Fludrocortisone

Mechanism :

Fludrocortisone Acetate is a synthetic adrenocortical steroid possessing very potent mineralocorticoid properties and high glucocorticoid activity, however it is used only for its mineralocorticoid effects. The physiologic action of fludrocortisone acetate is similar to that of hydrocortisone. However, the effects on electrolyte balance and also on carbohydrate metabolism, are considerably heightened and prolonged. Mineralocorticoids act on the distal tubules of the kidney to enhance the reabsorption of sodium ions from the tubular fluid into the plasma and increase the urinary excretion of both potassium and hydrogen ions.

Indication :

• Adrenocortical insufficiency
• Congenital adrenal hyperplasia

Contraindications :

Corticosteroids are contraindicated in patients with systemic fungal infections and in those with a history of possible or known hypersensitivity to these agents. Growth and development of children on prolonged therapy should be monitored.

Dosing :

Adverse Effect :

Hypertension, edema, congestive heart failure, potassium loss, cardiac enlargement, hypocalcemic alkalosis, muscle weakness, osteoporosis, loss of muscle mass, steroid myopathy, fractures, convulsions, increased intracranial pressure with papilledema, vertigo, headache, severe mental disturbances, peptic ulcer with possible perforation and hemorrhage, abdominal distention, pancreatitis, ulcerative esophagitis, menstrual irregularities, suppression of growth in children, development of the Cushingoid state, secondary adrenocortical and pituitary unresponsiveness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, and increased requirements for insulin or oral hypoglycemic agents in diabetics, impaired wound healing, bruising, thin fragile skin, petechiae and ecchymosis, increased sweating, facial erythema, purpura, subcutaneous fat atrophy, striae, hyperpigmentation of the skin and nails, hirsutism, reactions to skin tests may be suppressed, posterior subcapsular cataracts, glaucoma, exophthalmos, hyperglycemia, glycosuria.

Interaction :

Amphotericin B or potassium-depleting diuretics: Hypokalemia. Check serum potassium levels at frequent intervals and use potassium supplements if necessary.
Digitalis glycosides: Enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.
Oral anticoagulants: Decreased prothrombin time response. Monitor prothrombin levels and adjust anticoagulant dosage accordingly.
Antidiabetic drugs: Diminished antidiabetic effect. Monitor for symptoms of hyperglycemia
Aspirin: increased ulcerogenic effect, decreased pharmacologic effect of aspirin.
Barbiturates, Phenytoin, or Rifampin: Increased metabolic clearance of fludrocortisone acetate because of the induction of hepatic enzymes.
Anabolic Steroids such as Oxymetholone, Methandrostenolone, Norethandrolone: Enhanced tendency toward edema.
Vaccines: Neurological complications and lack of antibody response.

Renal Dose :

Hepatic Dose :