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Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressuresalt and water retentionand increased excretion of potassiumThese effects are less likely to occur with the synthetic derivatives except when used in large dosesHoweversince fludrocortisone acetate is a potent mineralocorticoidboth the dosage and salt intake should be carefully monitored in order to avoid the development of hypertensionedemaor weight gainPeriodic checking of serum electrolyte levels is advisable during prolonged therapydietary salt restriction and potassium supplementation may be necessaryAll corticosteroids increase calcium excretion.

Development of hypertensionedemahypokalemiaexcessive increase in weightand increase in heart size are signs of overdosage of fludrocortisone acetateWhen these are notedadministration of the drug should be discontinuedafter which the symptoms will usually subside within several dayssubsequent treatment with fludrocortisone acetate should be with a reduced doseMuscular weakness may develop due to excessive potassium loss and can be treated by administering a potassium supplementRegular monitoring of blood pressure and serum electrolytes can help to prevent overdosagesee WARNINGS

In generaldose selection for an elderly patient should be cautioususually starting at the low end of the dosing rangereflecting the greater frequency of decreased hepaticrenalor cardiac functionand of concomitant disease or other drug therapy.

Patients should be monitored regularly for blood pressure determinations and serum electrolyte determinationssee WARNINGS

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