Fludrocortisone Acetate

A to Z Drug Facts

 Action 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.

 Indications Partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison's disease; treatment of salt-losing adrenogenital syndrome. unlabeled use(s): Treatment of severe orthostatic hypotension.

 Contraindications Systemic fungal infections.

 Route/Dosage

Addison's Disease

ADULTS & CHILDREN: PO 0.05 to 0.1 mg/day (range 0.1 mg 3 times/wk to 0.2 mg/day). INFANTS: PO 0.1 to 0.2 mg/day.

Salt-Losing Adrenogenital Syndrome

ADULTS & CHILDREN: PO 0.1 to 0.2 mg/day.

Severe Orthostatic Hypotension

ADULTS: PO 0.1 to 0.4 mg/day.

 Interactions

Amphotericin, potassium-losing diuretics: May increase potassium loss. Hydantoins (eg, phenytoin), rifampin: Decreased fludrocortisone activity.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Edema; hypertension; CHF; heart enlargement. DERM: Bruising; increased sweating; hives; rash. OTHER: Hypokalemic alkalosis. May also cause adverse reactions associated with glucocorticoids (eg, dexamethasone).

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Addison's disease: Patients with Addison's disease may exhibit exaggerated side effects; 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. Electrolyte disturbances: Sodium retention and potassium loss are increased by high sodium intake. Sodium restriction and potassium supplementation may be necessary. Supplemental measures: Patients receiving fludrocortisone may need supplemental measures (eg, glucocorticoids, electrolyte control) for optimal control of symptoms.

 Administration/Storage

• Store in tightly closed container at room temperature. Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note cardiovascular disorders and recent or present fungal infection or other systemic infections.
• Assess baseline psychological status before beginning therapy.
• Take pulse and BP and monitor daily during therapy.
• Ensure that chest x-ray and serum electrolyte levels have been obtained before beginning therapy, and monitor frequently during treatment.
• Monitor weight gain and I&O during therapy.
• If signs of concurrent infection, significant increase in weight or BP, signs of hypokalemic alkalosis, dizziness, or severe headache occur, notify physician.

 Patient/Family Education

• 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 physician if more than one dose is missed or a dosage cannot be taken due to nausea and/or vomiting.
• Advise patient to reduce dietary sodium, which accelerates potassium loss, and to eat foods rich in potassium.
• Tell patient to notify physician when experiencing a stressful situation (eg, emotional upheavals, dental extractions, trauma, surgery, or illness) as increased dosage may be needed.
• Instruct patient to report the following symptoms to physician: Increased or irregular heart beat, high BP, fluid retention, joint pain, muscle weakness, headache, dizziness, fever, or 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.
• Advise patient of the importance of keeping follow-up visits.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts