Allergy Drug Facts for Zetonna

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Zetonna is an inhaled corticosteroid nasal aerosol that is used for the treatment of both seasonal and perennial allergic rhinitis. In the United States, Zetonna is available by prescription only. Zetonna received FDA approval for use in January 2012 for adults and children 12 years of age or older.

Zetonna comes in a "dry" aerosol canister that delivers a 37-microgram dose, unlike Omnaris, which is similar to Zetonna (same active ingredient) but in a "wet" nasal spray. You may prefer the "dry" aerosol if nasal sprays give you a bad aftertaste or if you dislike the spray being wet or giving you the sensation of having a runny nose.

Woman suffering from seasonal allergies
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Active Ingredient

Ciclesonide is the only active ingredient in Zetonna. Ciclesonide is a glucocorticoid, or corticosteroid, that suppresses the immune system and the inflammatory response. Ciclesonide also breaks down into a byproduct that is a potent anti-inflammatory agent, helping to provide you relief from congestion due to allergies.

Zetonna is known as a non-halogenic medication, meaning that it does not contain these five chemical elements:

  • Fluorine
  • Chlorine
  • Bromine
  • Iodine
  • Astatine

Alternative prescription medications could include beclomethasone or budesonide.

Dosing Information

Zetonna currently comes in one dosage of 37 micrograms per spray, and the recommended dose is usually one spray in each nostril twice daily.

The same active ingredient (ciclesonide) is sold under different brand names (in different doses). This means your healthcare provider has options available to prescribe you various forms of ciclesonide if you need smaller or larger doses:

  • Zetonna (intranasal)—37 micrograms, 1 spray per nostril each day (74 micrograms total)
  • Omnaris (intranasal)—50 micrograms, 2 sprays per nostril each day (200 micrograms total)
  • Alvesco (oral inhalation)—80 or 160 micrograms 

While both Zetonna and Omnaris are approved for seasonal and perennial allergies, Alvesco is FDA-approved only for the maintenance of asthma.

Zetonna comes in a pressurized canister and must be used with the supplied actuator. Zetonna has 60 doses, or a one-month supply, per canister. However, if it's not used regularly, you will not receive 60 doses, as you may need to actuate (prime the pump) the canister by spraying it into the air three times if you haven't used the inhaler in the last 10 consecutive days.

The dose used does not need to be changed if you have kidney or liver failure.

How It Works

How Zetonna treats the symptoms of seasonal or perennial allergic rhinitis is not well understood. Glucocorticoids, in general, are well known for decreasing inflammation and decreasing your body's immune response.

Glucocorticoids inhibit white blood cells in your body that are involved in inflammation, including eosinophils, lymphocytes, macrophages, mast cells, and neutrophils. Glucocorticoids also block chemical mediators that are involved in the inflammatory response, including cytokines, eicosanoids, histamine, and leukotrienes.

As ciclestanide is metabolized, its byproduct, des-ciclestanide, is 120 times more potent at reducing inflammation than the drug's original active ingredient. Daily use of this medication is the most effective way to maintain a reduction in your symptoms of seasonal and perennial allergies. It may take a few days of using Zetonna for you to notice an improvement in your symptoms.

Side Effects

The most common side effects of taking Zetonna, experienced by approximately 10 to 11 out of 100 people, may include:

  • Headache
  • Swollen/sore nasal passages and back of the throat (nasopharyngitis)
  • Nose bleed

While a headache and nasopharyngitis are the most common side effects, there are many different side effects that occur in about 1 to 10 out of 100 people, including:

  • Facial swelling
  • Influenza
  • Back pain
  • Muscle strain
  • Otalgia (ear pain)
  • Cough
  • Nasal septum perforation
  • Dizziness

Should I Take Zetonna?

Your healthcare provider may suggest Zetonna if you suffer from certain allergies or in rare cases to prevent an asthma attack. However, you should not take Zetonna if you have ever had an allergic reaction to Zetonna, ciclesonide, Alvesco, or Omnaris. Zetonna may be used in both adults and children.

People with certain nasal conditions should also not use Zetonna. You should tell your healthcare provider before using Zetonna if you have frequent nosebleeds, have recently had nasal surgery or injured your nose, or if you have nasal ulcers. You should also notify your healthcare provider if you have an active infection of any kind before starting Zetonna.

Zetonna should be used with caution by women who are pregnant, as there are currently no good studies demonstrating the safety of this drug during pregnancy. It is also not known if Zetonna is excreted in breast milk. You should notify your healthcare provider if you are pregnant or breastfeeding prior to using Zetonna (or if you find out that you are pregnant while taking Zetonna).

Zetonna may react with other medications, especially other steroid-based medications. You should review your medications with your healthcare provider or pharmacist before starting Zetonna. 

How to Use

Your inhaler will come with a detailed set of instructions and diagrams to help you learn how to use it. It's also a good idea to ask your healthcare provider or pharmacist to show you how to use it. If you still need help, here are some tips.

  • The medication should be at room temperature.
  • Do not spray this medication in your mouth or eyes.
  • Prime Zetonna with three test sprays the first time you use it, or if it has been 10 consecutive days since you last used it.
  • The first time you use the inhaler, you will need to gently shake the medication. However, it is not necessary to do this every time you use it.
  • Before using Zetonna, blow your nose in order to clear your nasal passages.
  • Close the opposite nostril while using the intranasal aerosol.
  • Tilt your head back.
  • Breathe in through the open nostril with the Zetonna in it and depress once.
  • After using the inhaler, you should try to hold your breath for at least 10 seconds before breathing out through your mouth.
  • Repeat the process in your other nostril.
  • Avoid blowing your nose for about 15 minutes in order to give the medication plenty of time to work.
  • Clean the nose piece each week with a clean cloth. Do not use water on any part of the actuator or canister.

Because Zetonna is an aerosol, it is important that you do not use it near an open flame. The aerosol bottle may burst if exposed to flame or high temperatures.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.