Corticosteroid (oxazoline derivative of prednisolone) Pregnancy: Use lowest effective dose; transfer of corticosteroid to fetus low. Crosses placenta — like prednisolone, generally regarded as compatible with pregnancy.

Deflazacort

Brand names: Calcort, Emflaza (US)

Adult dose

Dose: Anti-inflammatory / immunosuppressive: 6–90 mg OD; usual maintenance 3–18 mg/day. Conversion: 6 mg deflazacort ≈ 5 mg prednisolone.

Route: Oral

Frequency: Once daily (morning)

Take with food. Use lowest effective dose; taper if course >2 weeks.

Paediatric dose

Dose: 0.9 mg/kg

Route: Oral

Frequency: Once daily (morning)

Duchenne muscular dystrophy: 0.9 mg/kg/day OD (FDA-approved indication). Other paediatric inflammatory: 0.25–1.5 mg/kg/day in single morning dose. Do NOT abruptly stop — taper.

Dose adjustments

Renal

No adjustment.

Hepatic

Severe: caution; no specific adjustment.

Paediatric weight-based calculator

Patient weight (kg)

Duchenne muscular dystrophy: 0.9 mg/kg/day OD (FDA-approved indication). Other paediatric inflammatory: 0.25–1.5 mg/kg/day in single morning dose. Do NOT abruptly stop — taper.

Clinical pearls

Specific niche role: Duchenne Muscular Dystrophy (DMD) — first-line (or alongside prednisolone) per international DMD care standards. Deflazacort 0.9 mg/kg/day vs prednisolone 0.75 mg/kg/day — similar functional efficacy, somewhat less weight gain and Cushingoid features but more cataracts.
Deflazacort 6 mg ≈ prednisolone 5 mg ≈ hydrocortisone 20 mg. Slightly less mineralocorticoid effect than prednisolone.
MUST taper if course >2 weeks — adrenal suppression. Standard dose-equivalent taper as for prednisolone.
Bone protection in long-term DMD use: calcium + vitamin D from outset; bisphosphonate when DEXA z-score ≤-2 or after fragility fracture.
FRAILTY/cataract surveillance (annual eye exam) and screening for vertebral fractures in long-term paediatric use.
Bone/cardiac/respiratory monitoring as per DMD multidisciplinary care framework.

Contraindications

Systemic untreated infection (relative — sepsis must be controlled or covered)
Live vaccines during high-dose treatment
Hypersensitivity

Side effects

Suppressed growth in children (less than equivalent prednisolone — small advantage in DMD)
Cushingoid features (less weight gain than prednisolone — its main advantage)
Hypertension, hyperglycaemia
Osteoporosis (long-term)
Cataracts, glaucoma
Mood changes, psychosis
Adrenal suppression
Increased infection risk
Skin thinning, easy bruising
Peptic ulcer

Interactions

CYP3A4 inducers (rifampicin, phenytoin, carbamazepine): ↓ deflazacort — increase dose 1.5–2×
CYP3A4 inhibitors (clarithromycin, ritonavir, ketoconazole): ↑ levels — reduce dose
Live vaccines: avoid during high-dose treatment
NSAIDs: ↑ GI bleeding risk
Diuretics, amphotericin: ↑ hypokalaemia
Anticoagulants: variable effect on INR

Monitoring

BP, glucose, weight, height (in children)
DEXA in long-term use
Annual ophthalmic review (cataracts/glaucoma)
Adrenal axis if course >3 weeks at supraphysiological dose

Reference: BNFc; BNF 90; BNF for Children 2024; SmPC Calcort; DMD Care Considerations Lancet Neurol 2018; FDA Approval Emflaza (deflazacort) for DMD 2017. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways