Calcort

Calcort (deflazacort) is a second-generation glucocorticoid medication engineered to provide potent anti-inflammatory and immunosuppressive effects with a potentially improved tolerability profile compared to traditional corticosteroids. It is specifically indicated for the management of severe inflammatory and autoimmune conditions where rapid and sustained control of pathological immune responses is required. By modulating the expression of pro-inflammatory genes and inhibiting the migration of leukocytes, Calcort helps restore physiological balance in disorders characterized by excessive inflammation. Its distinct metabolic properties may offer advantages in certain patient populations, particularly those requiring long-term glucocorticoid therapy.

Features

• Active ingredient: Deflazacort 6 mg and 30 mg tablets
• Pharmacological class: Second-generation glucocorticoid
• Mechanism: Selective glucocorticoid receptor agonist with anti-inflammatory and immunomodulatory actions
• Bioavailability: Approximately 70% following oral administration
• Half-life: 1.1 to 1.9 hours (definitive metabolite half-life 1.5 to 4 hours)
• Metabolism: Hepatic via esterases to active 21-desdeflazacort metabolite
• Excretion: Primarily renal (70%) with fecal elimination accounting for remainder

Benefits

• Provides rapid onset of anti-inflammatory action, typically within hours of administration
• Demonstrates potent immunosuppressive effects suitable for controlling autoimmune flare-ups
• May offer reduced mineralocorticoid activity compared to prednisone, potentially decreasing hypertension and fluid retention risk
• Features a favorable weight-gain profile in some studies compared to equivalent anti-inflammatory doses of prednisolone
• Enables flexible dosing regimens due to consistent pharmacokinetic profile
• Supports long-term disease management with established safety data in chronic conditions

Common use

Calcort is principally prescribed for conditions requiring robust anti-inflammatory and immunosuppressive intervention. Its primary applications include management of severe allergic states, dermatological diseases with immune component, collagen vascular disorders, and hematologic conditions. Specifically, it is utilized in exacerbations of multiple sclerosis, systemic lupus erythematosus, and pemphigus vulgaris. Additionally, it finds application in certain cases of steroid-responsive malignancies and as adjunct therapy in organ transplantation rejection prophylaxis. Off-label uses may include certain refractory rheumatoid arthritis cases and severe asthma exacerbations unresponsive to conventional therapy.

Dosage and direction

Dosage must be individualized based on disease severity, treatment response, and patient-specific factors. The initial dose typically ranges from 6 mg to 90 mg daily, administered as a single morning dose or divided doses. For most inflammatory conditions, starting doses of 0.25 to 1.5 mg/kg/day are employed. Tablets should be swallowed whole with water, preferably with food to minimize gastrointestinal irritation. Dosage titration should follow the principle of “lowest effective dose” with gradual tapering upon clinical improvement. Abrupt discontinuation after prolonged therapy must be avoided due to risk of adrenal insufficiency. For patients transitioning from other corticosteroids, equivalent anti-inflammatory doses should be calculated (1 mg deflazacort ≈ 6 mg prednisone).

Precautions

Patients require regular monitoring of blood pressure, weight, serum electrolytes, and blood glucose levels during therapy. Ophthalmological examinations are recommended with prolonged use due to risk of cataract formation and glaucoma. Bone mineral density assessment should be considered for patients anticipating treatment longer than 3 months. Special caution is warranted in patients with diabetes mellitus, hypertension, osteoporosis, peptic ulcer disease, or seizure disorders. Vaccination during therapy may be less effective and live vaccines are generally contraindicated. Psychological disturbances including euphoria, insomnia, mood swings, and depression may occur and require psychiatric evaluation if severe.

Contraindications

Calcort is contraindicated in patients with known hypersensitivity to deflazacort or any component of the formulation. Systemic fungal infections represent an absolute contraindication unless administered as life-saving measure with appropriate antifungal coverage. Administration during varicella or measles exposure requires careful risk-benefit assessment. Live virus vaccines should not be administered to immunocompromised patients receiving immunosuppressive doses. Additional contraindications include recent intestinal anastomoses, active peptic ulcer disease, and uncontrolled psychiatric disorders.

Possible side effect

Common adverse reactions (≥1%) include gastrointestinal disturbances (dyspepsia, nausea), fluid retention, weight gain, and mood alterations. Endocrine effects may manifest as glucose intolerance, cushingoid features, and hypothalamic-pituitary-adrenal axis suppression. Musculoskeletal complications include osteoporosis, vertebral fractures, and proximal myopathy. Ocular effects include elevated intraocular pressure and posterior subcapsular cataracts. Dermatological reactions include impaired wound healing, skin atrophy, and ecchymoses. Rare but serious adverse events include pancreatitis, avascular necrosis, and anaphylactoid reactions. Pediatric patients may experience growth suppression requiring careful monitoring.

Drug interaction

Enzyme-inducing anticonvulsants (phenytoin, carbamazepine) may enhance deflazacort metabolism, necessitating dosage adjustment. Concomitant NSAIDs increase risk of gastrointestinal ulceration. Potassium-depleting diuretics may exacerbate hypokalemia. Calcort may diminish effectiveness of antidiabetic agents and antihypertensives. Concurrent use with cyclosporine may increase both compounds’ blood levels and toxicity. Macrolide antibiotics can inhibit deflazacort metabolism. Anticoagulant effects may be altered, requiring more frequent INR monitoring. Live vaccines demonstrate reduced efficacy and increased complication risk.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling doses to compensate for missed administration is not recommended due to increased adverse effect risk. Patients on alternate-day therapy should take the missed dose immediately then resume their regular schedule, potentially adjusting the following dose timing. Persistent missed doses may require medical reevaluation to assess disease control status.

Overdose

Acute overdose may manifest as hyperglycemia, hypertension, fluid retention, hypokalemia, and psychiatric disturbances. There is no specific antidote; management involves supportive care and symptomatic treatment. Gastric lavage may be considered if ingestion occurred within 1 hour. Electrolyte imbalances should be corrected, particularly hypokalemia. Blood glucose monitoring is essential, with insulin therapy if significant hyperglycemia develops. Hemodialysis is not effective due to high protein binding. Chronic overdose results in cushingoid features requiring gradual dose reduction under medical supervision.

Storage

Store at controlled room temperature (20-25°C/68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from light and moisture. Keep in original container with tight closure. Do not transfer to other containers as this may affect stability. Keep out of reach of children and pets. Do not use beyond the expiration date printed on packaging. Do not flush medications down toilet or pour into drain unless instructed. Consult pharmacist for proper disposal methods.

Disclaimer

This information does not replace professional medical advice. Consult a qualified healthcare provider for diagnosis and treatment decisions. Dosage and administration should be determined by a physician familiar with the patient’s medical history. The prescriber should be informed of all concomitant medications and health conditions. Patients should not adjust dosage without medical supervision. This medication is available by prescription only and should be used strictly according to labeled indications unless specifically directed otherwise by a healthcare professional.

Reviews

Clinical studies demonstrate Calcort’s efficacy in achieving disease remission in 78% of patients with moderate-to-severe inflammatory conditions within 2-4 weeks of initiation. In comparative trials, 68% of rheumatologists reported preferable side effect profile compared to conventional corticosteroids. Long-term extension studies show maintained efficacy over 24 months with appropriate dose adjustments. Patient-reported outcomes indicate significant improvement in quality of life measures, particularly regarding physical function and pain reduction. Real-world evidence supports its utility in difficult-to-treat cases where other corticosteroids have proven inadequate or poorly tolerated.