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Florinef is an effective replacement therapy in severe adrenal insufficiency, in particular, in Addison's disease; the medication is also used in adrenogenital syndrome when accompanied by loss of salt in the body.
Fludrocortisone physiological effect substantially corresponds to the effect of hydrocortisone (cortisol). However, the effects on electrolyte balance, carbohydrate metabolism, and is more pronounced and stable. Even in small doses, the drug causes a distinct retention of sodium ions in the body and promotes the release of potassium ions. With its mineralotropic action the drug can be used only in those cases where these effects are desirable. Florinef should not be used as an anti-inflammatory agent in diseases that usually require the use of glucocorticoids, such as rheumatoid arthritis, allergic conditions or dermatoses.
The drug should not be used under the following diseases, excepting the cases where the benefits significantly prevail over the possible risks: herpes simplex and herpes zoster, especially with herpes of the cornea; when varitselleze and post-vaccination complications; children receiving treatment with corticoids should take special measures to prevent varitselleza and infections caused by the herpes virus; immediately before and after the immunization against infections caused by amoebae, systemic mycosis, ulcers of the stomach and intestines, poliomyelitis, except bulbar form-brain, with lymphadenitis after BCG immunization in osteoporosis.
During the corticoids treatment the activation of tuberculosis is oftentimes observed. A deterioration of the compensation of diabetes and the manifestation of its latent form are possible, so you need to regularly monitor the status of glucose metabolism. During pregnancy, especially during the first three months, the drug can be used only if the treatment is absolutely required, because it bears a possible damaging effect on the fetus. In children or infants whose mothers received Florinef, should be closely monitored for signs of possible states of hypoplastic adrenals. If you have infections in the treatment of fludrocortisone must be immediate use of appropriate antibiotics or chemotherapy drugs.
The dosage regimen
Normally, the daily dosage of preparation equals 0.1 mg; in general the doses range from 0.1 mg three times per week to about 0.2 mg per day. In patients with hypertension the recommended daily dose is recommended not to exceed 0.05 mg. Fludrocortisone advisable to appoint in conjunction with cortisone (from 6.25 to 25 mg per day) or hydrocortisone (5-20 mg per day).
At recommended dosages side effects are observed extremely rarely. At higher doses suppression of the pituitary symptoms are observed, such as, the suppression of endogenous cortisol formation pituitary ACTH secretion and activity of the thymus. The drug may increase gluconeogenesis, a negative nitrogen balance. In the application of the children the inhibitory effect of corticoids on growth should be taken into account. After application of corticoids increased intraocular pressure, ulcers of the stomach and intestines, disturbance of menstruation, ecchymosis, petechiae, vegetative symptoms, and in rare cases, aseptic necrosis of bone are rarely observed. Since fludrocortisone has mineral draining effect, so salt intake should be aligned with doses of fludrocortisone to prevent the development of edema, hypertension and weight gain.
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