fludrocortisone acetate: clinical use

Prescribing considerations

• Confirm the indication and whether use is licensed for the selected formulation.
• Assess salt intake and risks of hypertension, oedema, weight gain, hypokalaemia and heart failure.
• Avoid abrupt withdrawal after prolonged therapy; consider adrenal-risk planning around severe illness, trauma or procedures.
• Review chickenpox, shingles and measles exposure promptly and check vaccination plans.
• Use particular caution in older people and patients with diabetes, osteoporosis, glaucoma, psychiatric illness, gastrointestinal ulceration, renal or hepatic impairment, infection or cardiovascular disease.

Contraindications and cautions

• Hypersensitivity to fludrocortisone acetate or formulation excipients.
• Systemic infection unless appropriate anti-infective treatment is being used.

Monitoring

• Clinical response and symptoms of under- or over-replacement.
• Sitting or lying and standing blood pressure where clinically relevant.
• Weight, oedema and signs of heart failure or volume overload.
• Serum sodium and potassium; consider plasma renin when assessing mineralocorticoid replacement.
• Blood glucose in people with diabetes or increased risk.
• Growth and development during prolonged use in children; consider eye, bone and mental-health effects according to risk.

Clinical pharmacology

A potent synthetic mineralocorticoid that promotes renal sodium and water retention and potassium excretion. It is rapidly and completely absorbed after oral administration and hydrolysed from the acetate ester to active fludrocortisone.

Formulation and product differences

• The selected tablets contain lactose; their score line is for easier swallowing rather than equal division.
• The oral solution is oily, protected from light and supplied with a bottle adaptor and oral syringe.
• The oral solution is unsuitable for patients with swallowing difficulties because aspiration may occur, but is compatible with specified enteral feeding tubes.
• Discard opened oral solution after four months.

Oral solution

Route: Oral

Strengths: 0.1 mg/mL

Tablet

Route: Oral

Strengths: 0.05 mg, 0.1 mg