In the recommended small dosages, the side effects seen with cortisone and its derivatives are not usually a problem with fludrocortisone. However, the following untoward effects should be kept in mind, particularly when this agent is used over a prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.
Fluid and Electrolyte Disturbances:
Sodium and fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalaemic alkalosis and hypertension.
Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis or femoral and humeral heads, pathologic fracture of long bones and spontaneous fractures.
Peptic ulcer with possible perforation and haemorrhage, pancreatitis, abdominal distension and ulcerative oesophagitis.
Impaired and wound healing, thin fragile skin, bruising, petechiae and ecchymoses, facial erythema, increased sweating, subcutaneous fat atrophy, purpura, striae, hyperpigmentation of the skin and nails, hirsutism and acne-form eruptions, reactions to skin tests may be suppressed.
Convulsions, increased intracranial pressure with papilloedema (pseudotumour cerebri) usually after treatment, vertigo, headache, severe mental disturbances.
Menstrual irregularities, development of the cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress (eg, trauma, surgery or illness), decreased carbohydrate tolerance, manifestations of latent diabetes mellitus and increased requirements for insulin or oral hypoglycaemic agents in diabetes.
Posterior subcapsular cataracts, increased intraocular pressure, glaucoma and exophthalmos.
Hyperglycaemia, glycosuria and negative nitrogen balance due to protein catabolism.
Other adverse reactions that may occur following the administration of a corticosteroid are necrotising angitis, thrombophlebitis, aggravation or masking of infections, insomnia, syncopal episodes and anaphylactoid reactions.