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The physiologic action of fludrocortisone acetate is similar to that of hydrocortisoneHoweverthe effects of fludrocortisone acetateparticularly on electrolyte balancebut also on carbohydrate metabolismare considerably heightened and prolongedMineralocorticoids act on the distal tubules of the kidney to enhance the reabsorption of sodium ions from the tubular fluid into the plasmathey increase the urinary excretion of both potassium and hydrogen ionsThe consequence of these three primary effects together with similar actions on cation transport in other tissues appear to account for the entire spectrum of physiological activities that are characteristic of mineralocorticoidsIn small oral dosesfludrocortisone acetate produces marked sodium retention and increased urinary potassium excretionIt also causes a rise in blood pressureapparently because of these effects on electrolyte levels.
Stress to the patient the importance of regular follow-up visits to check his progress and the need to promptly notify the physician of dizzinesssevere or continuing headachesswelling of feet or lower legsor unusual weight gain.
Adequate studies have not been performed in animals to determine whether fludrocortisone acetate has carcinogenic or mutagenic activity or whether it affects fertility in males or females.
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
In generaldose selection for an elderly patient should be cautioususually starting at the low end of the dosing rangereflecting the greater frequency of decreased hepaticrenalor cardiac functionand of concomitant disease or other drug therapy.
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