deflazacort (Rx)

Brand and Other Names:Emflaza
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 6mg
  • 18mg
  • 30mg
  • 36mg

oral suspension

  • 22.75mg/mL

Duchenne Muscular Dystrophy

Indicated for Duchenne muscular dystrophy (DMD)

0.9 mg/kg/day PO qDay

If tablets are used, round up to the nearest possible dose; may use any combination of tablet strengths to achieve calculated dose

If the oral suspension is used, round up to the nearest tenth of a milliliter (mL)

When discontinuing treatment, gradually decrease dose if administered for more than a few day

Dosage Modifications

Coadministration with CYP3A4 inhibitors

  • Moderate or strong CYP3A4 inhibitors: Give one third the recommended deflazacort dose
  • Example: Reduce a 36-mg/day dose to 12 mg/day when used with moderate or strong CYP3A4 inhibitors

Coadministration with CYP3A4 inducers

  • Moderate or strong CYP3A4 inducers: Avoid use

Renal impairment

  • Mild, moderate, or severe: No dose adjustment required

Hepatic impairment

  • Mild or moderate: No dose adjustment required
  • Severe: Not studied

Dosing Considerations

Assessments before initiating treatment

  • Administer all immunizations according to immunization guidelines
  • Administer live-attenuated or live vaccines at least 4-6 weeks before starting treatment

Dosage Forms & Strengths

tablet

  • 6mg
  • 18mg
  • 30mg
  • 36mg

oral suspension

  • 22.75mg/mL

Duchenne Muscular Dystrophy

Indicated for treatment of Duchenne muscular dystrophy (DMD) in patients aged ≥2 years

<2 years: Safety and efficacy not established

≥2 years

  • 0.9 mg/kg/day PO qDay
  • If tablets are used, round up to the nearest possible dose; may use any combination of tablet strengths to achieve calculated dose
  • If the oral suspension is used, round up to the nearest tenth of a milliliter (mL)
  • When discontinuing treatment, gradually decrease dose if administered for more than a few day

Dosage Modifications

Coadministration with CYP3A4 inhibitors

  • Moderate or strong CYP3A4 inhibitors: Give one third the recommended deflazacort dose
  • Example: Reduce a 36-mg/day dose to 12 mg/day when used with moderate or strong CYP3A4 inhibitors

Coadministration with CYP3A4 inducers

  • Moderate or strong CYP3A4 inducers: Avoid use

Renal impairment

  • Mild, moderate, or severe: No dose adjustment required

Hepatic impairment

  • Mild or moderate: No dose adjustment required
  • Severe: Not studied

Dosing Considerations

Assessments before initiating treatment

  • Administer all immunizations according to immunization guidelines
  • Administer live-attenuated or live vaccines at least 4-6 weeks before starting treatment
Next:

Interactions

Interaction Checker

and deflazacort

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (1)

            • mifepristone

              mifepristone, deflazacort. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.

            Serious - Use Alternative (83)

            • abametapir

              abametapir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • adenovirus types 4 and 7 live, oral

              deflazacort decreases effects of adenovirus types 4 and 7 live, oral by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • amobarbital

              amobarbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • anthrax vaccine

              deflazacort decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • apalutamide

              apalutamide will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • armodafinil

              armodafinil will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • artemether/lumefantrine

              artemether/lumefantrine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • axicabtagene ciloleucel

              deflazacort decreases effects of axicabtagene ciloleucel by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid prophylactic use of systemic corticosteroids as premedication before axicabtagene ciloleucel. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.

            • BCG vaccine live

              deflazacort decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • bosentan

              bosentan will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • butabarbital

              butabarbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • butalbital

              butalbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • carbamazepine

              carbamazepine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • chloramphenicol

              chloramphenicol will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Decrease dose by one third if combination cannot be avoided

            • clobazam

              clobazam will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • dabrafenib

              dabrafenib will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • diphtheria & tetanus toxoids

              deflazacort decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • diphtheria & tetanus toxoids/ acellular pertussis vaccine

              deflazacort decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

              deflazacort decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • efavirenz

              efavirenz will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • enzalutamide

              enzalutamide will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • eslicarbazepine acetate

              eslicarbazepine acetate will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • etravirine

              etravirine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • fexinidazole

              fexinidazole will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • grapefruit

              grapefruit will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid consuming grapefruit and grapefruit juice while taking deflazacort.

