Fludrocortisone Risks, Warnings, and Complications

HIGH BLOOD PRESSURE AND FLUID RETENTION: Fludrocortisone causes the body to retain fluids and salt. This can lead to adverse reactions such as high blood pressure, weight gain, swelling, and worsening cardiac disease. 

Before starting fludrocortisone therapy, tell your doctor if you have a history of electrolyte imbalance, kidney problems, high blood pressure, heart failure, heart disease, or a recent heart attack. Follow your doctor’s instructions on eating a low-salt diet. Keep all medical and laboratory appointments. Your doctor may want to check serum electrolytes and prescribe potassium supplementation if needed. Call your doctor without delay if you develop rapid weight gain or swelling.

WEAK BONES: Taking fludrocortisone for a prolonged period or at large doses can lead to weakening of your bones and an increased risk of bone fractures. People at high risk of this complication are infants, young children, and postmenopausal women, as well as those who drink alcohol or smoke. Steroid medicines can also cause slowed growth in children. Talk to your healthcare provider about these concerns and the potential benefits versus risks of taking fludrocortisone. 

WITHDRAWAL SYMPTOMS: Taking high doses of corticosteroid systemic therapy or taking them for a prolonged period can result in suppression of the adrenal glands, where they stop making natural hormones. In such people, stopping fludrocortisone therapy suddenly can be dangerous as the body is dependent on the medicine for its supply of steroids. Talk to your doctor before stopping fludrocortisone. Your provider will tell you how to lower the dose gradually before stopping treatment completely. Seek immediate medical care if you develop steroid withdrawal symptoms such as stomach upset, vomiting, loss of appetite, weight loss, dizziness, confusion, headache, or muscle pain. 

INCREASED RISK OF INFECTIONS: Steroid medications, including fludrocortisone, suppress the body’s immune system. This can increase the risk of infections and hide some of the signs of infections. Risk factors include taking other medications that weaken the immune system, prolonged fludrocortisone therapy, unvaccinated status, taking live vaccines, and contact with people who are sick. Your doctor will advise you to avoid contact with anyone who has chicken pox or measles. They will monitor you carefully if you have a history of tuberculosis in the past. Check with your healthcare provider before taking any live vaccines while on fludrocortisone therapy. 

GLAUCOMA AND CATARACTS: Long-term use of corticosteroids such as fludrocortisone can increase the risk of eye problems such as glaucoma and cataracts. You should not take fludrocortisone if you have ocular herpes simplex. Call your doctor immediately if you develop any eye symptoms such as eye pain, blurred vision, or vision changes. Get regular eye exams if you are on this medicine for a prolonged period. 

PSYCHIATRIC EFFECTS: Corticosteroid medications, including fludrocortisone, can cause changes in mood and behavior. Call your doctor right away if you develop anxiety, depression, mood changes, problems sleeping, or hallucinations (hearing or seeing things that aren't there) while on this medicine. 

STOMACH PROBLEMS: Fludrocortisone can damage the lining of your stomach. Risk factors for stomach problems include a history of stomach ulcers or gastrointestinal bleeding, ulcerative colitis, alcohol use, and taking other medications that can also damage the stomach. Tell your doctor if you develop persistent stomach pain or black, tarry stools. Your doctor may prescribe other medications to protect your stomach if you are on fludrocortisone for a long time.