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In larger dosesfludrocortisone acetate inhibits endogenous adrenal cortical secretionthymic activityand pituitary corticotropin excretionpromotes the deposition of liver glycogenandunless protein intake is adequateinduces negative nitrogen balance.
Adequate studies have not been performed in animals to determine whether fludrocortisone acetate has carcinogenic or mutagenic activity or whether it affects fertility in males or females.
Corticosteroids are contraindicated in patients with systemic fungal infections and in those with a history of possible or known hypersensitivity to these agents.
The physiologic action of fludrocortisone acetate is similar to that of hydrocortisoneHoweverthe effects of fludrocortisone acetateparticularly on electrolyte balancebut also on carbohydrate metabolismare considerably heightened and prolongedMineralocorticoids act on the distal tubules of the kidney to enhance the reabsorption of sodium ions from the tubular fluid into the plasmathey increase the urinary excretion of both potassium and hydrogen ionsThe consequence of these three primary effects together with similar actions on cation transport in other tissues appear to account for the entire spectrum of physiological activities that are characteristic of mineralocorticoidsIn small oral dosesfludrocortisone acetate produces marked sodium retention and increased urinary potassium excretionIt also causes a rise in blood pressureapparently because of these effects on electrolyte levels.
Children who are on immunosuppressant drugs are more susceptible to infections than healthy childrenChicken pox and measlesfor examplecan have a more serious or even fatal course in children on immunosuppressant corticosteroidsIn such childrenor in adults who have not had these diseasesparticular care should be taken to avoid exposureIf exposedtherapy with varicella zoster immune globulinVZIGor pooled intravenous immunoglobulinIVIGas appropriatemay be indicatedIf chicken pox developstreatment with antiviral agents may be considered.
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