Home Drug Guide Fludrocortisone Acetate

Drug Guide

Generic Name

Fludrocortisone Acetate

Brand Names Florinef

Classification

Therapeutic: Mineralocorticoid replacement in adrenal insufficiency

Pharmacological: Glucocorticoid and mineralocorticoid receptor agonist

FDA Approved Indications

Addison's disease and other causes of adrenal insufficiency
Salt-losing adrenogenital syndrome

Mechanism of Action

Fludrocortisone acts on mineralocorticoid receptors in the distal tubules of the kidney, promoting sodium reabsorption, and potassium and hydrogen ion excretion, thereby regulating electrolyte and water balance.

Dosage and Administration

Adult: Typically 0.1 mg once daily; dosage may be adjusted based on clinical response and laboratory parameters.

Pediatric: Dosing is individualized based on the child's clinical condition and response.

Geriatric: Use with caution; start at lower doses due to potential for increased sensitivity and comorbidities.

Renal Impairment: Dose adjustments are generally not necessary, but monitor response closely.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Well absorbed from the gastrointestinal tract.

Distribution: Widely distributed in body tissues; crosses the placenta and enters breast milk.

Metabolism: Metabolized primarily in the liver.

Excretion: Excreted mainly in urine.

Half Life: Approximately 3.1 hours.

Contraindications

Systemic fungal infections
Hypersensitivity to fludrocortisone or other corticosteroids

Precautions

Use with caution in renal impairment, hypertension, congestive heart failure, osteoporosis, certain metabolic disturbances, infections, and during pregnancy and lactation. Regular monitoring is essential.

Adverse Reactions - Common

Fluid retention, edema (Common)
Hypertension (Common)
Hypokalemia (Common)
Headache, dizziness (Common)

Adverse Reactions - Serious

Heart failure exacerbation (Rare)
Hypertensive crises (Rare)
Electrolyte disturbances (severe hypokalemia or hyperkalemia) (Rare)
Allergic reactions (Rare)

Drug-Drug Interactions

Thiazide diuretics (may increase hypokalemia)
ACE inhibitors and ARBs (may enhance hyperkalemia)
Other corticosteroids

Drug-Food Interactions

Salt substitutes containing potassium

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, weight, serum electrolytes (potassium, sodium), and signs of fluid overload.

Diagnoses:

Fluid volume excess or deficit
Electrolyte imbalance
Risk for hypertension

Implementation: Administer dosing as prescribed, typically in the morning to mimic natural cortisol rhythms. Monitor laboratory values regularly. Educate patient on dietary sodium and potassium intake.

Evaluation: Assess for improved symptoms of adrenal insufficiency and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed; do not stop suddenly.
Report signs of water retention, swelling, unusual weight gain, or symptoms of electrolyte imbalance.
Maintain regular follow-up appointments and lab tests.
Limit salt intake if advised and monitor blood pressure regularly.

Special Considerations

Black Box Warnings:

Use with caution due to potential for serious adrenal suppression if discontinued abruptly.

Genetic Factors: Genetic variations may influence steroid metabolism but are not routinely tested.

Lab Test Interference: Can alter glucose tolerance tests and electrolyte panels.

Overdose Management

Signs/Symptoms: Severe electrolyte disturbances, dehydration, changes in blood pressure, signs of heart failure.

Treatment: Discontinue drug immediately, provide supportive care, correct electrolyte imbalances, and manage blood pressure as necessary.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable for at least 24 months if stored properly.