Most adverse reactions are caused by the drug's
mineralocorticoid activity (retention of sodium and water) and include
hypertension, edema, cardiac enlargement, congestive heart failure, potassium
loss, and hypokalemic alkalosis.
When fludrocortisone is used in the small dosages
recommended, the glucocorticoid side effects often seen with cortisone and its
derivatives are not usually a problem; however the following untoward effects
should be kept in mind, particularly when fludrocortisone is used over a
prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.
Muscle weakness, steroid myopathy, loss of muscle mass,
osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and
humeral heads, pathologic fracture of long bones, and spontaneous fractures.
Peptic ulcer with possible perforation and hemorrhage,
pancreatitis, abdominal distention, and ulcerative esophagitis.
Impaired wound healing, thin fragile skin, bruising,
petechiae and ecchymoses, facial erythema, increased sweating, subcutaneous fat
atrophy, purpura, striae, hyperpigmentation of the skin and nails, hirsutism,
acneiform eruptions, and hives; reactions to skin tests may be suppressed.
Convulsions, increased intracranial pressure with
papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache,
and severe mental disturbances.
Menstrual irregularities, development of the cushingoid
state; suppression of growth in children; secondary adrenocortical and
pituitary unresponsiveness, particularly in times of stress (e.g., trauma, surgery,
or illness); decreased carbohydrate tolerance; manifestations of latent
diabetes mellitus; and increased requirements for insulin or oral hypoglycemic
agents in diabetics.
Posterior subcapsular cataracts, increased intraocular
pressure, glaucoma, and exophthalmos.
Hyperglycemia, glycosuria, and negative nitrogen balance
due to protein catabolism.
Allergic skin rash, maculopapular rash, and urticaria.
Other adverse reactions that may occur following the
administration of a corticosteroid are necrotizing angiitis, thrombophlebitis,
aggravation or masking of infections, insomnia, syncopal episodes, and anaphylactoid