Drugs

Mineralocorticoid - Uses and Benefits

Type of Drug:

Adrenal cortical steroid

How the Mineralocorticoid Works:

The mineralocorticoid, fludrocortisone, acts on the kidney to preserve sodium. It increases potassium and hydrogen loss in the urine.

Uses of The Mineralocorticoid:

To treat insufficient secretion of steroids from the adrenal cortex in

Addison disease. Used in conjunction with glucocorticoid therapy. To treat excessive salt loss.

Unlabeled Uses: Occasionally doctors may prescribe fludrocortisone for severe orthostatic hypotension (dizziness or lightheadedness that occurs when rising quickly from a lying or sitting position).

Precautions:

Do not use in the tollowing situations:

Allergy to fludrocortisone ace- tate or any of its ingredients immunization, concurrent

Use with caution in the tollowing situations: cirrhosis myasthenia gravis diverticulitis osteoporosis heart disease patients who have not had chick- herpes simplex, ocular enpox or measles high blood pressure peptic ulcer, active or latent hypothyroidism salicylates (eg, aspirin) use in immunosuppression hypoprothombinemic patients infection, active stress (eg, trauma, surgery, intestinal anastomoses, fresh severe illness) kidney disease tuberculosis, active liver disease ulcerative colitis, nonspecific

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Corticosteroids appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children have not been established. Monitor growth and development of infants and children on prolonged

Lab Tests:Lab tests may be required. Tests may include serum electrolyte levels and blood pressure monitoring.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with fluoridation acetate. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with fludrocortisone.

Side Effects of The Mineralocorticoid:

Every drug is capable of producing side effects. Many mineralocorticoid users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Severe side effects may occur if the dose is too high, if the mineralocorticoid is given for a long time, or if it is withdrawn too fast. Fludrocortisone may cause side effects similar to glucocorticoids. Possible side effects include:

Circulatory System: High blood pressure; heart failure; heart enlargement. Muscular System: Muscle weakness; steroid-induced muscle disease; loss of muscle mass; osteoporosis (brittle bones); compression fractures of the spine; hip bone or shoulder bone degradation; fracture of long bones due to diseases; spontaneous fractures.

Digestive Tract: Peptic ulcer with possible perforation and bleeding; pancreatitis; abdominal distention; inflammation of the esophagus.

Skin: Impaired wound healing; thin, fragile skin; bruising; small red spots under skin; unusual bruising; increased sweating; subcutaneous fat atrophy; red or purple spots or patches under the skin; stretch marks; excessive pigment in the skin and nails; abnormal hairiness or increased hair growth; acne-like eruptions; hives; rash; facial skin redness; itching.

Nervous System: Convulsions; increased intracranial pressure with fluid accumulation at the optic disc (pseudotumor corobri) usually after troatment; feeling of a whirling motion; headache; Navarro mental disturbances.

Other: Fluid retention; unusual weight gain; potassium loss; hypothalamic alkalosis; allergic reaction; high blood sugar; negative nitrogen balance due to protein catabolism; necrotizing angiitis; inflammation of the veins with clot formation; aggravation or masking of infections; sleeplessness; fainting; menstrual irregularities; development of the cushingoid state (eg, buffalo hump obesity, general obesity, high blood pressure, diabetes, osteoporosis); suppression of growth in children; secondary adrenocortical and pituitary unresponsiveness particularly in times of stress (eg, trauma, surgery, illness); decreased carbohydrate tolerance; manifestations of latent diabetes mellitus; increased requirements for insulin or oral hypoglycemic agents in diabetic patients; calcium loss; euphoria; mood swings; personality changes; depression; emotional instability; psychotic tendencies; glucose in the urine.

Guidelines for Use:

• Because of its marked effect on sodium retention, the use of fludrocortisone in the treatment of conditions other than those indicated is not advised.

• Dosage depends on the severity of the disease and the response of the patient.

• Addison Disease - Administer with a glucocorticoid (eg, 10 to 37.5 mg daily of cortisone or 10 to 30 mg daily of hydrocortisone, both in divided doses). The usual dose is 0.1 mg. Doses ranging from 0.1 to 0.2 mg daily have been used. If blood pressure increases, the dose may be decreased to 0.05 mg daily.

• Salt-Losing Adrenogenital Syndrome - The recommended dose is 0.1 mg to 0.2 mg daily.

• Carefully monitor salt intake in order to avoid developing high blood pressure, swelling, or weight gain.

• Higher doses may be required in times of stress (eg, trauma, surgery, severe illness) both during and 1 year after treatment with fludrocortisone.

• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose in order to catch up, unless advised to do so by your doctor. If more than one dose is missed or if it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.

• Do not stop taking the medicine suddenly.

• Corticosteroids may mask some signs of infection, and new infections may appear during their use. There may be decreased resistance and difficulty in reducing the spread of an infection when used. If an infection occurs during therapy, notify your doctor immediately.

• Dietary salt restriction and potassium supplementation may be necessary. All corticosteroids increase calcium secretion.

• Prolonged use of corticosteroids may produce cataracts, glaucoma with possible damage to optic nerves, and ocular infections.

• Chickenpox and Measles - Patients are more susceptible to infections such as chickenpox and measles. These infections can have a more serious or even fatal course in children. Avoid exposure to infections due to fungi or viruses.

• Carry medical identification indicating dependence on steroids and possibly carry an adequate supply of medicine for use in emergencies.

• Notify your doctor if dizziness, severe headaches, joint pain, extreme weakness, swelling of feet or lower legs, or unusual weight gain occurs.

• Lab tests may be needed to determine blood pressure and sodium and potassium levels in the blood. Regular follow-up visits will also be crucial in checking progress. Be sure to keep appointments.

• Store at room temperature (59° to 86°F). Avoid excessive heat.