            • hepatitis A vaccine inactivated

              deflazacort decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • hepatitis a/b vaccine

              deflazacort decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • hepatitis a/typhoid vaccine

              deflazacort decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • hepatitis b vaccine

              deflazacort decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • human papillomavirus vaccine, nonavalent

              deflazacort decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

            • human papillomavirus vaccine, quadrivalent

              deflazacort decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

            • influenza virus vaccine quadrivalent

              deflazacort decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine quadrivalent, cell-cultured

              deflazacort decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine quadrivalent, intranasal

              deflazacort decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine trivalent

              deflazacort decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • ivosidenib

              ivosidenib will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • Japanese encephalitis virus vaccine

              deflazacort decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • lonafarnib

              lonafarnib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • lorlatinib

              lorlatinib will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lumacaftor/ivacaftor

              lumacaftor/ivacaftor will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • macimorelin

              deflazacort, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin. .

            • measles (rubeola) vaccine

              deflazacort decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • measles mumps and rubella vaccine, live

              deflazacort decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of measles mumps and rubella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • measles, mumps, rubella and varicella vaccine, live

              deflazacort decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of measles, mumps, rubella and varicella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • meningococcal A C Y and W-135 polysaccharide vaccine combined

              deflazacort decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • mifepristone

              mifepristone will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Decrease dose by one third if combination cannot be avoided

            • mitotane

              mitotane will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • modafinil

              modafinil will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • nafcillin

              nafcillin will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • nevirapine

              nevirapine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • oxcarbazepine

              oxcarbazepine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • pentobarbital

              pentobarbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • phenobarbital

              phenobarbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • phenytoin

              phenytoin will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • pneumococcal vaccine 13-valent

              deflazacort decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • pneumococcal vaccine heptavalent

              deflazacort decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • pneumococcal vaccine polyvalent

              deflazacort decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • primidone

              primidone will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • quinidine

              quinidine will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • rabies vaccine

              deflazacort decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids may interfere with development of active immunity.

            • rabies vaccine chick embryo cell derived

              deflazacort decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • ribociclib

              ribociclib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Decrease dose by one third if combination cannot be avoided

            • rifabutin

              rifabutin will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • rifampin

              rifampin will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • rifapentine

              rifapentine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • rotavirus oral vaccine, live

              deflazacort decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of rotavirus oral vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • rubella vaccine

              deflazacort decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • secobarbital

              secobarbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • smallpox (vaccinia) vaccine, live

              deflazacort decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of smallpox (vaccinia) vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • squill

              deflazacort increases toxicity of squill by unspecified interaction mechanism. Avoid or Use Alternate Drug.

            • St John's Wort

              St John's Wort will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.

            • tetanus toxoid adsorbed or fluid

              deflazacort decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • tick-borne encephalitis vaccine

              deflazacort decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • tisagenlecleucel

              deflazacort decreases effects of tisagenlecleucel by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid using corticosteroids as premedication or during treatment with tisagenlecleucel, except for life-threatening emergence (eg, cytokine release syndrome).

            • travelers diarrhea and cholera vaccine inactivated

              deflazacort decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • tucatinib

              tucatinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • typhoid polysaccharide vaccine

              deflazacort decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • typhoid vaccine live

              deflazacort decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of typhoid vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • varicella virus vaccine live

              deflazacort decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of varicella virus vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • voxelotor

              voxelotor will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            • yellow fever vaccine

              deflazacort decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            • zoster vaccine live

              deflazacort decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              deflazacort increases effects of zoster vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids.

