Details of the Drug

General Information of Drug (ID: DM2NA4K)

• Drug Name: Ciclesonide
• Synonyms: Alvesco; Omnair; Omnaris; Osonase; Osonide; Alvesco HFA; Ciclesonide [INN]; Omnaris HFA; RPR 251526; Alvesco (TN); BTR-15; BTR-15K; BY-9010; BYK-20426; KS-1165; Omnaris (TN); Omniair (TN); TBN-15; B-9207-015; Ciclesonide (JAN/USAN/INN); (R)-11beta,16alpha,17,21-Tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with cyclohexanecarboxaldehyde, 21-isobutyrate

Indication

Disease Entry	ICD 11	Status	REF
Asthma	CA23	Approved	[1], [2], [3], [4]
Obstructive airway disease	CB40.Y	Approved	[1], [2], [3], [4]

• Therapeutic Class: Antiallergic Agents
• Drug Type: Small molecular drug
• #Ro5 Violations (Lipinski): 2:
  Molecular Weight (mw); 540.7
  Topological Polar Surface Area (xlogp); 5.3
  Rotatable Bond Count (rotbonds); 6
  Hydrogen Bond Donor Count (hbonddonor); 1
  Hydrogen Bond Acceptor Count (hbondacc); 7
• ADMET Property:
  BDDCS Class: Biopharmaceutics Drug Disposition Classification System (BDDCS) Class 2: low solubility and high permeability [5]
  Clearance: The drug present in the plasma can be removed from the body at the rate of 33.3 mL/min/kg [6]
  Elimination: 0% of drug is excreted from urine in the unchanged form [5]
  Half-life: The concentration or amount of drug in body reduced by one-half in 1.04 hours [6]
  Metabolism: The drug is metabolized via the liver [7]
  MRTD: The Maximum Recommended Therapeutic Dose (MRTD) of drug that ensured maximising efficacy and moderate side effect is 0.000001 micromolar/kg/day [8]
  Unbound Fraction: The unbound fraction of drug in plasma is 0.01% [6]
  Vd: Fluid volume that would be required to contain the amount of drug present in the body at the same concentration as in the plasma 2.9 L/kg [6]
  Water Solubility: The ability of drug to dissolve in water is measured as 0.0002 mg/mL [5]
• Chemical Identifiers:
  Formula: C32H44O7
  IUPAC Name: [2-[(1S,2S,4R,6R,8S,9S,11S,12S,13R)-6-cyclohexyl-11-hydroxy-9,13-dimethyl-16-oxo-5,7-dioxapentacyclo[10.8.0.02,9.04,8.013,18]icosa-14,17-dien-8-yl]-2-oxoethyl] 2-methylpropanoate
  Canonical SMILES: CC(C)C(=O)OCC(=O)[C@@]12[C@@H](C[C@@H]3[C@@]1(C[C@@H]([C@H]4[C@H]3CCC5=CC(=O)C=C[C@]45C)O)C)O[C@H](O2)C6CCCCC6
  InChI: InChI=1S/C32H44O7/c1-18(2)28(36)37-17-25(35)32-26(38-29(39-32)19-8-6-5-7-9-19)15-23-22-11-10-20-14-21(33)12-13-30(20,3)27(22)24(34)16-31(23,32)4/h12-14,18-19,22-24,26-27,29,34H,5-11,15-17H2,1-4H3/t22-,23-,24-,26+,27+,29+,30-,31-,32+/m0/s1
  InChIKey: LUKZNWIVRBCLON-GXOBDPJESA-N
• Cross-matching ID:
  PubChem CID: 6918155
  ChEBI ID: CHEBI:31397
  CAS Number: 126544-47-6
  DrugBank ID: DB01410
  TTD ID: D0K7HU
  VARIDT ID: DR01408
  INTEDE ID: DR0319

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Corticosteroid-binding globulin (SERPINA6)	TTJL8VG	CBG_HUMAN	Binder	[9], [10]

Drug Transporter (DTP)

DTP Name	DTP ID	UniProt ID	MOA	REF
P-glycoprotein 1 (ABCB1)	DTUGYRD	MDR1_HUMAN	Substrate	[11]

Drug-Metabolizing Enzyme (DME)

