Brexucabtagene Autoleucel
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
Ciclesonide
Inhaled / intranasal corticosteroid (prodrug) · Prophylaxis of asthma
START
Asthma: 80–160 mcg inhaled twice daily; rinse mouth after
TYPICAL MAX
Asthma ~640 mcg/day (region-dependent)
STOP IF
Paradoxical bronchospasm or systemic steroid effects
WATCH
Inhaler technique, oral candidiasis, growth (children)
CDSCO approvedSchedule HATC R03BA08
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption
- PEAK
- 1.5h · metabolite Cmax
- t½
- 6.5h · metabolite t½
- DURATION
- 12h · BID
EXCRETION
Mainly faecal; minor renal
route + CYP
INTERACTIONS
4 major
SEVERE in our sources
PREGNANCY
Use if needed for control; inhaled steroids generally acceptable in pregnancy.
FDA category + note
Top interactionssee all 6 →
- Brexucabtagene AutoleucelSevereDatabaseDDInter
- CladribineSevereDatabaseDDInter
- DesmopressinSevereDatabaseDDInter
- DinutuximabSevereDatabaseDDInter
Mechanism
Inhaled prodrug activated by esterases in airway epithelium to desisobutyryl-ciclesonide; binds glucocorticoid receptors in the airway, suppressing inflammatory gene transcription — low systemic exposure due to high first-pass metabolism.
Indications
Asthma maintenance (≥12 y; or ≥6 y per region)Allergic rhinitis (intranasal)
Dosing
- Adult
- Asthma: inhaled 80–320 mcg twice daily (or once daily at lower doses). Intranasal: 200 mcg (2 sprays per nostril) once daily.
- Pediatric
- ≥6 y: 80–160 mcg twice daily (per product/region).
- Renal adjustment
- No adjustment.
- Hepatic adjustment
- Caution in severe hepatic impairment (reduced metabolism).
- Geriatric
- No specific adjustment.
- Max dose
- Asthma 640 mcg/day (per region; varies)
Pharmacokinetics
Onset
Asthma control over days–weeks
Peak effect
Active metabolite ~1–2 h (plasma)
Duration
~12–24 h (twice-/once-daily)
Half-life
Parent ~0.7 h; active metabolite ~6–7 h
Bioavailability
Low oral (extensive first-pass); pulmonary deposition variable
Protein binding
>99% (active metabolite)
Metabolism
Esterase activation; hepatic CYP3A4
Excretion
Mainly faecal; minor renal
Contraindications
- Primary treatment of acute bronchospasm / status asthmaticus
- Hypersensitivity
- Caution: active infection (TB, viral)
Side effects
Common
HeadacheNasopharyngitisCoughDysphonia/hoarsenessLocal oral/nasal irritation
Serious
- Adrenal suppression (very low risk at standard doses)
- Oral/nasal candidiasis
- Paradoxical bronchospasm
- Glaucoma/cataract (rare, chronic)
Pregnancy & lactation
Pregnancy
Use if needed for control; inhaled steroids generally acceptable in pregnancy.
Lactation
Likely compatible (low systemic exposure).
Drug interactions
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Desmopressin
Severe
Database
Clinical effect not specified
Source: DDInter
Dinutuximab
Severe
Database
Clinical effect not specified
Source: DDInter
Other Systemic Corticosteroids
Moderate
Database
Additive systemic steroid effect
Minimise; taper when possible
Source: Kimi deep-research + Cla
Strong Cyp3a4 Inhibitors
Moderate
Database
Reduced clearance of active metabolite
Use lowest dose; monitor
Source: Kimi deep-research + Cla
6 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Ciclesonide
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20