ALVESCO 160 INHALER

Active substance: CICLESONIDE

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PACKAGE LEAFLET: INFORMATION FOR THE USER

Alvesco® 160 Inhaler
(ciclesonide)
This product is available using the above name but will be referred to as Alvesco
throughout the following leaflet. Please note leaflet also contains information about
other strengths (Alvesco 40 and 80 Inhaler).
Read all of this leaflet carefully before you start using this medicine because it
contains important information for you.
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only. Do not pass it on to others. It may
harm them, even if their signs of illness are the same as yours.
If you get any side effects talk to your doctor, pharmacist or nurse. This includes any
possible side effects not listed in this leaflet. See section 4.
What is in this leaflet:
1.
2.
3.
4.
5.
6.

What Alvesco is and what it is used for
What you need to know before you use Alvesco
How to use Alvesco
Possible side effects
How to store Alvesco
Contents of the pack and other information

1. What Alvesco is and what it is used for
What Alvesco is:
Alvesco is a clear and colourless aerosol spray for you to breathe in through your
mouth and into your lungs. It is a Preventer medication (corticosteroid) that has to be
taken every day and which becomes active only after it has been inhaled into your
lungs.
The active ingredient in this medicine is ciclesonide.
(For the other ingredients, see Section 6).
What Alvesco is used for:
This medicine is prescribed to control persistent asthma in adult and adolescent
patients (12 years old and more).
It helps you to breathe more easily by decreasing the symptoms of your asthma and
by lessening the chances of an asthma attack. The effect builds up over a period of
time, so this medicine needs to be taken every day, even when you are feeling well.
This medicine is not suitable for use in an acute attack of breathlessness.
For quick relief from such an attack, use only your Reliever inhaler.
2. What you need to know before you use Alvesco
Do not use Alvesco
if you are allergic (hypersensitive) to ciclesonide or any of the other ingredients of this
medicine (listed in section 6).

Patients with liver or kidney disorders
There is no need to adjust the dose of ciclesonide if you have liver or kidney problems.
If you suffer from a severe liver condition, your doctor will check you more carefully for
possible side effects resulting from disturbance of normal steroid production.
Children below 12 years of age:
This medicine is not recommended for children below the age of 12 because of a lack
of information about its possible effects.
Other medicines and Alvesco
Please inform your doctor before using Alvesco, if you are currently being treated for
any fungal or viral infections with medicine containing:
■ ketoconazole,
■ itraconazole,
■ ritonavir,
■ nelfinavir.
These may intensify the action of Alvesco so that the probability of side effects cannot
be completely ruled out.
Please tell your doctor or pharmacist if you are taking or have recently taken
any other medicines, including medicines obtained without a prescription.
Using this medicine with food and drink
There is no interaction between Alvesco and food and drink.
Pregnancy, breast-feeding and fertility
Tell your doctor if you are pregnant, want to become pregnant or are breast-feeding.
■ Because there is not enough information about the effects of Alvesco on pregnant
women, your doctor will discuss with you the risks and benefits of using Alvesco.
■ Ciclesonide (the active ingredient in Alvesco) may be taken during pregnancy only
when the possible benefits to the mother justify the possible risk to the developing
baby. If your doctor decides that you can continue using Alvesco, the smallest
possible dose of ciclesonide will be used to maintain asthma control.
■ The adrenal function will be carefully monitored in children of mothers who received
corticosteroids during pregnancy.
■ Talk to your doctor if you want to use Alvesco during breast-feeding.
■ It is not known whether inhaled ciclesonide passes into the breast milk in humans.
■ Prescribing Alvesco to women who are breast feeding will therefore only be
considered if the expected benefit to the mother outweighs the possible risk to the
child.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
Alvesco and its ingredients have no or negligible effects on the ability to drive or to use
machinery.
3. How to use Alvesco
Always use this medicine exactly as your doctor has told you. You should check with
your doctor or pharmacist if you are not sure.


