fludrocortisone acetate 0.1 MG Oral Tablet

Generic Name: FLUDROCORTISONE ACETATE
Brand Name: Fludrocortisone Acetate
  • Substance Name(s):
  • FLUDROCORTISONE ACETATE

WARNINGS

BECAUSE OF ITS MARKED EFFECT ON SODIUM RETENTION THE USE OF FLUDROCORTISONE ACETATE IN THE TREATMENT OF CONDITIONS OTHER THAN THOSE INDICATED HEREIN IS NOT ADVISED.

Corticosteroids may mask some signs of infection, and new infections may appear during their use.

There may be decreased resistance and inability to localize infection when corticosteroids are used.

If an infection occurs during fludrocortisone acetate therapy, it should be promptly controlled by suitable antimicrobial therapy.

Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses.

Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium.

These effects are less likely to occur with the synthetic derivatives except when used in large doses.

However, since fludrocortisone acetate is a potent mineralocorticoid, both the dosage and salt intake should be carefully monitored in order to avoid the development of hypertension, edema or weight gain.

Periodic checking of serum electrolyte levels is advisable during prolonged therapy; dietary salt restriction and potassium supplementation may be necessary.

All corticosteroids increase calcium excretion.

Patients should not be vaccinated against smallpox while on corticosteroid therapy.

Other immunization procedures should not be undertaken in patients who are on corticosteroids, especially on high dose, because of possible hazards of neurological complications and a lack of antibody response.

The use of fludrocortisone acetate in patients with active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen.

If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary since reactivation of the disease may occur.

During prolonged corticosteroid therapy these patients should receive chemoprophylaxis.

Children who are on immunosuppressant drugs are more susceptible to infections than healthy children.

Chicken pox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids.

In such children, or in adults who have not had these diseases, particular care should be taken to avoid exposure.

If exposed, therapy with variicella zoster immune globulin (VZIG) or pooled intravenous immunoglobulin (IVIG), as appropriate, may be indicated.

If chicken pox develops, treatment with antiviral agents may be considered.

DRUG INTERACTIONS

Drug Interactions When administered concurrently, the following drugs may interact with adrenal corticosteroids.

Amphotericin B or potassium-depleting diuretics (benzothiadiazines and related drugs, ethacrynic acid and furosemide)—enhanced hypokalemia.

Check serum potassium levels at frequent intervals; use potassium supplements if necessary (see WARNINGS ).

Digitalis glycosides— enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.

Monitor serum potassium levels; use potassium supplements if necessary.

Oral anticoagulants— decreased prothrombin time response.

Monitor prothrombin levels and adjust anticoagulant dosage accordingly.

Antidiabetic drugs (oral agents and insulin)—diminished antidiabetic effect.

Monitor for symptoms of hyperglycemia; adjust dosage of antidiabetic drug upward if necessary.

Aspirin— increased ulcerogenic effect; decreased pharmacologic effect of aspirin.

Rarely salicylate toxicity may occur in patients who discontinue steroids after concurrent high-dose aspirin therapy.

Monitor salicylate levels or the therapeutic effect for which aspirin is given; adjust salicylate dosage accordingly if effect is altered (see PRECAUTIONS, General ).

Barbiturates, phenytoin, or rifampin—increased metabolic clearance of fludrocortisone acetate because of the induction of hepatic enzymes.

Observe the patient for possible diminished effect of steroid and increase the steroid dosage accordingly.

Anabolic steroids (particularly C-17 alkylated androgens such as oxymetholone, methandrostenolone, norethandrolone, and similar compounds)—enhanced tendency toward edema.

Use caution when giving these drugs together, especially in patients with hepatic or cardiac disease.

Vaccines—neurological complications and lack of antibody response (see WARNINGS ).

Estrogen—increased levels of corticosteroid-binding globulin thereby increasing the bound (inactive) fraction; this effect is at least balanced by decreased metabolism of corticosteroids.

When estrogen therapy is initiated, a reduction in corticosteroid dosage may be required, and increased amounts may be required when estrogen is terminated.

OVERDOSAGE

Development of hypertension, edema, hypokalemia, excessive increase in weight, and increase in heart size are signs of overdosage of fludrocortisone acetate.

When these are noted, administration of drugs should be discontinued, after which the symptoms will usually subside within several days; subsequent treatment with fludrocortisone acetate should be with a reduced dose.

Muscular weakness may develop due to excessive potassium loss and can be treated by administering a potassium supplement.