DME Name	DME ID	UniProt ID	MOA	REF
Cytochrome P450 3A4 (CYP3A4) Main DME	DE4LYSA	CP3A4_HUMAN	Substrate	[12]
Cytochrome P450 2D6 (CYP2D6)	DECB0K3	CP2D6_HUMAN	Substrate	[12]

Molecular Expression Atlas of This Drug

• ICD Disease Classification: 12 Disease of the respiratory system
• Disease Class: ICD-11: CA23 Asthma
• The Studied Tissue: Nasal and bronchial airway
• The Studied Disease: Asthma [ICD-11:CA23]

Molecule Name	Molecule Type	Gene Name	p-value	Fold-Change	Z-score
Corticosteroid-binding globulin (SERPINA6)	DTT	SERPINA6	3.29E-04	-0.2	-0.2
P-glycoprotein 1 (ABCB1)	DTP	P-GP	3.27E-03	1.21E-01	3.74E-01
Cytochrome P450 2D6 (CYP2D6)	DME	CYP2D6	1.21E-04	-2.33E-01	-5.09E-01
Cytochrome P450 3A4 (CYP3A4)	DME	CYP3A4	6.90E-01	2.35E-02	7.88E-02

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Disease Different from Ciclesonide (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Levalbuterol	DM5YBO1	Minor	Increased risk of hypokalemia by the combination of Ciclesonide and Levalbuterol.	Asthma [CA23]	[39]
Troleandomycin	DMUZNIG	Moderate	Decreased metabolism of Ciclesonide caused by Troleandomycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[40]
Tucatinib	DMBESUA	Moderate	Decreased metabolism of Ciclesonide caused by Tucatinib mediated inhibition of CYP450 enzyme.	Breast cancer [2C60-2C6Y]	[40]
Vilanterol	DMF5EK1	Minor	Increased risk of hypokalemia by the combination of Ciclesonide and Vilanterol.	Chronic obstructive pulmonary disease [CA22]	[39]
Indacaterol	DMQJHR7	Minor	Increased risk of hypokalemia by the combination of Ciclesonide and Indacaterol.	Chronic obstructive pulmonary disease [CA22]	[40]
Stiripentol	DMMSDOY	Moderate	Decreased metabolism of Ciclesonide caused by Stiripentol mediated inhibition of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[40]
Boceprevir	DMBSHMF	Moderate	Decreased metabolism of Ciclesonide caused by Boceprevir mediated inhibition of CYP450 enzyme.	Hepatitis virus infection [1E50-1E51]	[40]
Telaprevir	DMMRV29	Moderate	Decreased metabolism of Ciclesonide caused by Telaprevir mediated inhibition of CYP450 enzyme.	Hepatitis virus infection [1E50-1E51]	[40]
Cobicistat	DM6L4H2	Moderate	Decreased metabolism of Ciclesonide caused by Cobicistat mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[40]
Ceritinib	DMB920Z	Moderate	Decreased metabolism of Ciclesonide caused by Ceritinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[40]
Idelalisib	DM602WT	Moderate	Decreased metabolism of Ciclesonide caused by Idelalisib mediated inhibition of CYP450 enzyme.	Mature B-cell leukaemia [2A82]	[40]
Omacetaxine mepesuccinate	DMPU2WX	Moderate	Additive immunosuppressive effects by the combination of Ciclesonide and Omacetaxine mepesuccinate.	Myeloproliferative neoplasm [2A20]	[41]
Abametapir	DM2RX0I	Moderate	Decreased metabolism of Ciclesonide caused by Abametapir mediated inhibition of CYP450 enzyme.	Pediculosis [1G00]	[42]
Lefamulin	DME6G97	Moderate	Decreased metabolism of Ciclesonide caused by Lefamulin mediated inhibition of CYP450 enzyme.	Pneumonia [CA40]	[43]
Lonafarnib	DMGM2Z6	Moderate	Decreased metabolism of Ciclesonide caused by Lonafarnib mediated inhibition of CYP450 enzyme.	Premature ageing appearance [LD2B]	[40]
Fostamatinib	DM6AUHV	Moderate	Decreased clearance of Ciclesonide due to the transporter inhibition by Fostamatinib.	Thrombocytopenia [3B64]	[44]

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