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Elderly subjects may commonly have conditions that may be exacerbated by fludrocortisone therapy includingbut not limited tohypertensionedemahypokalemiacongestive heart failurecataractsglaucomaincreased intraocular pressurerenal insufficiencyand osteoporisissee WARNINGSPRECAUTIONS and ADVERSE REACTIONSElderly subjects may also commonly be taking concomitant drug therapy such as digitalis glycosidesoral anticoagulantsantidiabetic drugsoral agents and insulinand aspirin which may interact with fludrocortisonesee PRECAUTIONSDrug Interactions
Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressuresalt and water retentionand increased excretion of potassiumThese effects are less likely to occur with the synthetic derivatives except when used in large dosesHoweversince fludrocortisone acetate is a potent mineralocorticoidboth the dosage and salt intake should be carefully monitored in order to avoid the development of hypertensionedemaor weight gainPeriodic checking of serum electrolyte levels is advisable during prolonged therapydietary salt restriction and potassium supplementation may be necessaryAll corticosteroids increase calcium excretion.
Corticosteroids are thought to actat least in partby controlling the rate of synthesis of proteinsAlthough there are a number of instances in which the synthesis of specific proteins is known to be induced by corticosteroidsthe links between the initial actions of the hormones and the final metabolic effects have not been completely elucidated.
Infants born of mothers who have received substantial doses of fludrocortisone acetate during pregnancy should be carefully observed for signs of hypoadrenalism.
Dosage depends on the severity of the disease and the response of the patientPatients should be continually monitored for signs that indicate dosage adjustment is necessarysuch as remissions or exacerbations of the disease and stresssurgeryinfectiontraumasee WARNINGS and PRECAUTIONSGeneral
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