace cap. To avoid the C spread of infection, do not use the con- tainer for more than 1 person. Zetonna: • For intranasal use only • Before the first use or if not used in 10 consecutive days, shake the inhaler gen- tly and prime the pump by actuating 3 times • Product should be discarded after 60 sprays following initial priming, or when the dose indicator reads zero • Clean the nose piece weekly by wiping with a clean, dry tissue or cloth; do not wash or put any part of the canister or applicator in water • Blow nose gently if needed. Insert spray tip into nostril, and close the other nostril with finger. With head slightly tilted back and bottle upright, press pump quickly and firmly while inhaling through nose. Avoid spraying into eyes and directly onto the nasal septum. To avoid the spread of infection, do not use the container for more than 1 person Inhalation route • Rinse mouth after use Intranasal route • Shake gently (Omnaris) before first use, then prime spraying 8 times, reprime with 1 spray if not used for 4 days • Before first use (Zetonna), prime spraying 3 times, reprime with 3 sprays if not used for 10 days
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Assess: • Nasal condition: assess for dryness, discharge, sneezing, cough • Anaphylaxis, angioedema (assess for rash, trouble breathing): discontinue treat- ment and notify provider immediately • HPA suppression: monitor chil- dren for growth suppression in long- term therapy Patient/family education: • Teach patient to take as prescribed, not to skip or double doses • Teach patient and caregiver how to use • Advise patient to discuss with provider all OTC, Rx, herbs, supplements taken • Advise patient to notify provider if pregnancy is planned or suspected, or if breastfeeding • Inform patient that continuing follow- up exams may be needed
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CLINICAL CONSIDERATIONS
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PHARMACOKINETICS INH: onset >4 wk, peak 1 hr, duration unknown Nasal: onset 1-2 days, peak 1-5 wk, unknown
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• Adult and child ≥12 yr in those previ- ously taking bronchodilators alone: INH 80 mcg bid, increase to max of 160 mcg bid after 4 wk, if needed
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• Adult and child ≥12 in those previ- ously taking inhaled corticosteroids: INH 80 mcg bid, increase to 320 mcg bid after 4 wk if needed
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• Adult and child ≥12 yr in those previ- ously taking oral corticosteroids: INH 320 mcg bid Perennial allergic rhinitis
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• Adult and child ≥12 yr: Nasal 2 sprays in each nostril daily (Omnaris) or 1 actuation (Zetonna) in each nostril daily Seasonal allergic rhinitis
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• Adult and child ≥12 yr: Nasal 1 actua- tion (Zetonna) in each nostril daily
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• Adult and child ≥6 yr: Nasal 2 sprays (Omnaris) in each nostril daily
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