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Elderly subjects may commonly have conditions that may be exacerbated by fludrocortisone therapy includingbut not limited tohypertensionedemahypokalemiacongestive heart failurecataractsglaucomaincreased intraocular pressurerenal insufficiencyand osteoporisissee WARNINGSPRECAUTIONS and ADVERSE REACTIONSElderly subjects may also commonly be taking concomitant drug therapy such as digitalis glycosidesoral anticoagulantsantidiabetic drugsoral agents and insulinand aspirin which may interact with fludrocortisonesee PRECAUTIONSDrug Interactions

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.

When administered concurrentlythe following drugs may interact with adrenal corticosteroids.

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.

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