            Monitor Closely (221)

            • aceclofenac

              aceclofenac, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • acemetacin

              acemetacin, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • albuterol

              albuterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • amiodarone

              amiodarone will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              amiodarone will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • amphotericin B cholesteryl sulfate

              amphotericin B cholesteryl sulfate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • amphotericin B liposomal

              amphotericin B liposomal and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • amphotericin B phospholipid complex

              amphotericin B phospholipid complex and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • ampicillin

              ampicillin and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • antithrombin alfa

              deflazacort, antithrombin alfa. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • antithrombin III

              deflazacort, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • aprepitant

              aprepitant will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • arformoterol

              arformoterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • argatroban

              deflazacort, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • aspirin

              aspirin, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • aspirin rectal

              aspirin rectal, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • atazanavir

              atazanavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • atorvastatin

              atorvastatin will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • atracurium

              atracurium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

            • belzutifan

              belzutifan will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

            • bemiparin

              deflazacort, bemiparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • bicalutamide

              bicalutamide will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • bisacodyl

              bisacodyl and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • bisacodyl rectal

              bisacodyl rectal and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • bivalirudin

              deflazacort, bivalirudin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • bumetanide

              bumetanide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • caspofungin

              caspofungin and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • castor oil

              castor oil and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • celecoxib

              celecoxib, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • cenobamate

              cenobamate will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • ceritinib

              ceritinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • chlorothiazide

              chlorothiazide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • chlorthalidone

              chlorthalidone and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • cholestyramine

              cholestyramine decreases levels of deflazacort by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • cisatracurium

              cisatracurium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

            • cisplatin

              cisplatin and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • clarithromycin

              clarithromycin will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              clarithromycin will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • clotrimazole

              clotrimazole will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • clozapine

              clozapine will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • cobicistat

              cobicistat will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • conivaptan

              conivaptan will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • crizotinib

              crizotinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • cyclosporine

              cyclosporine will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              cyclosporine will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              deflazacort, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase or decrease cyclosporine concentrations. Also, cyclosporine may increase the plasma concentrations of the corticosteroids. Monitor for changes in cyclosporine concentrations and for toxicities of corticosteroids and/or cyclosporine.

            • dalteparin

              deflazacort, dalteparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • darunavir

              darunavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • dengue vaccine

              deflazacort decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

            • desipramine

              desipramine will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • diclofenac

              diclofenac, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • diflunisal

              diflunisal, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • diltiazem

              diltiazem will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • dobutamine

              dobutamine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • dopamine

              dopamine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • doxycycline

              doxycycline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • dronedarone

              dronedarone will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              dronedarone will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • duvelisib

              duvelisib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

            • elagolix

              elagolix will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • encorafenib

              encorafenib, deflazacort. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • enoxaparin

              deflazacort, enoxaparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • ephedrine

              ephedrine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • epinephrine

              epinephrine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • epinephrine racemic

              epinephrine racemic and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • erythromycin base

              erythromycin base will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              erythromycin base will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              erythromycin ethylsuccinate will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              erythromycin lactobionate will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              erythromycin stearate will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • ethacrynic acid

              ethacrynic acid and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • etodolac

              etodolac, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • fedratinib

              fedratinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • felodipine

              felodipine will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • fenoprofen

              fenoprofen, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • fluconazole

              fluconazole will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              fluconazole and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • fluvoxamine

              fluvoxamine will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose by one-third of recommended dose if coadministered with moderate or strong CYP3A4 inhibitors

            • fondaparinux

              deflazacort, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • formoterol

              formoterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • fosamprenavir

              fosamprenavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • furosemide

              furosemide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • gentamicin

              gentamicin and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • glycerin

              glycerin and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • glycerin rectal

              glycerin rectal and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • haemophilus influenzae type b vaccine

              deflazacort decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored.

            • haloperidol

              haloperidol will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • heparin

              deflazacort, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • hydrochlorothiazide

              hydrochlorothiazide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • ibuprofen

              ibuprofen, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • ibuprofen IV

              ibuprofen IV, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • idelalisib

              idelalisib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • iloperidone

              iloperidone will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • imatinib

              imatinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • indapamide

              indapamide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • indinavir

              indinavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              indinavir will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • indomethacin

              indomethacin, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • influenza virus vaccine quadrivalent, recombinant

              deflazacort decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

            • influenza virus vaccine trivalent, recombinant

              deflazacort decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

            • insulin aspart

              insulin aspart and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin aspart protamine/insulin aspart

              insulin aspart protamine/insulin aspart and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin degludec

              insulin degludec and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin detemir

              insulin detemir and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin glargine

              insulin glargine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin glulisine

              insulin glulisine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin inhaled

              insulin inhaled and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin isophane human/insulin regular human

              insulin isophane human/insulin regular human and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin lispro

              insulin lispro and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin lispro protamine/insulin lispro

              insulin lispro protamine/insulin lispro and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin NPH

              insulin NPH and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • insulin regular human

              insulin regular human and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • isoniazid

              isoniazid will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • isoproterenol

              isoproterenol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • itraconazole

              itraconazole will increase the level or effect of deflazacort by Other (see comment). Modify Therapy/Monitor Closely. Itraconazole is a strong P-gp and CYP3A4 inhibitor.Decrease deflazacort (P-gp and CYP3A4 substrate) dose to one-third of the recommended dose if coadministered with strong CYP3A4 and/or P-gp inhibitors.

