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Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressuresalt and water retentionand increased excretion of potassiumThese effects are less likely to occur with the synthetic derivatives except when used in large dosesHoweversince fludrocortisone acetate is a potent mineralocorticoidboth the dosage and salt intake should be carefully monitored in order to avoid the development of hypertensionedemaor weight gainPeriodic checking of serum electrolyte levels is advisable during prolonged therapydietary salt restriction and potassium supplementation may be necessaryAll corticosteroids increase calcium excretion.
Adequate animal reproduction studies have not been conducted with fludrocortisone acetateHowevermany corticosteroids have been shown to be teratogenic in laboratory animals at low dosesTeratogenicity of these agents in man has not been demonstratedIt is not known whether fludrocortisone acetate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacityFludrocortisone acetate should be given to a pregnant woman only if clearly needed.
Infants born of mothers who have received substantial doses of fludrocortisone acetate during pregnancy should be carefully observed for signs of hypoadrenalism.
The physician should advise the patient to report any medical history of heart diseasehigh blood pressureor kidney or liver disease and to report current use of any medicines to determine if these medicines might interact adversely with fludrocortisone acetatesee Drug Interactions
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