Fludrocortisone


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Primary adrenocortical insufficiency 50-300 mcg/day. Salt-losing adrenogenital hyperplasia 100-200 mcg/day.
Dosage Details
Oral
Primary adrenocortical insufficiency
Adult: 50-300 mcg daily, usually given in combination w/ cortisone or hydrocortisone. Dosage depends on the severity of the disease and patient’s response.

Oral
Salt-losing adrenogenital hyperplasia
Adult: 100-200 mcg daily.
Administration
Should be taken with food.
Contraindications
Systemic infections not controlled by antibiotics.
Special Precautions
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.
Adverse Reactions
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.
MonitoringParameters
Monitor BP, blood glucose, electrolytes, wt, salt intake.
Drug Interactions
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.
Lab Interference
May produce false-negative results in nitrobluetetrazolium test for bacterial infection. May suppress reaction to skin tests.
Action
Description: 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). 
Chemical Structure

Chemical Structure Image
Fludrocortisone

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

Storage
Store between 15-30°C. Protect from excessive heat.
ATC Classification
H02AA02 - fludrocortisone ; Belongs to the class of mineralocorticoids. Used in systemic corticosteroid preparations.
References
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 .

Disclaimer: This information is independently developed by MIMS based on Fludrocortisone from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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