            • ketoconazole

              ketoconazole will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              ketoconazole will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              ketoconazole and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • ketoprofen

              ketoprofen, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • ketorolac

              ketorolac, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • ketorolac intranasal

              ketorolac intranasal, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • lactulose

              lactulose and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • lapatinib

              lapatinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              lapatinib will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • levalbuterol

              levalbuterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • lonapegsomatropin

              lonapegsomatropin decreases effects of deflazacort by Other (see comment). Use Caution/Monitor. Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.

              deflazacort decreases effects of lonapegsomatropin by Other (see comment). Use Caution/Monitor. Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.

            • lopinavir

              lopinavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • loratadine

              loratadine will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • lornoxicam

              lornoxicam, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • lovastatin

              lovastatin will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • lubiprostone

              lubiprostone and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • magnesium citrate

              magnesium citrate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • magnesium hydroxide

              magnesium hydroxide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • malt soup extract

              malt soup extract and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • meclofenamate

              meclofenamate, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • mefenamic acid

              mefenamic acid, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • meloxicam

              meloxicam, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • metaproterenol

              metaproterenol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • metolazone

              metolazone and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • metronidazole

              metronidazole will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • nabumetone

              nabumetone, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • nafcillin

              nafcillin and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • naproxen

              naproxen, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • nefazodone

              nefazodone will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              nefazodone will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nelfinavir

              nelfinavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • netupitant/palonosetron

              netupitant/palonosetron will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • nicardipine

              nicardipine will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              nicardipine will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • nifedipine

              nifedipine will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              nilotinib will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • norepinephrine

              norepinephrine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • ocrelizumab

              deflazacort and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with high doses of corticosteroids is expected to increase the risk of immunosuppression.

            • ofatumumab SC

              ofatumumab SC, deflazacort. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

            • oxaliplatin

              oxaliplatin and deflazacort both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Use of oxaliplatin with concomitant immunosuppressants or with impaired immune systems may increased risk for serious infections.

            • oxaprozin

              oxaprozin, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • ozanimod

              ozanimod, deflazacort. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

            • pancuronium

              pancuronium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

            • parecoxib

              parecoxib, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • penicillin G aqueous

              penicillin G aqueous and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • phenindione

              deflazacort, phenindione. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • phenobarbital

              phenobarbital will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • phenytoin

              phenytoin will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • pirbuterol

              pirbuterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • piroxicam

              piroxicam, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • poliovirus vaccine inactivated

              deflazacort decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

            • polyethylene glycol & electrolytes

              polyethylene glycol & electrolytes and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • polyethylene glycol/electrolytes/sodium ascorbate/ascorbic acid

              polyethylene glycol/electrolytes/sodium ascorbate/ascorbic acid and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • ponesimod

              ponesimod and deflazacort both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • posaconazole

              posaconazole will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              posaconazole and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • protamine

              deflazacort, protamine. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • quercetin

              quercetin will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • quinupristin/dalfopristin

              quinupristin/dalfopristin will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • ranolazine

              ranolazine will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              ritonavir will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rocuronium

              rocuronium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

            • rucaparib

              rucaparib will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • salicylates (non-asa)

              salicylates (non-asa), deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • salmeterol

              salmeterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • salsalate

              salsalate, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • saquinavir

              saquinavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • schisandra

              schisandra will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • senna

              senna and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sertraline

              sertraline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • simvastatin

              simvastatin will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sirolimus

              sirolimus will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sodium acid phosphate

              sodium acid phosphate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sodium bicarbonate

              sodium bicarbonate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sodium phosphate rectal

              sodium phosphate rectal and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              sodium picosulfate/magnesium oxide/anhydrous citric acid and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sodium polystyrene sulfonate

              sodium polystyrene sulfonate and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of deflazacort by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of deflazacort by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • sofosbuvir/velpatasvir

              sofosbuvir/velpatasvir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • somapacitan

              somapacitan decreases effects of deflazacort by Other (see comment). Modify Therapy/Monitor Closely. Comment: Microsomal enzyme 11-beta-hydroxysteroid dehydrogenase type 1 (11-beta-HSD-1) required for cortisone conversion to its active metabolite, cortisol, in hepatic and adipose tissue. GH inhibits 11-beta-HSD-1. Patients treated with glucocorticoid for hypoadrenalism may require increased maintenance or stress doses after initiating somapacitan.

