Emflaza Uses, Dosage, Side Effects, Food Interaction and all others data.

Emflaza provides anti-inflammatory action by inhibiting Phospholipase A2 enzyme which is responsible for prostaglandin synthesis. Besides Emflaza decreases the release of certain chemicals that are important in the immune system. By decreasing the release of these chemicals Emflaza provides immunosuppressive action.

Emflaza exerts anti-inflammatory activity in DMD, likely improving various symptoms, including muscle weakness and cardiorespiratory symptoms in addition to delaying their onset. This allows for an increased quality of life and prevents the necessity for surgical procedures, such as those for scoliosis, which is associated with DMD. Studies showed significant preservation of muscle mass in patients generally treated with 0.9 mg/kg/day of deflazacort compared to a control group. The following findings are based on clinical studies using deflazacort on a long term basis:

Effects on muscle strength

At age 16, individuals treated with long-term deflazacort had 63 ± 4% score in muscle strength compared to a mean muscle strength score of 31 ± 3% for control patients. Significant improvements in climbing stairs and rising from a supine position were also seen in patients taking deflazacort.

Trade Name Emflaza
Availability Prescription only
Generic Deflazacort
Deflazacort Other Names Deflazacort
Related Drugs Emflaza, Exondys 51, Amondys 45, Vyondys 53, eteplirsen, golodirsen
Weight 22.75mg/ml, 18mg, 30mg, 36mg, 6mg,
Type Oral suspension, oral tablet
Formula C25H31NO6
Weight Average: 441.524
Monoisotopic: 441.215137722
Protein binding

The protein binding of the active metabolite of deflazacort is approximately 40%.

Groups Approved, Investigational
Therapeutic Class Glucocorticoids
Available Country United States,
Last Updated: September 19, 2023 at 7:00 am


  • Anaphylaxis, asthma, severe hypersensitivity reactions
  • Rheumatoid arthritis, juvenile chronic arthritis, polymyalgia rheumatica
  • Systemic lupus erythematosus, dermatomyositis, mixed connective tissue disease (other than systemic sclerosis), polyarteritis nodosa, sarcoidosis
  • Pemphigus, bullous pemphigoid, pyoderma gangrenosum
  • Minimal change nephrotic syndrome, acute interstitial nephritis
  • Rheumatic carditis
  • Ulcerative colitis, Crohn's disease
  • Uveitis, optic neuritis
  • Autoimmune haemolytic anaemia, idiopathic thrombocytopenic purpura
  • Acute and lymphatic leukaemia, malignant lymphoma, multiple myeloma
  • Immune suppression in transplantation

Emflaza is also used to associated treatment for these conditions: Duchenne's Muscular Dystrophy (DMD)

How Emflaza works

Emflaza is a corticosteroid prodrug with an active metabolite, 21-deflazacort, which binds to the glucocorticoid receptor to exert anti-inflammatory and immunosuppressive effects on the body. The exact mechanism by which deflazacort exerts its therapeutic effects in patients with DMD is unknown but likely occurs via its anti-inflammatory activities.


Emflaza dosage


  • For acute disorders:up to 120 mg/day Emflaza may need to be given initially. Maintenance doses in most conditions are within the range 3-18 mg/day.
  • Rheumatoid arthritis: The maintenance dose is usually within the range 3-18 mg/day. The smallest effective dose should be used and increased if necessary.
  • Bronchial asthma: In the treatment of an acute attack, high doses of 48-72 mg/day may be needed depending on severity and gradually reduced once the attack has been controlled. For maintenance in chronic asthma, doses should be titrated to the lowest dose that controls symptoms.
  • Other conditions: The dose of Emflaza depends on clinical need titrated to the lowest effective dose for maintenance. Starting doses may be estimated on the basis of ratio of 5 mg prednisone or prednisolone to 6 mg Emflaza.


Alternate day administration may be appropriate. Doses of Emflaza usually lie in the range 0.25-1.5 mg/kg/day. The following ranges provide general guidance:

  • Juvenile chronic arthritis: The usual maintenance dose is between 0.25 to 1.0 mg/kg/day.
  • Nephrotic syndrome: Initial dose of usually 1.5 mg/kg/day followed by down titration according to clinical need.
  • Bronchial asthma: The initial dose should be between 0.25 - 1.0 mg/kg on alternate days.
  • Emflaza withdrawal:In patients who have received more than physiological doses of systemic corticosteroids (approximately 9 mg per day or equivalent) for greater than 3 weeks, withdrawal should not be abrupt. How dose reduction should be carried out depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced.

Side Effects

After administration occasionally GI disturbances like dyspepsia, nausea; musculoskeletal disorders like myopathy; depressed mood, skin atrophy, acne etc. may occur.


