Side effects of fludrocortisone – Cardiology MCQ – Answer

Side effects of fludrocortisone – Cardiology MCQ – Answer

Side effects of fludrocortisone does not include – Correct answer: d) Postural hypotension

Fludrocortisone is an important drug for the treatment of postural hypotension. It is a synthetic steroid with mineralocorticoid activity. It increases sodium reabsorption in the renal tubules. The drug in turn increases potassium excretion and cause hypokalemia. Sodium retention causes volume expansion decreases the chance of postural hypotension. For the same reason it may cause supine hypertension in these patients. Often supine hypertension is an important problem in some of the disorders which cause orthostatic hypotension. Though high doses of fludrocortisone has glucocorticoid activity, it seldom produces steroid induced diabetes or secondary adrenal insufficiency, the two common problems with glucocorticoids [1].

Weight gain due to fluid retention may be seen in only higher doses (0.3 mg to 1 mg per day) and need not occur in lower doses of 0.1 mg or 0.2 mg per day [1].

Supine hypertension in fludrocortisone treated patients with orthostatic hypotension may be quite significant enough to cause reported instances of hypertensive retinopathy and cardiomegaly [2].

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References

1. Freeman R, Abuzinadah AR, Gibbons C, Jones P, Miglis MG, Sinn DI. Orthostatic Hypotension: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018 Sep 11;72(11):1294-1309.
2. Chobanian AV, Volicer L, Tifft CP, Gavras H, Liang CS, Faxon D. Mineralocorticoid-induced hypertension in patients with orthostatic hypotension. N Engl J Med. 1979 Jul 12;301(2):68-73.