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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

When fludrocortisone is used in the small dosages recommendedthe glucocorticoid side effects often seen with cortisone and its derivatives are not usually a problemhowever the following untoward effects should be kept in mindparticularly when fludrocortisone is used over a prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.

Aspirin should be used cautiously in conjunction with corticosteroids in patients with hypoprothrombinemia.

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.

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