The LD50 for the oral dose is 5200 mg/kg (mouse); Oral TDLO (woman): 0.12 mg/kg

A note on altered endocrine function and immunosuppression

Emflaza, as a steroid prodrug used over a long-term period, can cause hormone imbalance leading to diseases such as Cushing's Syndrome and hypothalamic-pituitary-adrenal axis suppression. It can also predispose to infection, as it promotes immunosuppression. It is important to monitor for hormonal imbalance and infection and provide necessary treatment if they occur.


Mutagenicity assays were negative in various laboratory and in vivo assays performed on rats. Chronic use in mice for 2 years in one study resulted in a higher rate of osteoma and osteosarcomas in mice receiving 0.06, 0.12, 0.25, 0.50, or 1.0 mg/kg of deflazacort daily.

Use in pregnancy

There are no sufficient data to support the administration of deflazacort during pregnancy. Corticosteroid drugs such as deflazacort should only be used during pregnancy only if the benefits of therapy outweigh the potential risks.

Use in lactation

Corticosteroids, when administered systemically, are excreted in the breastmilk. Exposure may lead to disturbances in bone development and growth and endocrine disturbances in the exposed infant.


The following clinical conditions require special caution and frequent patient monitoring is necessary: Adrenal suppression and infection, child, adolescents, elderly, history of TB and steroid myopathy, hypertension, recent myocardial infarction, congestive heart failure, liver failure, renal impairment, diabetes mellitus and glaucoma (including family history), osteoporosis, corneal perforation, epilepsy, peptic ulcer, hypothyroidism, pregnancy and lactation.


Emflaza is metabolized in the liver. It is recommended to increase the maintenance dose of Emflaza if drugs which are liver enzyme inducers are co-administered, e.g. rifampicin, rifabutin, carbamazepine, phenobarbitone, phenytoin, primidone and aminoglutethimide. For drugs which inhibit liver enzymes, (e.g. ketoconazole) it may be possible to reduce the maintenance dose of Emflaza.

Food Interaction

  • Avoid grapefruit products. Grapefruit inhibits CYP3A metabolism, which may increase the serum concentration of deflazacort.
  • Avoid St. John's Wort. This herb induces CYP3A metabolism and may reduce serum levels of deflazacort.
  • Take with or without food. The tablets may be crushed and mixed with applesauce and consumed immediately.

[Moderate] GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of 21-desdeflazacort, the active metabolite of deflazacort that is formed by esterases after oral administration and further metabolized by CYP450 3A4 to several inactive metabolites.

The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism in the gut wall by certain compounds present in grapefruit.

In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands.

Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition.

Increased systemic exposure to 21-desdeflazacort may increase the risk of corticosteroid adverse effects such as hypercorticism, hyperglycemia, adrenal suppression, immunosuppression, hypertension, salt and water retention, electrolyte abnormalities, behavioral and mood disturbances, posterior subcapsular cataracts, glaucoma, bone loss, and growth retardation in children and adolescents.
br> MANAGEMENT: Emflaza should not be administered with grapefruit juice.

Emflaza Cholesterol interaction

[Moderate] Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods.

Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.

Emflaza Hypertension interaction

[Moderate] Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure.

These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone.

The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities.

However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods.

Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and

Dietary sodium restriction and potassium supplementation may be advisable.

Volume of Distribution

One study determined the volume of distribution to be 204 ± 84 L.

Elimination Route

Emflaza is rapidly absorbed after oral administration with peak concentration occurring within 1-2 hours. One pharmacokinetic study determined an AUC (area under the curve) of 280 ng/ml · h.

The bioavailability of both the oral suspension and tablet are similar. In clinical studies, coadministration of deflazacort crushed with food or applesauce did not affect absorption or bioavailability.

Half Life

The half-life of deflazacort ranges from 1.1 to 1.9 h


114 ±27 L/h, according to one noncompartmental pharmacokinetic study.

The clearance of corticosteroids is enhanced in hypothyroid patients and increased in patients with hyperthyroidism. Dosing adjustments may be considered according to thyroid status. A study of corticosteroid clearance was performed in patients with a creatinine clearance of 15 mL/min or less, and determined that the active metabolite of deflazacort, 21-deflazacort was similar to that in patients with normal renal clearance.

Elimination Route

Urinary excretion is the major route of deflazacort elimination, accounting for about about 70% of the excreted dose. The remainder of the dose (about 30%) is excreted in the feces. Elimination is almost completed by 24 hours post-dose. 21-deflazacort makes up about 18% of the eliminated drug in the urine.

