What sets apart Alvesco and Advair? (+3 key differences)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss the difference between Alvesco and Advair, the key differences between Advair and Alevsco, FDA-approved clinical uses, mechanisms of action, side effect profiles and withdrawal risks. In addition, how to choose between Alvesco and Advair will also be discussed.
What sets apart Alvesco and Advair?
Alvesco and Advair are both inhaled medications used to treat asthma. However, both medications differ in their active pharmaceutical ingredients, their mechanisms of action, their FDA-approved uses and action, side effects profile and withdrawal symptoms.
Alvesco is the brand name for a corticosteroid called ciclesonide. It is an inhaled medication used for the opening of airways to treat asthma in individuals older than 12 years (1).
Advair is the brand name for a combination medication. It contains fluticasone propionate, a corticosteroid and salmeterol, a long-acting beta agonist. They are used to treat and manage asthma and chronic pulmonary obstructive disorder (COPD)(2) (3).
FDA-approved clinical uses
Alvesco and Advair are both FDA-approved for the treatment of asthma. However, the specific indications of both these medications differ slightly.
Alvesco, ciclesonide is a corticosteroid that is approved for the treatment of asthma in patients aged 12 or more. It helps with the treatment by reducing airway inflammation. It is a prophylactic treatment therapy. It controls asthma with less suppression of HPA function as compared to similar doses of prednisone (4).
Advair, a combination medication is used to treat asthma in patients of age 4 or more. In addition to the treatment of asthma, it is also used for the management of COPD, emphysema and chronic bronchitis in patients who are 9 years of age or older (5).
However, both are used for the treatment of asthma as they both contain corticosteroid that helps with the inflammation of airways.
Mechanism of action
Alvesco, containing ciclesonide works by getting converted into an active metabolite in the lungs as it is inhaled. This metabolite binds to the glucocorticoid receptor as it has anti-inflammatory properties. After binding to the receptor, the metabolite reduces the release and synthesis of inflammatory modulators that help with the inflammation mechanisms (6).
On the other hand, Advair has two drugs that both work differently to provide relief. Fluticasone propionate is similar in action to ciclesonide. It is a long-term anti-inflammatory drug (7). However, salmeterol is a long-acting bronchodilator that helps in opening up the airways by dilation of the muscles. It binds to beta-2 adrenergic receptors (8).
Side effect profile
Alvesco and Advair both affect the throat causing hoarseness and throat irritation. Whereas, the side effect profile of Alvesco is generally milder as compared to the side effect profile of Advair. This might be attributed to the single-ingredient formulation of Alvesco and lower systemic exposure (9) (10).
| Side effects | Alvesco | Advair |
| Cough | Uncommon | Common |
| Nausea | Uncommon | Common |
| Trouble breathing | Common | Common |
| Skin rash | Uncommon | Common |
This is not a detailed list of the side effects of Advair and Alvesco. The incidence of side effects varies among individuals due to various factors.
Withdrawal
Advair and Alvesco, both require a gradual tapering of doses for a safe and effective treatment strategy. Alvesco may have a lower risk of withdrawal symptoms due to its product nature and lower systemic exposure.
It is important to withdraw these drugs under the supervision of an experienced healthcare provider. They might suggest you use some alternative medication that may have a lower withdrawal risk before completely stopping either of the two drugs (11) (12).
Dosage and administration
Alvesco is available in three strengths: 80mcg, 160mcg and 320 mcg. The most commonly used strength is 160mcg commonly required by adults. It is taken once daily through a metered dose inhaler (MDI).
Advair is available in four different strengths: 50/250 mcg, 100/250 mcg, 125/250 mcg and 250/250 mcg. The required dose depends upon the condition of the patient. The most commonly used strength is 100/250 mcg taken twice daily. It is inhaled through a diskus (A dry powder inhaler) or a HFA (hydroflouroalkane inhaler).
How to choose between Advair and Alvesco?
Alvesco and Advair are both used to treat asthma. However, the selection of the drug depends upon multiple factors including the needs of the patient.
- In case of a mild condition of asthma that is well-controlled, a single daily dose of Alvesco’s long-term anti-inflammatory effect may suffice. It also has a milder side effect profile.
- However, if the condition of the patient is serious, there are frequent attacks or persistent inflammation, then your doctor might prescribe you Advair for immediate relief and its long-term control.
The decision of the selection of the best treatment therapy should be made by your doctor after a discussion on the severity of the condition of the patient.
In my opinion, Alvesco and Advair are both effective treatments for asthma, but there are some significant differences between the two medications. The major differences are the one in the mechanism of action, side effect profile and withdrawal symptoms. Your prescribed medication depends upon your condition and the severity of the symptoms.
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References
1.-
Deeks ED, Perry CM. Ciclesonide: a review of its use in the management of asthma. Drugs. 2008;68(12):1741-70. doi: 10.2165/00003495-200868120-00010. Erratum in: Drugs. 2008;68(15):2162. PMID: 18681495
2.-
Adams, B. S. (2023, May 23). Salmeterol. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557453/#:~:text=Salmeterol%20is%20a%20medication%20used,2%20adrenergic%20agonist%20class%20medications.
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Remien, K. (2022, November 14). Fluticasone. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK542161/#:~:text=Fluticasone%20is%20a%20corticosteroid%20given,(COPD)%20and%20eosinophilic%20esophagitis.
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Dahl R. (2006). Ciclesonide for the treatment of asthma. Therapeutics and clinical risk management, 2(1), 25–38.
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Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011 Mar 15;335(1):2-13. [PMC free article] [PubMed] [Reference list]
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Song N, Fang Y, Sun X, Jiang Q, Song C, Chen M, Ding J, Lu M, Hu G. Salmeterol, agonist of β2-aderenergic receptor, prevents systemic inflammation via inhibiting NLRP3 inflammasome. Biochem Pharmacol. 2018 Apr;150:245-255. [PubMed] [Reference list]
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Hanania NA, Chapman KR, Kesten S. Adverse effects of inhaled corticosteroids. Am J Med. 1995 Feb;98(2):196-208. [PubMed] [Reference list]
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Jarad NA, Wedzicha JA, Burge PS, Calverley PM. An observational study of inhaled corticosteroid withdrawal in stable chronic obstructive pulmonary disease. ISOLDE Study Group. Respir Med. 1999 Mar;93(3):161-6. doi: 10.1016/s0954-6111(99)90001-x. PMID: 10464871.
12.-
Wouters, E. F., Postma, D. S., Fokkens, B., Hop, W. C., Prins, J., Kuipers, A. F., Pasma, H. R., Hensing, C. A., Creutzberg, E. C., & COSMIC (COPD and Seretide: a Multi-Center Intervention and Characterization) Study Group (2005). Withdrawal of fluticasone propionate from combined salmeterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomised controlled trial. Thorax, 60(6), 480–487. https://doi.org/10.1136/thx.2004.034280
