Ciclesonide Advanz Pharma 80 mcg per metered dose pressurised inhalation, solution

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• 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.

1. What Ciclesonide Advanz Pharma is and what it is used for
2. What you need to know before you use Ciclesonide Advanz Pharma
3. How to use Ciclesonide Advanz Pharma
4. Possible side effects
5. How to store Ciclesonide Advanz Pharma
6. Contents of the pack and other information

Ciclesonide Advanz Pharma contains the active substance ciclesonide. Ciclesonide Advanz Pharma 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.

Ciclesonide Advanz Pharma is used to treat persistent asthma in adult and adolescent patients (12 years old and more).

Ciclesonide Advanz Pharma 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.

• if you are allergic to ciclesonide or any of the other ingredients of this medicine. (listed in section 6).

Talk to your doctor, pharmacist or nurse before using Ciclesonide Advanz Pharma.

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.

Check with your doctor if you are not sure. It is important to make sure that Ciclesonide Advanz Pharma is the right medicine for you.

During your treatment with Ciclesonide Advanz Pharma 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 experience blurred vision or other visual disturbances.

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.

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

Ciclesonide Advanz Pharma 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 Ciclesonide Advanz Pharma 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 Ciclesonide Advanz Pharma 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.

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.

This medicine is not recommended for children below the age of 12 because of a lack of information about its possible effects.

Tell your doctor or pharmacist if you are using, have recently taken/used or might use any other medicines, including medicines obtained without a prescription.

Please inform your doctor before using Ciclesonide Advanz Pharma, if you are currently being treated for any fungal or viral infections with medicine containing:

• ketoconazole,
• itraconazole,
• cobicistat,
• ritonavir,
• nelfinavir.

These may intensify the action of Ciclesonide Advanz Pharma so that the probability of side effects cannot be completely ruled out.

There is no interaction between Ciclesonide Advanz Pharma and food and drink.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

• Because there is not enough information about the effects of Ciclesonide Advanz Pharma on pregnant women, your doctor will discuss with you the risks and benefits of using Ciclesonide Advanz Pharma.
• Ciclesonide (the active ingredient in Ciclesonide Advanz Pharma) 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 Ciclesonide Advanz Pharma, 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 Ciclesonide Advanz Pharma during breast-feeding.
• It is not known whether inhaled ciclesonide passes into the breast milk in humans.
• Prescribing Ciclesonide Advanz Pharma 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.

Ciclesonide Advanz Pharma and its ingredients have no or negligible effects on the ability to drive or to use machines.

This medicine contains 4.7 mg of alcohol (ethanol) in each actuation. The amount in a dose of this medicine is equivalent to less than 1 ml beer or wine. The small amount of alcohol in this medicine will not have any noticeable effects.

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.

• The recommended dose of Ciclesonide Advanz Pharma 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 Ciclesonide Advanz Pharma 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.

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 Ciclesonide Advanz Pharma 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.

It is important that a doctor, nurse or pharmacist shows you first how to use your Ciclesonide Advanz Pharma 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 practise in front of the mirror for the first couple of times until you are confident that you are using your Ciclesonide Advanz Pharma 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 Ciclesonide Advanz Pharma 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.

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 the canister at the top) with your forefinger on the base of the canister and your thumb under the mouthpiece.
3. Breathe out as far as is comfortable.
Do not breathe out through the inhaler.

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.

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.

For hygiene reasons Please clean the mouthpiece weekly with a dry tissue, both inside and out.

1. remove the mouthpiece cover, do not remove the inhaler from the plastic actuator;
2. using a dry, folded tissue, wipe over the front of the small hole where the medicine comes out.
3. do not use water or any other liquids.

A correct technique will ensure the right amount of Ciclesonide Advanz Pharma 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.

• 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 Ciclesonide Advanz Pharma is called AeroChamber Plus Flow-Vu spacer device. If you use the AeroChamber Plus Flow-Vu spacer device, please follow the instructions provided with it.

Your doctor or pharmacist will be able to advise you about the device.

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.

There is no specific treatment necessary if you have used too much Ciclesonide Advanz Pharma 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.

If you have forgotten to use your Ciclesonide Advanz Pharma, just take your usual dose when it is next due.

Do not take a double dose to make up for a forgotten dose.

Even if you feel better, you should not stop using your Ciclesonide Advanz Pharma.

If you do stop using this medicine, you must tell your doctor immediately.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via

Yellow Card Scheme

Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

• The active ingredient is ciclesonide. Each actuation releases a puff (dose delivered through the mouthpiece) that contains either 80 or 160 micrograms of ciclesonide.
• The other ingredients are anhydrous ethanol and propellant (Norflurane).
• This medicine contains fluorinated greenhouse gases.
• Each inhaler contains 0.0088 kg of HFA-134a (Norflurane) corresponding to 0.0126 tonne CO2 equivalent (global warming potential GWP= 1430).

Ciclesonide Advanz Pharma 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 canister is fitted into a plastic casing incorporating a mouthpiece and fitted with a green (Ciclesonide Advanz Pharma 80 micrograms) or purple (Ciclesonide Advanz Pharma 160 micrograms) dust cap.

Pack sizes:

1 Inhaler with 120 metered actuations