Pregnancy & Breastfeeding use

Use in pregnancy: Emflaza does cross the placenta. When administered for prolonged periods or repeatedly during pregnancy, corticosteroids may increase the risk of intra-uterine growth retardation. As with all drugs, corticosteroids should only be prescribed when the benefits to the mother and child outweigh the risks.

Use in lactation: Corticosteroids are excreted in breast milk. Doses up to 50 mg daily of Emflaza are unlikely to cause systemic effects in the infant.


Hypersensitivity to or any of the ingredients. Patients receiving live virus immunisation.

Special Warning

Elderly: In elderly patients, no special precautions other than those usually adopted in patients receiving glucocorticoid therapy are necessary.

Hepatic impairment: In patients with hepatic impairment, blood levels of Emflaza may be increased. Therefore the dose of Emflaza should be carefully monitored and adjusted to the minimum effective dose.

Renal impairment: In renal impaired patients, no special precautions other than those usually adopted in patients receiving glucocorticoid therapy are necessary.

Acute Overdose

In patients who have received more than physiological doses of systemic corticosteroids (approximately 9mg per day or equivalent) for greater than 3 weeks, withdrawal should not be abrupt. How dose reduction should becarried out depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced.

Storage Condition

Store in a cool (below 25° C.) and dry place , protected from light & moisture. Keep out of the reach of children.

Innovators Monograph

You find simplified version here Emflaza

Emflaza contains Deflazacort see full prescribing information from innovator Emflaza Monograph, Emflaza MSDS, Emflaza FDA label


What is Emflaza used for?

Emflaza is used to treat duchenne muscular dystrophy in adults and children 2 years of age and older.

How safe is Emflaza?

Emflaza can weaken your immune system, and you may get an infection more easily. You may need frequent medical tests. Your vision and bone mineral density may also need to be checked.Emflaza may increase your risk of developing osteoporosis.

How does Emflaza work?

Emflaza works by reducing inflammation and by changing the way the immune system works.

What are the common side effects of Emflaza?

Common side effects of Emflaza are include:

  • Cushingoid appearance
  • Weight gain
  • Increased appetite
  • Upper respiratory tract infection
  • Cough
  • Urinary frequency

Is Emflaza safe during pregnancy?

Taking Emflaza during early pregnancy may increase the risk of cleft lip and palate in a newborn. Tell your doctor if you are pregnant or plan to become pregnant. Taking Emflaza at any time during pregnancy may affect adrenal gland hormones in the newborn baby.

Is Emflaza safe during breastfeeding?

Higher doses may be expected to affect the degree of adrenal suppression and should be used with caution.There are no data on the effects on milk production.

Can I drink alcohol with Emflaza?

Mixing alcohol with Emflaza can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing.

When should be taken of Emflaza?

Emflaza is usually taken once a day with or without food. Take Emflaza at around the same time every day.

Can I take Emflaza on empty stomach?

It can be taken on an empty stomach or after food.

Is Emflaza harmful?

Emflaza can weaken your immune system, and you may get an infection more easily.

Can I take Emflaza for a long time?

People who use Emflaza for a long time may develop glaucoma or cataracts. Talk to your doctor about the risks of using Emflaza and how often you should have your eyes examined during your treatment.

How long does Emflaza stay in my system?

Emflaza elimination plasma half-life is 1.1 to 1.9 hours. Elimination takes place primarily through the kidneys; 70% of the administered dose is excreted in the urine.

Who should not take Emflaza?

You should not use Emflaza if you are allergic to it.Emflaza should not be given to a child younger than 2 years old.

What happens if I miss a dose of Emflaza?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Is Emflaza a strong steroid?

Emflaza is less potent than prednisone and is usually administered at proportionately higher doses.

Can I drive after taking Emflaza?

Avoid driving if you experience dizziness after taking Emflaza.

Is Emflaza used for cough?

Emflaza engaged in manufacturing and supplying an excellent range of Emflaza for Cold and cough that is widely used as an anti-inflammatory and immunosuppressant.

Is Emflaza an antibiotic?

Emflaza is in a class of medications called cephalosporin antibiotics.

What happen If I suddenly stop taking Emflaza?

Do not stop taking Emflaza without talking to your doctor. Stopping the drug abruptly may cause symptoms such as loss of appetite, an upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss.

Is Emflaza safe in diabetes?

These results indicate that Emflaza, when employed in an anti-inflammatory dose equivalent to prednisone, should prove advantageous in insulin-treated diabetics who require steroid treatment.

Does Emflaza increase blood sugar?

Glucocorticoid treatment produces a deterioration of blood glucose control in diabetics. Recent reports have indicated that Emflaza is less diabetogenic than prednisone in healthy subjects.

*** Taking medicines without doctor's advice can cause long-term problems.