Regular monitoring of blood pressure and serum electrolytes can help to prevent overdosage (see WARNINGS ).

DESCRIPTION

Fludrocortisone Acetate Tablets USP, 0.1 mg contain fludrocortisone acetate, a synthetic adrenocortical steroid possessing very potent mineralocorticoid properties and high glucocorticoid activity; it is used only for its mineralocorticoid effects.

The chemical name for fludrocortisone acetate is 9-fluoro-11β, 17, 21-trihydroxypregn-4-ene-3, 20-dione 21-acetate; its structural formula is: C23H31FO6 MW 422.49 Fludrocortisone acetate tablets USP, 0.1 mg are available for oral administration as scored tablets providing 0.1 mg fludrocortisone acetate per tablet.

Inactive ingredients: croscarmellose sodium NF, lactose monohydrate NF, magnesium stearate NF, and microcrystalline cellulose NF.

Chemical Structure

HOW SUPPLIED

Fludrocortisone Acetate Tablets USP, 0.1 mg—Each white to off-white, round, convex tablet debossed with a “7033” on one side and with a bisect on the other side.

Unit dose packages of 100 (10 x 10) NDC 68084-288-01 Store at controlled room temperature 15° to 30°C (59° to 86°F) (see USP).

Avoid excessive heat.

INDICATIONS AND USAGE

Fludrocortisone acetate tablets USP, 0.1 mg are indicated as partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease and for the treatment of salt-losing adrenogenital syndrome.

PEDIATRIC USE

Pediatric Use Safety and effectiveness in children have not been established.

Growth and development of infants and children on prolonged corticosteroid therapy should be carefully observed.

PREGNANCY

Pregnancy Teratogenic Effects Category C Adequate animal reproduction studies have not been conducted with fludrocortisone acetate.

However, many corticosteroids have been shown to be teratogenic in laboratory animals at low doses.

Teratogenicity of these agents in man has not been demonstrated.

It is not known whether fludrocortisone acetate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.

Fludrocortisone acetate should be given to a pregnant woman only if clearly needed.

NUSRING MOTHERS

Nursing Mothers Corticosteroids are found in the breast milk of lactating women receiving systemic therapy with these agents.

Caution should be exercised when fludrocortisone acetate is administered to a nursing woman.

INFORMATION FOR PATIENTS

Information for Patients The physician should advise the patient to report any medical history of heart disease, high blood pressure, or kidney or liver disease and to report current use of any medicines to determine if these medicines might interact adversely with fludrocortisone acetate (see Drug Interactions ).

Patients who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chicken pox or measles and, if exposed, to obtain medical advice.

The patient’s understanding of his steroid-dependent status and increased dosage requirement under widely variable conditions of stress is vital.

Advise the patient to carry medical identification indicating his dependence on steroid medication and, if necessary, instruct him to carry an adequate supply of medication for use in emergencies.

Stress to the patient the importance of regular follow-up visits to check his progress and the need to promptly notify the physician of dizziness, severe or continuing headaches, swelling of feet or lower legs, or unusual weight gain.

Advise the patient to use the medicine only as directed, to take a missed dose as soon as possible, unless it is almost time for the next dose, and not to double the next dose.

Inform the patient to keep this medication and all drugs out of the reach of children.

DOSAGE AND ADMINISTRATION

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

Patients should be continually monitored for signs that indicate dosage adjustment is necessary, such as remission or exacerbations of the disease and stress (surgery, infection, trauma)(see WARNINGS and PRECAUTIONS, General ).

Addison’s Disease In Addison’s disease, the combination of fludrocortisone acetate tablets with a gluco-corticoid such as hydrocortisone or cortisone provides substitution therapy approximating normal adrenal activity with minimal risks of unwanted effects.

The usual dose is 0.1 mg of fludrocortisone acetate tablets daily, although dosage ranging from 0.1 mg three times a week to 0.2 mg daily has been employed.

In the event transient hypertension develops as a consequence of therapy, the dose should be reduced to 0.05 mg daily.

Fludrocortisone acetate tablets are preferably administered in conjunction with cortisone (10 mg to 37.5 mg daily in divided doses) or hydrocortisone (10 mg to 30 mg daily in divided doses).

Salt-Losing Adrenogenital Syndrome The recommended dosage for treating the salt-losing adrenogenital syndrome is 0.1 mg to 0.2 mg of fludrocortisone acetate tablets daily.