            • somatrem

              deflazacort decreases effects of somatrem by pharmacodynamic antagonism. Use Caution/Monitor.

            • sorafenib

              deflazacort decreases levels of sorafenib by increasing metabolism. Use Caution/Monitor.

            • sorbitol

              sorbitol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • St John's Wort

              St John's Wort will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sterculia

              sterculia and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • stiripentol

              stiripentol, deflazacort. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • succinylcholine

              succinylcholine, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

            • sulfasalazine

              sulfasalazine, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • sulindac

              sulindac, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • tacrolimus

              tacrolimus will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • tazemetostat

              tazemetostat will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • terbutaline

              terbutaline and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • tetracycline

              tetracycline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • theophylline

              theophylline and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • tipranavir

              tipranavir will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • tolfenamic acid

              tolfenamic acid, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • tolmetin

              tolmetin, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

            • tolvaptan

              tolvaptan will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • torsemide

              torsemide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • trastuzumab

              trastuzumab, deflazacort. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trastuzumab deruxtecan

              trastuzumab deruxtecan, deflazacort. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trazodone

              trazodone will decrease the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • vecuronium

              vecuronium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

            • verapamil

              verapamil will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              verapamil will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • voriconazole

              voriconazole will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

              voriconazole and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • warfarin

              deflazacort, warfarin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • xipamide

              xipamide, deflazacort. pharmacodynamic synergism. Use Caution/Monitor. Risk of hypokalemia.

            • zafirlukast

              zafirlukast will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • zoster vaccine recombinant

              deflazacort decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.

            Minor (67)

            • acarbose

              deflazacort decreases effects of acarbose by pharmacodynamic antagonism. Minor/Significance Unknown.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate, deflazacort. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential for hypokalemia.

            • aspirin

              deflazacort decreases levels of aspirin by increasing renal clearance. Minor/Significance Unknown.

            • aspirin rectal

              deflazacort decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

            • aspirin/citric acid/sodium bicarbonate

              deflazacort decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

            • balsalazide

              deflazacort decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.

            • bendroflumethiazide

              deflazacort, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • bumetanide

              deflazacort, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • calcium acetate

              deflazacort decreases levels of calcium acetate by increasing elimination. Minor/Significance Unknown.

            • calcium carbonate

              deflazacort decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • calcium chloride

              deflazacort decreases levels of calcium chloride by increasing elimination. Minor/Significance Unknown.

            • calcium citrate

              deflazacort decreases levels of calcium citrate by increasing elimination. Minor/Significance Unknown.

            • calcium gluconate

              deflazacort decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

            • chlorothiazide

              deflazacort, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • chlorpropamide

              deflazacort decreases effects of chlorpropamide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • chlorthalidone

              deflazacort, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • choline magnesium trisalicylate

              deflazacort decreases levels of choline magnesium trisalicylate by increasing renal clearance. Minor/Significance Unknown.

            • chromium

              deflazacort decreases levels of chromium by increasing renal clearance. Minor/Significance Unknown.

            • colestipol

              colestipol decreases levels of deflazacort by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • cyclopenthiazide

              deflazacort, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • danazol

              danazol, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • diflunisal

              deflazacort decreases levels of diflunisal by increasing renal clearance. Minor/Significance Unknown.

            • ethacrynic acid

              deflazacort, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • feverfew

              deflazacort decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

            • fluoxymesterone

              fluoxymesterone, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • furosemide

              deflazacort, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • glimepiride

              deflazacort decreases effects of glimepiride by pharmacodynamic antagonism. Minor/Significance Unknown.

