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Indications - Used for oral mineralocorticoid replacement therapy in: Primary and secondary adrenocortical insufficiency in Addison’s disease Salt losing adrenogenital syndrome Postural hypotension

Dosage & Administration - Primary and secondary Adrenocortical Insufficiency in Addison’s disease: Usual dose may range from 0.2 mg 3 times weekly to 0.2 mg daily. If hypertension occurs, reduce dosage to 0.05 mg daily. Administer concomitantly with Cortisone or hydrocortisone. Salt-Losing Adrenogenital Syndrome: 0.1 to 0.2 mg/day. Postural Hypotension: 0.1-0.4 mg daily to diabetic patients with postural hypotension; 0.05-0.2 mg daily to patients with postural hypotension secondary to Levodopa therapy.

Side Effects - Most adverse reactions are caused by the drug’s mineralocorticoid activity (retention of sodium andwater) include erythema, purpura, vertigo, pancreatitis, increased intraocular pressure, muscular weakness, hypertension, edema, cardiac enlargement, congestive heart failure, steroid myopathy, peptic ulcer, osteoporosis, convulsions, menstrual irregularities, potassium loss, hypokalemic alkalosis, allergic and anaphylactic reaction etc. When Fludrocortisones is used in the small dosages recommended, side effects are not usually a problem; however the above mentioned unwanted effects should be kept in mind, particularly when Fludrocortisones is used over a prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.

Contraindications - In case of adrenal insufficiency, no absolute contraindications are applicable. In the treatment of non-endocrine diseases where pharmacological dose are more likely to be used, the contraindications to be considered carefully. Relative contraindications include: systemic fungal infection, hypersensitivity to Fludrocortisone, diabetic mellitus, osteoporosis and acute infection.

Others - Pregnancy & Lactation Pregnancy category C. There are no adequate and well-controlled studies in pregnant women. Fludrocortisone is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk. Lactation: There are no data on the excretion of fludrocortisone into human milk. However, corticosteroids (systemic therapy) are distributed into breast milk and could cause growth suppression and/or other adverse effects in nursing infants. The manufacturer recommends that caution be used when administering Fludrocortisone to nursing women.