Xalcort (Deflazacort): Systemic Glucocorticoid Therapy

Xalcort contains Deflazacort, a systemic corticosteroid with potent anti-inflammatory and immunosuppressive actions. It works by inhibiting the phospholipase A2 enzyme—blocking the synthesis of prostaglandins—and by decreasing the release of key inflammatory chemicals in the immune system.

📋 Indications: Severe Inflammatory & Autoimmune Conditions

Xalcort is used across multiple medical specialties to treat complex disorders, including:

• Allergic & Respiratory: Severe asthma attacks, anaphylaxis, and acute hypersensitivity reactions.

• Rheumatological: Rheumatoid arthritis, juvenile chronic arthritis, and polymyalgia rheumatica.

• Autoimmune & Connective Tissue: Systemic lupus erythematosus (SLE), dermatomyositis, mixed connective tissue disease, and sarcoidosis.

• Dermatological: Pemphigus, bullous pemphigoid, and pyoderma gangrenosum.

• Renal & Gastrointestinal: Minimal change nephrotic syndrome, acute interstitial nephritis, ulcerative colitis, and Crohn's disease.

• Other: Advanced ocular inflammation (uveitis, optic neuritis), autoimmune hemolytic anemia, and as a component in treating certain leukemias and lymphomas.

🥄 Dosage & Administration

The dosage of Deflazacort must be individualized to the patient’s clinical need and strictly titrated to the lowest effective maintenance dose.

Adult Guidelines

• Acute Flare-ups: Up to 120 mg/day may be required initially.

• Standard Maintenance: Typically ranges from 3 mg to 18 mg/day.

• Asthma Attacks: 48 mg to 72 mg/day initially, stepping down gradually once control is achieved.

Pediatric Guidelines

Glucocorticoids carry risks of growth suppression in children; the lowest effective dose or alternate-day dosing is strongly advised. The typical pediatric range is 0.25 to 1.5 mg/kg/day.

• Juvenile Chronic Arthritis: 0.25 to 1.0 mg/kg/day maintenance.

• Nephrotic Syndrome: Started at 1.5 mg/kg/day, followed by a careful downward titration.

⚠️ The Golden Rule of Steroid Withdrawal: If you have been taking a dose higher than 9 mg/day for more than 3 weeks, never stop taking this medication abruptly. Abrupt cessation can cause acute, life-threatening adrenal crisis. Your doctor will provide a structured, gradual tapering schedule.

⚠️ Precautions, Warnings & Special Populations

Frequent monitoring is critical if you have any of the following pre-existing conditions:

• Cardiovascular: Hypertension, congestive heart failure, or a history of blood clots. Corticosteroids cause salt and water retention while depleting potassium; dietary salt restrictions or potassium supplements may be necessary.

• Gastrointestinal: Active peptic ulcers, diverticulitis, or severe ulcerative colitis where there is a risk of intestinal perforation.

• Metabolic & Endocrine: Diabetes (steroids elevate blood sugar), osteoporosis, or hypothyroidism.

• Hepatic Impairment: Liver failure decreases the metabolism of Deflazacort, elevating drug levels in the blood. Doses must be carefully reduced to the minimum effective amount.

🛑 Contraindications & Drug Interactions

• Contraindications: Known hypersensitivity to deflazacort. Do not receive live virus immunizations (vaccines) while on this medication, as your suppressed immune system cannot fight off the weakened virus.

• Liver Enzyme Inducers: Medications like Rifampicin, Carbamazepine, Phenytoin, and Phenobarbitone speed up the clearance of Xalcort, meaning your steroid maintenance dose may need to be increased.

• Liver Enzyme Inhibitors: Antifungals like Ketoconazole slow down drug clearance, meaning your Xalcort dose may need to be reduced to avoid toxicity.

🤰 Pregnancy & Lactation

• Pregnancy: Deflazacort crosses the placenta. Prolonged or repeated use during pregnancy carries a risk of intrauterine growth retardation. It should only be prescribed if the maternal benefit heavily outweighs the risk to the fetus.

• Lactation: Corticosteroids transfer into breast milk. While doses under 50 mg daily are unlikely to affect a nursing infant, higher maternal doses require close monitoring for infant adrenal suppression.

📦 Storage Conditions

• Store in a cool, dry place below 25°C. Protect the medication thoroughly from light and moisture. Keep safely out of reach of children.