            • glipizide

              deflazacort decreases effects of glipizide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • glyburide

              deflazacort decreases effects of glyburide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • hydrochlorothiazide

              deflazacort, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • indapamide

              deflazacort, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • insulin aspart

              deflazacort decreases effects of insulin aspart by pharmacodynamic antagonism. Minor/Significance Unknown.

            • insulin detemir

              deflazacort decreases effects of insulin detemir by pharmacodynamic antagonism. Minor/Significance Unknown.

            • insulin glargine

              deflazacort decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • insulin glulisine

              deflazacort decreases effects of insulin glulisine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • insulin lispro

              deflazacort decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.

            • insulin NPH

              deflazacort decreases effects of insulin NPH by pharmacodynamic antagonism. Minor/Significance Unknown.

            • insulin regular human

              deflazacort decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • isoniazid

              deflazacort decreases effects of isoniazid by unknown mechanism. Minor/Significance Unknown.

            • mesalamine

              deflazacort decreases levels of mesalamine by increasing renal clearance. Minor/Significance Unknown.

            • mesterolone

              mesterolone, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • metformin

              deflazacort decreases effects of metformin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • methyclothiazide

              deflazacort, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • metolazone

              deflazacort, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • metyrapone

              deflazacort decreases effects of metyrapone by unspecified interaction mechanism. Minor/Significance Unknown.

            • miglitol

              deflazacort decreases effects of miglitol by pharmacodynamic antagonism. Minor/Significance Unknown.

            • nateglinide

              deflazacort decreases effects of nateglinide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • oxandrolone

              oxandrolone, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • oxymetholone

              oxymetholone, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • pioglitazone

              deflazacort decreases effects of pioglitazone by pharmacodynamic antagonism. Minor/Significance Unknown.

            • repaglinide

              deflazacort decreases effects of repaglinide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • rosiglitazone

              deflazacort decreases effects of rosiglitazone by pharmacodynamic antagonism. Minor/Significance Unknown.

            • salicylates (non-asa)

              deflazacort decreases levels of salicylates (non-asa) by increasing renal clearance. Minor/Significance Unknown.

            • salsalate

              deflazacort decreases levels of salsalate by increasing renal clearance. Minor/Significance Unknown.

            • saxagliptin

              deflazacort decreases effects of saxagliptin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • sitagliptin

              deflazacort decreases effects of sitagliptin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • somatropin

              deflazacort decreases effects of somatropin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • sulfasalazine

              deflazacort decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.

            • tacrolimus

              deflazacort, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

            • testosterone

              testosterone, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • testosterone buccal system

              testosterone buccal system, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • testosterone topical

              testosterone topical, deflazacort. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

            • tolazamide

              deflazacort decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • tolbutamide

              deflazacort decreases effects of tolbutamide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • torsemide

              deflazacort, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

            • vildagliptin

              deflazacort decreases effects of vildagliptin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • willow bark

              deflazacort decreases levels of willow bark by increasing renal clearance. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Cushingoid appearance (33%)

            Weight increased (20%)

            Increased appetite (14%)

            Upper respiratory tract infection (12%)

            Cough (12%)

            Pollakiuria (12%)

            1-10%

            Nasopharyngitis (10%)

            Hirsutism (10%)

            Central obesity (10%)

            Erythema (8%)

            Irritability (8%)

            Rhinorrhea (8%)

            Abdominal discomfort (6%)

            Eye disorders: Lacrimation increased (1-4%)

            Gastrointestinal disorders: Dyspepsia, nausea, gastrointestinal disorder (1-4%)

            General disorders and administration site conditions: Thirst (1-4%)

            Infections: Hordeolum, impetigo, influenza, otitis externa, pharyngitis, tooth abscess, urinary tract infection, viral infection (1-4%)

            Injury, poisoning and procedural complications: Back injury, contusion, face injury, fibula fracture, greenstick fracture, heat exhaustion (1-4%)

            Investigations: Glucose urine present, heart rate irregular (1-4%)

            Musculoskeletal and connective tissue disorders: Back pain, muscle spasms, myalgia, neck mass, neck pain, pain in extremity (1-4%)

            Nervous system disorders: Dizziness, psychomotor hyperactivity (1-4%)

            Psychiatric disorders: Affect lability, aggression, depression, emotional disorder, middle insomnia, mood altered, mood swings, sleep disorder (1-4%)

