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Pregnancy Category: C
Sodium loss and hypotension associated with adrenocortical insufficiency (given with hydrocortisone or cortisone).Management of sodium loss due to congenital adrenogenital syndrome (congenital adrenal hyperplasia).Idiopathic orthostatic hypotension (with increased sodium intake).Type IV renal tubular acidosis.
Causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule.
Maintenance of sodium balance and BP in patients with adrenocortical insufficiency.
Absorption: Well absorbed following oral administration.
Distribution: Widely distributed; probably enters breast milk.
Protein Binding: High.
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: 3.5 hr.
Time/action profile (mineralocorticoid activity)
Contraindicated in: Hypersensitivity.
Use Cautiously in: HF;Addison’s disease (patients may have exaggerated response); Obstetric / Lactation / Pediatric: Safety not established.
Adverse Reactions/Side Effects
Central nervous system
- HF (life-threatening)
- adrenal suppression
- weight gain
Fluid and Electrolyte
- hypokalemic alkalosis
- muscular weakness
- tendon contractures
- ascending paralysis
- hypersensitivity reactions
Drug-Drug interactionUse with thiazide or loop diuretics, piperacillin, or amphotericin B may ↑ risk of hypokalemia.Hypokalemia may ↑ risk of digoxin toxicity.May produce prolonged neuromuscular blockade following the use of nondepolarizing neuromuscular blocking agents.Phenobarbital or rifampin may ↑ metabolism and ↓ effectiveness.Large amounts of salt or sodium-containing foods may cause excessive sodium retention and potassium loss.
Oral (Adults) Adrenocortical insufficiency—100 mcg/day (range 100 mcg 3 times weekly—200 mcg daily). Doses as small as 50 mcg daily may be required by some patients. Use with 10–37.5 mg cortisone daily or 10–30 mg hydrocortisone daily. Adrenogenital syndrome—100–200 mcg/day. Idiopathic hypotension—50–200 mcg/day (unlabeled).
Oral (Children) 50–100 mcg/day.
Availability (generic available)
Tablets: 100 mcg (0.1 mg)
- Monitor BP periodically during therapy. Report significant changes. Hypotension may indicate insufficient dose.
- Monitor for fluid retention (weigh daily, assess for edema, and auscultate lungs for rales/crackles).
- Monitor patients with Addison’s disease closely and stop treatment if a significant increase in weight or BP, edema, or cardiac enlargement occurs. Patients with Addison’s disease are more sensitive to the action of fludrocortisone and may have an exaggerated response.
- Lab Test Considerations: Monitor serum electrolytes periodically during therapy. Fludrocortisone causes ↓ serum potassium levels.
Potential Nursing DiagnosesDeficient fluid volume (Indications)
Excess fluid volume (Side Effects)
- Oral: Tablets are scored and may be broken if dose adjustment is necessary.
- Instruct patient to take medication as directed. Take missed doses as soon as remembered but not just before next dose is due. Explain that lifelong therapy may be necessary and that abrupt discontinuation may lead to Addisonian Crisis. Patient should keep an adequate supply available at all times.
- Advise patient to follow dietary modification prescribed by health care professional. Instruct patient to follow a diet high in potassium (see ). Amount of sodium allowed in diet varies with pathophysiology.
- Instruct patient to inform health care professional if weight gain or edema, muscle weakness, cramps, nausea, anorexia, or dizziness occurs.
- Advise patient to carry identification at all times describing disease process and medication regimen.
- Normalization of fluid and electrolyte balance without the development of hypokalemia or hypertension.
A trademark for the drug fludrocortisone acetate.