Take special care with Alvesco
Before beginning treatment with this medicine, please tell your doctor if:
■ you have ever been treated, or are currently being treated, for pulmonary
tuberculosis (TB), fungal, viral or bacterial infections.

How much Alvesco should I take each day?
Your doctor will have spoken to you about how much of your medicine you need to
take each day. This will depend on your individual need.


Check with your doctor if you are not sure. It is important to make sure that Alvesco is
the right medicine for you.
During your treatment with Alvesco contact your doctor immediately if:
■ breathing becomes difficult and your symptoms, coughing, breathlessness,
wheezing, tightness in the chest, increasing noises (rhonchi) or other symptoms of
narrowing of the airways are getting worse. (You should use your Reliever inhaler
which will normally lead quickly to an improvement.)
■ you are waking up at night with your symptoms.
■ you are not getting relief from using your Reliever inhaler.
Your doctor will decide on your further treatment.
Specific patient groups
Patients with severe asthma are at risk of acute asthma attacks. For such patients
the doctor will carry out regular thorough asthma control checks, including a lung
function test.
Patients who are already taking corticosteroid tablets:
Alvesco can be used to replace your tablets, or to reduce the number of tablets you
need to take. Please follow your doctor’s instructions carefully.












This will start about a week after you begin your Alvesco inhalations.
The number of tablets you take will be reduced with caution over a period of time.
During this period you may sometimes suffer from a general feeling of being unwell.
In spite of this, it is important to continue both with your Alvesco inhalations and
with slowly reducing the number of tablets you take.
If you get serious symptoms such as nausea (feeling sick), vomiting (being sick),
diarrhoea or a high temperature, contact your doctor.
This process may sometimes reveal minor allergies such as rhinitis (inflammation of
the inside of the nose) or eczema (itchy, reddening skin).
If you have changed over from tablets, you will continue for a time to be at risk of
reduced adrenal function, which is related to the corticosteroid tablets you take. The
symptoms of reduced adrenal function (e.g. dizziness, fainting, nausea, loss of
appetite, moodiness, decrease in body hair, inability to cope with stress, weakness,
headaches, memory problems, allergies, food cravings, and blood sugar disorders)
may also continue for some time.
You may also need to see a specialist to determine the extent of the reduction in
adrenal function.
Your doctor will also do regular checks on your adrenal function.
During periods of stress, for example, having an operation, worsening asthma
attacks, it is possible that you will need extra corticosteroid tablets. If so, you must
carry a steroid warning card which says so.

If you have just started to use this medicine instead of, or as well as, taking
corticosteroid tablets, see section 2, Patients who are already taking
corticosteroid tablets.




The recommended dose of Alvesco is 160 micrograms once daily, which leads to
asthma control in the majority of patients.
In some patients a dose reduction to 80 micrograms, once daily, may be an
adequate dose for maintaining effective control of their asthma.
An increased dosage of Alvesco may become necessary for a short period of time
in patients who suffer a severe worsening of their asthma symptoms. This can be
up to 640 micrograms per day, delivered as 320 micrograms twice daily but no data
confirming the additional therapeutic effect after 3 months with these higher doses
are available.

If necessary, your doctor may also prescribe corticosteroid tablets and/or, in the case
of an infection, an antibiotic.
■ Your doctor will adjust your dose to the minimum necessary to control your asthma.
■ You should start to notice an improvement in your symptoms (wheezing, tight chest
and coughing) within 24 hours.
When should I use my Alvesco inhaler?
In most cases, either in the morning or in the evening – as one or two puffs once a
day. Follow your doctor’s instructions very carefully. It is important that you take
Alvesco regularly every day, even if you feel better.
If you find that you have to use your Reliever inhaler more than 2-3 times a week, you
should contact your doctor to have your medicine reviewed.
How do I use my Alvesco inhaler?
It is important that a doctor, nurse or pharmacist shows you first how to use your
Alvesco inhaler properly. A good technique will make sure you are receiving the
correct amount into your lungs. Please use the instructions in this leaflet as a
reminder.
You may wish to practice in front of the mirror for the first couple of times until you are
confident that you are using your Alvesco inhaler properly. Make sure that none of
your medicine is escaping from the top or sides of your mouth.
If you have a new inhaler, or if you have not used your inhaler for a week or more, it
must be tested before you use it. Remove the mouthpiece cover and press down
three times on the canister inside the inhaler to release three puffs into the air - away
from you.
You do not need to shake your Alvesco inhaler before using it. The medicine is
already in a very fine solution, mixed to ensure you receive the correct dose with each
puff.
During inhalation, you can either be sitting down or standing up.