            Renal and urinary disorders: Chromaturia, dysuria, hypertonic bladder (1-4%)

            Reproductive system and breast disorders: Testicular pain (1-4%)

            Respiratory, thoracic, and mediastinal disorders: Hypoventilation, rhinorrhea (1-4%)

            Skin and subcutaneous tissue disorders: Acne, alopecia, dermatitis acneiform (1-4%)

            Vascular disorders: Hot flush (1-4%)

            Postmarketing Reports

            Blood and lymphatic system disorders: Leukocytosis

            Cardiac disorder: Heart failure

            Eye disorders: Chorioretinopathy, corneal or scleral thinning

            Gastrointestinal disorders: Acute pancreatitis (especially in children), hemorrhage, peptic ulceration, perforation of peptic ulcer

            General disorders and administration site conditions: Edema, impaired healing

            Immune system disorders: Hypersensitivity including anaphylaxis

            Metabolism and nutrition disorders: Impaired carbohydrate tolerance with increased requirement for antidiabetic therapy, negative protein and calcium balance, potassium loss and hypokalemic alkalosis when coadministered with beta2-agonist and xanthines

            Musculoskeletal and connective tissue disorders: Avascular necrosis, muscle wasting, negative nitrogen balance, tendonitis and tendon rupture when coadministered with quinolones, vertebral and long bone fractures

            Nervous system disorders: Aggravation of epilepsy, increased intracranial pressure with papilledema in children (pseudotumor cerebri) usually after treatment withdrawal, vertigo

            Psychiatric disorders: Anxiety, cognitive dysfunction including confusion and amnesia, delusions, hallucinations, mania, suicidal thoughts

            Skin and subcutaneous tissue disorders: Toxic epidermal necrolysis

            Vascular disorders: Thromboembolism, in particular in patients with underlying conditions associated with increased thrombotic tendency, benign intracranial hypertension

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            Warnings

            Contraindications

            Hypersensitivity to deflazacort or to any of the inactive ingredients

            Cautions

            Known hypersensitivity; instances of hypersensitivity, including anaphylaxis, have occurred with corticosteroid therapy

            Alterations in cardiovascular/renal function: Monitor for elevated blood pressure and sodium levels, and for decreased potassium levels

            Gastrointestinal perforation: Increased risk with certain GI disorders (eg, active/latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, ulcerative colitis); signs and symptoms may be masked

            Behavioral and mood disturbances: May include euphoria, insomnia, mood swings, personality changes, severe depression, and psychosis

            Effects on bones: Monitor for decreases in bone mineral density with long-term use

            Ophthalmic effects: May include cataracts, infections, and glaucoma; monitor intraocular pressure if used for >6 weeks

            Myopathy may occur with concomitant neuromuscular blocking agents or disorders of neuromuscular transmission (eg, myasthenia gravis)

            Kaposi sarcoma reported in patients receiving corticosteroid therapy, most often for chronic conditions; discontinuation of corticosteroids may result in clinical improvement

            Oral suspension contains benzyl alcohol and is not approved for use in children aged <5 yr; serious and fatal adverse reactions including (gasping syndrome) can occur in neonates and low-birth-weight infants treated with benzyl alcohol-preserved drugs

            Observational studies have shown an increased risk of thromboembolism (including VTE), particularly with higher cumulative doses of corticosteroids

            Alterations in endocrine function

            • Corticosteroids can cause serious and life-threatening alterations in endocrine function, especially with long-term use
            • Corticosteroids produce reversible hypothalamic-pituitary-adrenal (HPA) axis suppression and potentially develop secondary adrenal insufficiency after withdrawal of corticosteroid treatment
            • Acute adrenal insufficiency can occur if corticosteroids are withdrawn abruptly, and can be fatal; the risk is reduced by gradually tapering the dose
            • Adrenal insufficiency may persist, however, for months after discontinuation of prolonged therapy; therefore, in any situation of stress occurring during that period of discontinuation, corticosteroid therapy should be reinstituted
            • Cushing syndrome (hypercortisolism) occurs with prolonged exogenous corticosteroid exposure; symptoms include hypertension, truncal obesity and thinning of the limbs, purple striae, facial rounding, facial plethora, muscle weakness, easy and frequent bruising with thin fragile skin, posterior neck fat deposition, osteopenia, acne, amenorrhea, hirsutism and psychiatric abnormalities
            • Corticosteroid may increase blood glucose, worsen pre-existing diabetes, predispose those on long-term therapy to diabetes mellitus, and may reduce the effect of antidiabetic drugs; monitor blood glucose at regular intervals and if needed, antidiabetic treatment should be initiated
            • Corticosteroid metabolic clearance is decreased in patients with hypothyroidism and increased in patients with hyperthyroidism
            • Pheochromocytoma crisis, which can be fatal, has been reported after administration of systemic corticosteroids

