Deflazacort

Therapeutic Indications

It is a steroid drug that is mainly used to treat body inflammations. It is mainly used to treat Duchenne muscular dystrophy and other serious illnesses. It is also called Calcort. However, this is not a curative medicine for this condition but one that is used to make the condition much more bearable. The drug does this by strengthening muscles and slows down the rate of degeneration of muscles and progression of the disability. There are other uses for this drug that include:

• Asthma
• Rheumatoid arthritis
• Allergies
• Treatment of skin, heart, kidney, digestive system problems and other eye or blood infections
• Suppression of the immune system for transplant operations
• Treatment of areas in the body where tumors and other growths that are detected in the body
• Can be used to improve pulmonary function and reduction of the need for scoliosis surgery and delaying onset of cardiomyopathy
• Improvement of timed motor function
• Systemic lupus erythematosus, dermatomyositis
• Rheumatic carditis
• Uveitis, optic neuritis

Do I need a prescription?

The drug is only issued by prescription by a doctor. It has wide applications which only a doctor can assess the appropriate strength and condition of background. The drug can cause serious side effects.

Chemical Composition

Deflazacort is the main active ingredient. Excipient ingredients include microcrystalline cellulose, lactose, maize starch, and magnesium stearate.

Mechanism of Action (MOA)

The drug is also sold by a trade name, Cacort, whose full name is glucocorticoids. Glucocorticoids occur naturally in the body and are used to stabilize health and well being of a person. When taken, they help to treat several inflammations in the body. If the inflammations are not stopped in the body, they could worsen the health of a person. The drug helps to stop autoimmune reactions, which occur when the immune system of a body attacks itself to cause several damages. Thus, to get maximum benefit, the drug needs to be taken regularly.

Contraindications

• Alteration of endocrine function
• Immunosuppression, which increases the risk of infection
• Change in cardiovascular/ renal function
• Behavioral and mood changes
• Effects on bones-reduction in bone density
• Ophthalmic effects
• Vaccination
• Severe skin rashes
• May affect growth and development
• Myopathy
• Kaposi’s Sarcoma
• Anaphylaxis
• Thromboembolic events
• Benzyl Alcohol Preservative may have adverse effects on infants
• Hyperglycemia-corticosteroids can increase blood sugar level, and this can worsen other conditions such as diabetes. Taking this drug can worsen the effect of antidiabetic drugs. A doctor should be consulted if diabetic patients are taking this drug
• Cushing’s Syndrome. The condition may occur if patients are exposed to this drug for a long time. Symptoms may include hypertension, truncal obesity and thinning of limbs. Others include weakness of muscles, fragile skin, facial plethora and deposition of fats at the posterior neck.
• Pheochromocytoma Crisis-it is a fatal condition that has been reported after patients took systemic corticosteroids

Side effects

Less serious side effects

• Weight gain
• Headache
• Depression
• Nausea
• Acne
• Depression or the feeling of high
• Vertigo
• Mood swings
• Stomach upsets, which can happen straight away after taking the drug. In such as a case, see a doctor immediately

Rare effects

These are not common but are known to affect between 1 and 10 people for a population of 1000 users.

• Allergic reactions such as rash
• Difficulties in breathing
• Swelling of lips, face, throat or tongue-these can cause difficulties swallowing orb breathing
• Itchy lumps or rashes (hives)
• Nettle rash (urticaria) could indicate an allergic reaction
• Black tarry stools
• Bloody spots in stools
• Dark bits, appearing like coffee grounds which could indicate stomach ulcers
• Increased thirst
• Increased thirst and abnormal desire to pass water, which are symptoms associated with diabetes. If you suspect such, report to a doctor immediately
• Feeling of tiredness, confusion or muscle weakness
• Mood changes
• Loss of sleep
• Increased appetite
• Increased density of hair growth
• Patients that had tuberculosis may have a reprisal of this disease due to immunosuppression
• Acne and other skin problems such as rashes
• Possibilities of getting rashes

These are cases which are extremely rare and frequency cannot be estimated from data collected from patients as they are hardly known.

• Severe stomachaches that may extend to the back. These are symptoms of pancreatitis, which require urgent medical attention.
• Bones and tendons breaking easily or becoming inflamed
• Periods in some women may become irregular or may stop completely for others
• Symptoms for schizophrenic patients may get worse
• Some though in extremely rare cases may become dependent on this drug
• Fungal infections such as thrash may increase
• Blood diseases such as leucocytes
• Vision becoming blurred
• Eye diseases such as glaucoma and cataracts
• Eye diseases that make eyes to bulge and retina to separate
• Blood clotting risks
• Blood vessels becoming visible and thinning of skin
• Wounds and cuts take unusually too long to heal

Some symptoms may be noted in 1-10 in 10,000 people.

• General muscle weakness
• Bleeding under skin

Drug Interactions

Moderate or strong CYP3A4 inhibitors:  In such a case, reduce dosage to a third of what was prescribed earlier.

