Common Uses:Off Label Uses:Side Effects:
Most adverse reactions are caused by the drug's mineralocorticoid activity (retention of sodium and water) and include hypertension, edema, cardiac enlargement, congestive heart failure, potassium loss, and hypokalemic alkalosis.

When fludrocortisone is used in the small dosages recommended, the glucocorticoid side effects often seen with cortisone and its derivatives are not usually a problem; however the following untoward effects should be kept in mind, particularly when fludrocortisone is used over a prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.

Musculoskeletal-muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones, and spontaneous fractures.

Gastrointestinal-peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, and ulcerative esophagitis.

Dermatologic-impaired 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, acneiform eruptions, and hives; reactions to skin tests may be suppressed.

Neurological-convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache, and severe mental disturbances.

Endocrine-menstrual irregularities; development of the cushingoid state; suppression of growth in children; secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress (e.g., trauma, surgery, or illness); decreased carbohydrate tolerance; manifestations of latent diabetes mellitus; and increased requirements for insulin or oral hypoglycemic agents in diabetics.

Ophthalmic-posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and exophthalmos.

Metabolic-hyperglycemia, glycosuria, and negative nitrogen balance due to protein catabolism.

Allergic Reactions-allergic skin rash, maculopapular rash, and urticaria.

Other adverse reactions that may occur following the administration of a corticosteroid are necrotizing angiitis, thrombophlebitis, aggravation or masking of infections, insomnia, syncopal episodes, and anaphylactoid reactions.

Cautions / Warnings:Drug Interactions:
Drug Interactions with fludrocortisone acetate include the following:

Amphotericin, potassium-losing diuretics
May increase potassium loss.

Anticholinesterase agents (eg, neostigmine)
May antagonize the effects of anticholinesterase agents in myasthenia gravis.

Anticoagulants (eg, warfarin)
Dose requirement of anticoagulant may be reduced or effect opposed.

Barbiturates, hydantoins (eg, phenytoin), rifampin
Decreased fludrocortisone activity.

Salicylates
Serum levels may be reduced by corticosteroids, decreasing the effectiveness; in addition, the ulcerogenic effects of both agents may be increased

Adverse Reactions to fludrocortisone acetate include the following:

Cardiovascular: Edema; hypertension; CHF; heart enlargement.

Dermatologic: Bruising; increased sweating; hives; rash.

Miscellaneous: Hypokalemic alkalosis. May also cause adverse reactions associated with glucocorticoids (eg, dexamethasone).