            Immunosuppression and increased risk of infection

            • Increased risk of new, exacerbation, dissemination, or reactivation of latent infections, which can be severe and at times fatal; signs and symptoms of infection may be masked
            • Monitor for development of infection and consider withdrawal of corticosteroids or reduction of the dose of corticosteroids as needed
            • Varicella zoster virus exposure: Prophylaxis with varicella zoster immune globulin (VZIG) may be indicated; if chickenpox/varicella zoster develops, treatment with antiviral agents may be considered
            • Measles exposure: Prophylaxis with immunoglobulin (IG) may be indicated
            • Hepatitis B virus reactivation can occur in patients who are hepatitis B carriers undergoing treatment with immunosuppressive drugs including corticosteroids; reactivation can also occur with resolved hepatitis B infection
            • Fungal infections
              • If a systemic fungal infection develops, withdrawal of corticosteroids or dose reduction is recommended
              • Amebiasis: Corticosteroids may activate latent amebiasis; rule out latent or active amebiasis before initiating corticosteroids in any patient who has spent time in the tropics or other patients with unexplained diarrhea
              • Strongyloides (threadworm) infestation: Corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination of widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia; withdrawal of corticosteroids or dose reduction is recommended

            Drug interaction overview

            • Active metabolite of deflazacort, 21-desDFZ, is a substrate of CYP3A4
            • Coadministration of deflazacort with moderate or strong CYP3A4 inducers significantly decreases exposure of the active metabolite; avoid coadministration
            • Coadministration with neuromuscular blocking drugs (eg, pancuronium) may increase risk of acute myopathy
            • Caution if coadministered with other drugs that decrease serum potassium; monitor serum potassium or use an alternant drug
            • Vaccines
              • Immunosuppressive doses of corticosteroids may interfere with efficacy of live or live-attenuated vaccines
              • Patients on deflazacort may receive concurrent vaccinations, except for live-attenuated or live vaccines
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            Pregnancy

            Pregnancy

            Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus

            Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism

            Lactation

            Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects

            Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Corticosteroid prodrug, whose active metabolite, 21-desDFZ, acts through the glucocorticoid receptor to exert anti-inflammatory and immunosuppressive effects

            The precise mechanism by which deflazacort exerts its therapeutic effects in patients with DMD is unknown

            Absorption

            Peak plasma time: ~1 hr (fasting); ~2 hr (high-fat meal)

            Distribution

            Protein bound: 40%

            Metabolism

            Rapidly converted to the active metabolite 21-desDFZ by esterases after oral administration

            21-desDFZ is further metabolized by CYP3A4 to several inactive metabolites

            Elimination

            Excretion: Predominantly urinary (~68% [active metabolite accounts for 18% of this]); elimination is nearly complete by 24 hr post dose

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            Administration

            Oral Administration

            May take with or without food

            Tablets

            • Administer tablets whole or crushed and taken immediately after mixing with applesauce

            Oral suspension

            • Shake suspension well before measuring dose
            • Use only the oral dispenser provided with the product to measure the dose
            • After withdrawing the dose into the oral dispenser, slowly add suspension into 3-4 ounces of juice or milk and mix well
            • Administer dose immediately after mixing
            • Do not mix or administer with grapefruit juice

            Storage

            Tablets and oral suspension: Store at controlled room temperature (20-25°C [68-77°F]); excursion permitted to 15-30°C (59-86°F)

            Oral suspension: Discard any unused oral suspension remaining after 1 month of first opening the bottle

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Emflaza oral
            -
            18 mg tablet
            Emflaza oral
            -
            36 mg tablet
            Emflaza oral
            -
            6 mg tablet
            Emflaza oral
            -
            30 mg tablet
            Emflaza oral
            -
            22.75 mg/mL suspension

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.