Deflazacort for ENT
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Deflazacort in ENT
What is Deflazacort?
Deflazacort is a synthetic oxazoline corticosteroid derived from prednisolone. It is an inactive prodrug converted to its active metabolite 21-desacetyl-deflazacort after oral administration.
Key pharmacological properties:
- Anti-inflammatory potency: ~1.5 mg deflazacort ≡ 1 mg prednisolone (conversion ratio)
- Relative glucocorticoid activity: moderate; lower mineralocorticoid activity than prednisolone
- Lower risk of metabolic side effects (weight gain, osteoporosis, hyperglycemia) compared to equivalent-dose prednisolone
Indications in ENT Practice
1. Allergic Rhinitis & Nasal Polyposis
- Used as a short-course systemic corticosteroid for:
- Severe/uncontrolled allergic rhinitis not responding to topical steroids
- Nasal polyposis — pre-operative polypectomy shrinkage or post-operative recurrence prevention
- Polyposis associated with Samter's triad (aspirin-exacerbated respiratory disease)
- Advantage over prednisolone: better tolerability for short courses
2. Sudden Sensorineural Hearing Loss (SSNHL)
- Systemic steroids are the mainstay of treatment for SSNHL
- Deflazacort used as an alternative to prednisolone in patients where minimizing metabolic side effects is desired (e.g., diabetics, elderly)
- Typical regimen: 1–1.5 mg/kg/day tapered over 10–14 days
3. Laryngeal & Subglottic Oedema
- Post-intubation laryngeal oedema — deflazacort helps reduce mucosal swelling
- Croup (laryngotracheobronchitis) — used as an alternative systemic steroid
- Laryngeal angioedema
4. Autoimmune / Inflammatory ENT Conditions
- Autoimmune inner ear disease (AIED) — initial high-dose steroid trial
- Granulomatous diseases: Wegener's (GPA), sarcoidosis with ENT involvement (saddle nose, laryngeal sarcoid)
- Bell's palsy — short-course steroids; deflazacort used as prednisolone substitute
5. Perioperative Use
- Reduction of post-tonsillectomy oedema and pain (adjunct)
- Post-septorhinoplasty oedema reduction
- Reduction of post-adenoidectomy swelling
6. Otitis Media with Effusion (Glue Ear)
- Short-course systemic steroids have limited but documented benefit
- Deflazacort used in selected cases for tubal oedema reduction
Dosing (Adults — General ENT)
| Indication | Dose | Duration |
|---|---|---|
| Nasal polyposis | 1 mg/kg/day (max 60 mg) | 5–7 days, then taper |
| SSNHL | 1–1.5 mg/kg/day | 10–14 days taper |
| Allergic rhinitis (severe) | 30–60 mg/day | 5–7 days |
| Post-operative oedema | 30 mg/day | 3–5 days |
| Bell's palsy | 1 mg/kg/day | 10 days, then taper |
Paediatric dose: 0.5–1 mg/kg/day depending on indication.
Advantages Over Prednisolone in ENT
| Feature | Deflazacort | Prednisolone |
|---|---|---|
| Weight gain | Less | More |
| Bone loss (osteoporosis) | Less | More |
| Glucose intolerance | Less | More |
| Fluid retention | Less | More |
| HPA axis suppression | Comparable | Comparable |
| Cost | Higher | Lower |
This favourable metabolic profile makes deflazacort preferred when:
- Repeated short courses are needed (recurrent polyposis)
- Patient has diabetes, obesity, or osteoporosis risk
- Paediatric patients (growth suppression risk lower)
Contraindications & Precautions
- Absolute: untreated systemic infections, live vaccines during therapy
- Relative: active peptic ulcer, uncontrolled diabetes, severe hypertension, psychosis
- Administer with food to minimise GI irritation
- Do not stop abruptly if used >1–2 weeks (taper to avoid adrenal insufficiency)
Side Effects (Relevant to Short ENT Courses)
- Short courses (≤7 days): generally well tolerated — mild GI upset, mood changes, transient hyperglycaemia
- Prolonged use: Cushingoid features, osteoporosis, adrenal suppression, cataracts, immunosuppression
Key Takeaway for ENT Practice
Deflazacort is a safe, well-tolerated alternative to prednisolone for conditions requiring short-to-medium systemic corticosteroid courses in ENT. Its primary niche is in patients who are metabolically vulnerable (diabetics, obese, elderly, children) and in conditions where repeated steroid courses are anticipated (recurrent nasal polyposis). The clinical efficacy is equivalent to prednisolone at the 1.5:1 dose ratio.
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