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Pronunciation: flew-droe-CORE-tih-sone ASS-uh-TATE
- Tablets 0.1 mg
Exerts salt-retaining (mineralocorticoid) activity by acting on renal distal tubules to enhance reabsorption of sodium and increasing urinary excretion of potassium, hydrogen, and magnesium ions.
Fludrocortisone is rapidly absorbed from the GI tract. T max is 1.7 h.
The plasma t 1/ 2 is about 3.5 h. The biological t 1/ 2 is 18 to 36 h.
Indications and Usage
Partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison disease; treatment of salt-losing adrenogenital syndrome.
Treatment of severe orthostatic hypotension.
Systemic fungal infections.
Dosage and AdministrationAddison Disease
PO 0.05 to 0.1 mg/day (range, 0.1 mg 3 times/wk to 0.2 mg/day).Salt-Losing Adrenogenital Syndrome
PO 0.1 to 0.2 mg/day.
Drug InteractionsAmphotericin, potassium-losing diuretics
May increase potassium loss.Anticholinesterase agents (eg, neostigmine)
May antagonize the effects of anticholinesterase agents in myasthenia gravis.Anticoagulants (eg, warfarin)
Dose requirement of anticoagulant may be reduced or effect opposed.Barbiturates, hydantoins (eg, phenytoin), rifampin
Decreased fludrocortisone activity.Salicylates
Serum levels may be reduced by corticosteroids, decreasing the effectiveness; in addition, the ulcerogenic effects of both agents may be increased.
Laboratory Test Interactions
None well documented.
Edema; hypertension; CHF; heart enlargement.
Bruising; increased sweating; hives; rash.
Hypokalemic alkalosis. May also cause adverse reactions associated with glucocorticoids (eg, dexamethasone).
Category C .
Excreted in breast milk.
Safety and efficacy not established.
Patients with Addison disease may exhibit exaggerated adverse reactions; monitor closely for development of edema, significant weight gain, or increases in BP.
Adrenal insufficiency may occur. Increased doses may be needed before, during, or after stressful situations.
Sodium retention and potassium loss are increased by high sodium intake. Sodium restriction and potassium supplementation may be necessary.
Use with caution in patients with nonspecific ulcerative colitis if there is a possibility of impending perforation, abscess or other pyogenic infection, diverticulitis, fresh intestinal anastomoses, or peptic ulcer.
Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection.
Because of possible hazards of neurological complications and a lack of antibody response, do not vaccinate patients against smallpox while receiving corticosteroid therapy or undertake other immunization procedures.
Prolonged use may produce posterior subcapsular cataracts and glaucoma with possible damage to the optic nerves and may enhance the establishment of secondary ocular infections caused by fungi or viruses.
Patients receiving fludrocortisone may need supplemental measures (eg, glucocorticoids, electrolyte control) for optimal control of symptoms.
Hypertension, edema, hypokalemia, excessive weight gain, increase in heart size.
- Instruct patient to take medication exactly as prescribed. If dose is missed, it should be taken as soon as possible. Do not double up if within several hours of next dose. Caution patient not to stop medication abruptly. Instruct patient to notify health care provider if greater than 1 dose is missed or a dosage cannot be taken because of nausea or vomiting.
- Advise patient to reduce dietary sodium, which accelerates potassium loss, and to eat foods rich in potassium.
- Tell patient to notify health care provider when experiencing a stressful situation (eg, emotional upheavals, dental extractions, trauma, surgery, illness) as increased dosage may be needed.
- Instruct patient to report the following symptoms to health care provider: increased or irregular heart beat, high BP, fluid retention, joint pain, muscle weakness, headache, dizziness, fever, unusual weight gain.
- Instruct patient to report euphoria, depression, or other changes in mental status.
- Tell patient to be alert for spontaneous fractures and impaired wound healing.
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