Fludrocortisone

Oral
Primary adrenocortical insufficiency

Oral
Salt-losing adrenogenital hyperplasia

Should be taken with food.

Systemic infections not controlled by antibiotics.

Patient w/ HTN, heart failure, DM, GI diseases (e.g. diverticulitis, active or latent peptic ulcer, ulcerative colitis, fresh intestinal anastomoses, abscess or other pyogenic infection), myasthenia gravis, cataract and/or glaucoma, osteoporosis, thyroid disease, history of seizure disorder. Renal and hepatic impairment. Pregnancy and lactation.

Significant: Adrenal suppression, immunosuppression, Kaposi sarcoma, psychiatric disturbances, myopathy. Rarely, anaphylactoid reactions.
Nervous: Increased intracranial pressure, convulsions, vertigo, headache, insomnia, syncopal episodes.
CV: Oedema, HTN, cardiac enlargement, CHF, necrotising angiitis, thrombophlebitis.
GI: Pancreatitis, peptic ulcer, ulcerative oesophagitis, abdominal distention.
Endocrine: Hyperglycaemia, negative nitrogen balance, glycosuria, menstrual irregularities, decreased carbohydrate tolerance, manifestations of latent DM.
Ophthalmologic: Increased intraocular pressure, posterior subcapsular cataracts, exophthalmos.
Dermatologic: Bruising, petechiae, ecchymoses, impaired wound healing, thin fragile skin, increased sweating, facial erythema, subcutaneous fat atrophy, striae, purpura, acneiform eruptions, hives, rash, urticariaa, hyperpigmentation of skin and nails, hirsutism.
Immunologic: Aggravation or masking of infections.
Others: K loss, hypokalaemic alkalosis.

PO: C

Monitor BP, blood glucose, electrolytes, wt, salt intake.

May increase risk of arrhythmias or toxicity w/ digitalis glycosides. May decrease prothrombin time response to oral anticoagulants. May decrease the therapeutic effect of antidiabetic drugs and aspirin. May diminish response to vaccines. Enhanced hypokalaemic effect w/ amphotericin B or K-depleting diuretics (e.g. benzothiadiazines, furosemide, etacrynic acid). Increased metabolic clearance w/ barbiturates, phenytoin, rifampicin. Increased risk of oedema w/ anabolic steroids particularly C-17 alkylated androgens (e.g. oxymetholone). Estrogens may increase levels of corticosteroid-binding globulin, thereby increasing the bound (inactive) fraction. May antagonise effect of anticholinesterase agents. May enhance neutropenic effect of immunosuppressants. May enhance adverse effect of NSAIDs.

May produce false-negative results in nitrobluetetrazolium test for bacterial infection. May suppress reaction to skin tests.

Description:
Mechanism of Action: Fludrocortisone is a corticosteroid w/ glucocorticoid and very potent mineralocorticoid activity. It acts on the renal distal tubules to promote the reabsorption of Na ions and increase the urinary excretion of K and hydrogen ions.
Pharmacokinetics:
Absorption: Rapidly and completely absorbed from the GI tract.
Distribution: Widely distributed throughout the body. Enters breast milk. Plasma protein binding: 70-80%, mainly to globulin fractions.
Metabolism: Hepatic.
Excretion: Elimination half-life: ≥3.5 hr (plasma); 18-36 hr (biological). 

Source: National Center for Biotechnology Information. PubChem Database. Fludrocortisone, CID=31378, https://pubchem.ncbi.nlm.nih.gov/compound/Fludrocortisone (accessed on Jan. 21, 2020)

Store between 15-30°C. Protect from excessive heat.

Corticosteroid Hormones

H02AA02 - fludrocortisone ; Belongs to the class of mineralocorticoids. Used in systemic corticosteroid preparations.

Anon. Fludrocortisone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 08/03/2017 .

Buckingham R (ed). Fludrocortisone Acetate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/03/2017 .

Fludrocortisone Acetate Tablet (Teva Pharmaceuticals USA, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 08/03/2017 .

Joint Formulary Committee. Fludrocortisone Acetate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/03/2017 .

McEvoy GK, Snow EK, Miller J et al (eds). Fludrocortisone Acetate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 08/03/2017 .