Follow these instructions carefully and use the pictures to guide you.
1. Remove the mouthpiece cover and check the
mouthpiece, both the inside and the outside, to
make sure that it is both clean and dry.

2. Hold the inhaler upside down (base of
canister at the top) with your forefinger on
base of the canister and your thumb under
mouthpiece.
3. Breathe out as far as is comfortable. Do
breathe out through the inhaler.

Uncommon side effects (may affect up to 1 in 100 patients treated):
hoarseness
■ burning, inflammation, irritation of mouth or throat
■ oral thrush (oral fungal infection)
■ headache
■ bad taste
■ dryness of mouth or throat
■ nausea or vomiting


the
the
the

Rare side effects (may affect up to 1 in 1,000 patients treated):
sensation of heartbeat (palpitations)
■ discomfort or pain in the abdomen
■ high blood pressure

not



4. Place the mouthpiece in your mouth and close
your lips firmly around it.
5. Just after starting to breathe in through your
mouth, press down with your forefinger on the top
of the inhaler to release a puff of the medicine
while you are still breathing in slowly and deeply.
Please take care that the puff of medicine does
not escape through the top, bottom or sides of
your mouth.

Frequency not known, but may also occur:
■ Sleeping problems, depression or feeling worried, restless, nervous, over-excited or
irritable. These effects are more likely to occur in children.
Alvesco may affect the normal production of corticosteroids in your body. This is
usually seen in patients taking high doses over a long period of time. These rare side
effects may include:
■ reduced rate of growth in adolescents
■ a thinning of the bones
■ possible clouding of the lens of the eye (cataracts) causing blurred vision
■ loss of vision caused by abnormally high pressure in the eye (glaucoma)
■ moon-shaped face, weight gain in the upper body and thinning arms and legs
(Cushingoid features or Cushing syndrome).
Adolescents who are receiving treatment for a long period of time will have their height
checked regularly by their doctor. If your growth rate is slowed, your doctor will adjust
your treatment if possible to the lowest dose at which effective control of asthma is
maintained.

6. Hold your breath, take the inhaler from your
mouth and remove your finger from the top of the
inhaler. Continue holding your breath for about
ten seconds or as long as is comfortable. Breathe
out slowly through your mouth. Do not breathe out
through the inhaler.
It is important that you do not rush steps 3 to 6.
7. If you have been instructed to take another puff,
wait about half a minute and repeat steps 3 to 6.
8. After use, always replace the mouthpiece cover to
keep out dust.
Replace firmly and snap into position.
9. For hygiene reasons
■ please clean the mouthpiece weekly with a dry
tissue, both inside and out.
■ using a dry, folded tissue, wipe over the front of
the small hole where the medicine comes out.
■ do not use water or any other liquids.

The other side effects seen with Alvesco are usually mild. In most cases you can
continue with your treatment. The side effects you may experience are:

Corticosteroid tablets can lead to more side effects than a corticosteroid inhaler such
as Alvesco. If you have been taking steroid tablets before or during the use of Alvesco,
the risk of side effects from the tablets may continue for a period of time. Regular
check-ups with your doctor will ensure that you are taking the right dose of Alvesco for
you. Regular check-ups will also identify any side effects early on and reduce the
chances of them worsening.
Spray
nozzle

A correct technique will ensure the right amount of Alvesco is getting into your lungs
every time you use your inhaler. Your doctor will check your inhalation technique
regularly to ensure that your treatment can have the very best effect.
When the canister is completely empty you will not feel or hear any of the propellant
being discharged.

Please remember: If any of the side effects gets serious, or if you notice any side
effects not listed in this leaflet, please tell your doctor or pharmacist.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any
possible side effects not listed in this leaflet. You can also report side effects directly
via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
By reporting side effects, you can help provide more information on the safety of this
medicine.
5. How to store Alvesco

If you begin to feel wheezy or tightness in the chest after using your Alvesco
inhaler:
■ do not take any more puffs.
■ use your reliever inhaler to help your breathing.
■ contact your doctor immediately.
If you find it difficult to use the inhaler, your doctor may recommend the use of a
spacer. The spacer that fits the Alvesco inhaler is called AeroChamber PlusTM. If you
use the AeroChamber PlusTM device, please follow the instructions provided with it.
Your doctor or pharmacist will be able to advise you about the device.
If you use more Alvesco than you should
It is important that you take your dose as advised by your doctor. You should not
increase or decrease your dose without seeking medical advice.

Keep out of the sight and reach of children.
The container contains a pressurised liquid. Do not store above 50°C.
■ The container should not be punctured, broken or burned even if it seems empty.
■ As with most inhaled medicines in pressurised containers, the healing effect of this
medicinal product may become smaller when the container is cold. However,
Alvesco delivers the same level of dose from minus 10°C to plus 40°C.
■ Do not use your inhaler after the expiry date which is stated on the label and the
carton after EXP. The expiry refers to the last day of that month.
If your doctor decides to stop treatment or if the inhaler is empty, return it to your
pharmacist for safe disposal. This is important as traces of medicine could remain in
the container even if you have the impression that it might be empty.



6. Contents of the pack and other information

There is no specific treatment necessary if you have used too much Alvesco but you
should inform your doctor. If high doses are used over long periods, a certain degree
of reduction in adrenal function cannot be ruled out and control of the adrenal function
may be necessary.

What Alvesco contains
■ The active ingredient is ciclesonide. Each actuation releases a puff (dose
delivered through the mouthpiece) that contains160 micrograms of ciclesonide.
■ The other ingredients are Norflurane (HFA-134a) and ethanol anhydrous.

If you forget to use Alvesco
If you have forgotten to use your Alvesco, just take your usual dose when it is next
due.
Do not take a double number of puffs to make up for the forgotten dose.

What Alvesco looks like and contents of the pack
Alvesco consists of a clear and colourless liquid in a pressurised aluminium container
which delivers through a mouthpiece an accurately measured dose of ciclesonide in
the form of a spray. The inhaler actuator is red as well as the mouthpiece and cap.

If you stop using Alvesco
Even if you feel better, you should not stop using your Alvesco inhaler.
If you do stop using this medicine, you must tell your doctor immediately.

The strength of the inhaler contains enough for 60 puffs which is accurately measured.
Depending on the number of puffs per day your physician has recommended you to
use:
■ the inhaler contains 60 puffs enough medication for one to two months.

4. Possible side effects
POM

PL No: 15814/1006

Like all medicines, Alvesco can cause side effects, although not everybody gets them.
If you notice any of the following serious side effects, stop using this medicine and talk
to your doctor straight away:
■ severe allergic reactions such as swelling of lips, tongue and throat (may affect up
to 1 in 1,000 patients treated)
■ allergic reactions: skin rashes, redness, itching or weals like nettle rash and hives
(may affect up to 1 in 100 patients treated)
■ cough, or wheezing, which gets worse soon after taking an inhalation (may affect up
to 1 in 100 patients treated)

Alvesco is manufactured by Nycomed GmbH, BYK-Gulden-Str. 2, D-78467 Konstanz,
Germany. Procured from within the EU by the Product Licence holder and repackaged
by OPD Laboratories Ltd, Colonial Way, Watford, Herts WD24 4PR.
Leaflet revision and issue date (Ref.) 23.10.2014.
Alvesco is a registered trademark of Takeda GmbH, Germany.
To request a copy of this leaflet in Braille, large print or audio please call 01923 332
796.

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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