Precautions

• The drug is recommended for children above 5 and adults. Children below 5 should seek medical advice before taking it.
• Inform a doctor if you have any other infections caused by bacteria, fungi or virus
• Take caution if you have or heart conditions such as blood pressure, heart disease such as stroke or if you have a family history of these conditions.
• Inform your doctor if you have edema or fluid retention issues
• Diabetic patients should not use Deflazacort before or without informing a doctor.
• Patients with eye diseases or infections such as cataracts, glaucoma or herpes that affects eyes are advised to seek medical advice before taking this drug
• The drug must be taken regularly for it to have optimum efficacy.
• The drug needs to be taken to completion. It must not be stopped, and the drug requires to be tapered rather than stopping abruptly. Stopping abruptly can cause other problems such as high body temperature, runny nose, reddening of eyes that may be sore, painful muscle joints, itchy skin and loss of weight. Other people may vomit, feel drowsy and experience headaches especially for children.
• When Deflazacort is stopped suddenly, serious side effects may be noted. In such a case, it is recommended to seek medical attention immediately. Such symptoms include:
• Severe back pain
• Severe stomachache and painful legs
• Feeling of sickness
• Fainting or dizziness, which indicates low blood pressure
• Vomiting and diarrhea
• The drug should not be used by people that have chicken pox, measles or shingle infections. In case you have taken this drug and have any of these infections, seek medical help at once
• Do not take the drug for more than three weeks, unless advised so by a doctor. In the UK, patients that plan to take steroid drugs for more than 3 weeks should be given a blue ‘steroid drug’ which should be given to any doctor attending to the patient.
• Please note that the side effects of this drug may last longer than a month before they are noted or detected. Such include limbs (arms and legs) weakness and the tendency of the face to round
• There may be new information about the drug, so be sure to read all instructions on the attached leaflet once it has been issued to you.
• Inform your doctor if you have any of the following conditions: high blood pressure, blood clot, stroke or history of the following conditions
• Problems related to thyroid, pituitary glands or adrenal gland may pose additional problems if taken with the drug. Inform your doctor
• Ensure to inform your doctor if you have a condition of low bone density
• The drug may not be taken by patients with colostomy or ileostomy
• Do not take the drug if you just had vaccinations. Recent vaccination means there are live viruses in the body that could weaken the body further. If you must take it, seek medical advice before doing so.
• Patients with manic-depression or bipolar disorder or severe depression may not take this drug unless advised so by a doctor. If you have a close relative with such condition, be cautious before taking this drug
• Psychotic patients or those with depression are advised to take extra precaution before taking the drug
• Deflazacort contains lactose. Take caution before taking this drug if you have issues such as indigestibility or intolerance to these or related sugars
• Long term use of the Deflazacort may affect endocrine function: functions such as Hypothalamic-pituitary-adrenal axis suppression, Cushing’s syndrome, and hyperglycemia could be affected
• Immunosuppression and Increased Risk of Infection-new infections or those already present may be exacerbated, reactivated or disseminated due to taking the drug and this could be fatal to the user. Sometimes, signs and symptoms are not apparent.
• Alterations in Cardiovascular/Renal Function- there could be high blood
• pressure and compromised the function of kidneys due to high levels of sodium and potassium in the blood
• Gastrointestinal Perforation-patients with gastrointestinal complications may be affected by this drug and these symptoms are masked
• Behavioral and Mood Disturbances: some patients may experience euphoria, loss of sleep (insomnia), mood swings and change in personality. Some may have depression and psychosis
• Effects of bones: there may be a reduction in bone density
• Do not drive or operate machinery. The drug may cause dizziness
• Do not dispose of this drug by flushing in a toilet. Ask a doctor on the proper way of disposal of this drug
• It is recommended to inform a doctor if you are taking antibiotics or antifungal medications
• Do not take Deflazacort if you are taking antidepressants or antiviral drugs such as those for HIV patients. Please seek the advice of a doctor first
• Patients with John’s Wort need to seek medical advice first

What to do if you skip a dose

Ensure to take the drug at the same time daily to minimize the chances of missing a dose. However, a skipped dose should be taken and normal routine resumed if the time is not close to the next schedule. Too close intervals can result in an overdose, hence the need to even intervals of taking the drug. It is too close, go ahead and skip it, wait for the next dosage, take a single dose and resume taking the drugs as usual and as advised by a doctor.

Dosage

There is no single dose that should be taken by all patients; they vary depending on their conditions. Dosage depends on the illness of a patient and whether they are taking other medicines. The drug is available in tablets of 6mg, 18mg, and 36mg. In suspension form, Deflazacort is available in strengths of 22.75mg/mL

Patients can take deflazacort with milk or juice to improve their taste. Do not take with grape juice. If mixed with fruits or milk, the mixture should be consumed immediately.

Adults

• Usually, adults with rheumatoid arthritis and most of the other diseases indicated for this drug is three tablets a day with intervals evened out in the day.
• Patients with asthma disease can take 8 to 12 tablets in a day. Once the condition has been controlled and the patient is stabilized, these drugs can be reduced.
• There are other conditions where over 20 tablets are swallowed daily for several days as may be recommended by a doctor.

Children  

• Children can be given the drug daily or after every other day but this ought to be decided by a doctor.
• Age and weight of a child are usually used by a doctor to determine the appropriate dosage for a child.
• Where no other factors are limiting or mitigating, children are given the lowest possible dosage.
• An example of normal dosage for arthritis is between 0.12mg and 1mg for every kg of a child every day.
• Patients with nephrotic syndrome (related to kidney problems) are given a dose of 1.5mg for every kg that a child weighs daily. These doses are not fixed, they are adjusted depending on the response of a child to the medication also.
• Asthmatic children may be given between 0.25mg to 1mg per kg that a child weighs every other day.
• Infants are diagnosed by assessing the structure and muscular tissues of a heart before administering the drug.

Risky populations

• Pregnancy
• Lactation
• Pediatric
• Geriatric
• Renal impairment
• Hepatic impairment

Substitutes of the drug

The drug is usually sold in other brand names such as Emflaza

Recommendations

• Read the attached leaflet and understand all directions provided
• If you are given this medicine, ensure that only can take the medicine and not any other person. No two persons or patients can share medicine without medical prescription
• If the drug is supplied in suspension, please shake it well before taking.

References

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