Systemic glucocorticoid (oxazoline derivative)
ATC code: H02AB13 (Deflazacort)
Brand names
Emflaza, Calcort
A prednisolone derivative with an oxazoline ring. Metabolized to the active 21-desacetyl-deflazacort. Binds cytoplasmic glucocorticoid receptors and suppresses pro-inflammatory cytokines, NF-κB, and phospholipase A2. Anti-inflammatory potency: 6 mg deflazacort equals 5 mg prednisolone. Advantage: less impact on mineral metabolism and less weight gain than equidose prednisolone. In Spain it is among the popular systemic corticosteroids under brands Zamene and Dezacor.
First line
Drug of choice for Duchenne muscular dystrophy in boys from age 4–5. Per DMD Care Considerations 2018 and 2023, deflazacort slows loss of muscle function, delays loss of ambulation by 2–3 years, and reduces scoliosis risk. Versus it produces fewer cushingoid features and less weight gain, so Spain and Italy often prefer it. Dose 0.9 mg/kg/day, lifelong, with scheduled monitoring of growth, bone density, and vision.
Second line
Used in moderate asthma exacerbations in patients intolerant of prednisolone or with GI complaints on it. Dose 30 mg once daily for 5 days. 2024 first-line for moderate flares is oral prednisolone 40–50 mg for 5–7 days; deflazacort is an alternative for individual reasons.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Deflazacort is a systemic corticosteroid. It is prescribed for Duchenne muscular dystrophy, autoimmune diseases, and acute exacerbations of asthma (AEMPS Ficha Técnica). For chronic fatigue without a confirmed diagnosis, deflazacort is not indicated. The drug has serious risks on long-term use: adrenal suppression, steroid diabetes, osteoporosis, immunosuppression, psychiatric disturbances, cataract, and hypertension. If deflazacort was prescribed for fatigue without a confirmed diagnosis, seek a second opinion immediately.
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In T1, glucocorticoids carry a small increase in cleft lip/palate risk (low absolute risk). With life-saving indications (Duchenne, severe asthma) therapy is continued. Prednisone or prednisolone with more pregnancy data are preferred.
Milk concentrations are low. Compatible with breastfeeding. At high doses (over 40 mg/day) defer feeding for 4 hours after the dose.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Deflazacort is evaluated for the following indications with varying evidence strength: Duchenne muscular dystrophy (evidence tier A), Asthma exacerbation (evidence tier B), Chronic fatigue (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Deflazacort (≥ 1 in 100): Weight gain, Cushingoid features (moon face, fat redistribution), Hypertension, Hyperglycemia, Mood changes, Insomnia. See the Safety section for uncommon and serious reactions.
FDA category C. In T1, glucocorticoids carry a small increase in cleft lip/palate risk (low absolute risk). With life-saving indications (Duchenne, severe asthma) therapy is continued. Prednisone or prednisolone with more pregnancy data are preferred.
Milk concentrations are low. Compatible with breastfeeding. At high doses (over 40 mg/day) defer feeding for 4 hours after the dose.
Deflazacort is contraindicated in: Deflazacort hypersensitivity; Systemic fungal infection; Live vaccines during therapy; Active tuberculosis without concomitant treatment; Severe osteoporosis. Full list in the Safety section.