Dexlansoprazole (DEXILANT)

2025-01-05T12:41:47Z

Annayung: /* Drug Class */

2020-09-05T12:29:06Z

Annayung:

[[Category: Drugs]] [[Category: Steroids]]
== Introduction ==
Fludrocortisone is a steroid with potent mineralocorticoid activity.
It is used to treat:
*Adrenocortical insufficiency
*Postural hypotension
*Adrenogenital syndrome

{| class="wikitable"
!Generic Name
!HA Code
!Legal Classification
|-
|Fludrocortisone Acetate Tablet 100mcg
|FLUD01
|P1S1S3
|}

{| class="wikitable"
!Brand Name
!HK Reg Number
!Active Ingredients
|-
|FLORINEF TABLET 0.1mg

|HK-00036
|fludrocortisone acetate
|}

== Mechanism of Action ==
Fludrocortisone is a corticosteroid with glucocorticoid and highly potent mineralocorticoid activity.

== Dosage ==
Fludrocortisone is used, usually with hydrocortisone, for replacement therapy in adrenocortical insufficiency.
{| class = "wikitable"
! Replacement therapy in adrenal insufficiency
| Oral: 50-300 micrograms daily
|-
! severe orthostatic hypotension
| Oral: 50-300 micrograms daily
|}

It is also used ear drops in concentration of 0.1%.
== Side Effects ==
Fludrocortisone acetate has glucocorticoid actions about 10 times as potent as hydrocortisone and mineralocorticoid effects more than 100 times as potent.
Adverse effects are mainly those due to mineralocorticoid activity:
*sodium and water retention
*swelling due to fluid retention (oedema)
*hypertension
*increased excretion of potassium leading to hypokalaemia
*heart failure may be induced in susceptible patients
Other side-effects include:
{| class = "wikitable"
!steroid-induced diabetes
| Raised blood sugar level
|-
!Osteoporosis, muscle wasting and weakness
| Particularly danger in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae
|-
! Susceptibility to infection
|
|-
! Disturbances of the gut
| Indigestion, peptic ulcer, distension of the abdomen
|-
!Suppression of growth in children
|
|-
!Endocrine side effects
|Menstrual irregularities , hirsutism (increased hair growth), weight gain
|-
!Neuropsychiatric side effects
| Aggravation of schizophrenia, aggravation of epilepsy, insomnia, irritability, depression
|-
!Dermatological side effects
| Easy bruising, impaired wound healing, thinning of skin and stretch marks
|-
!Ophthalmic side effects
| Glaucoma, partial loss of vision due to opacity in the lens of the eye (cataracts)
|}

== Pharmacokinetics ==
Fludrocortisone is readily absorbed from the gastrointestinal tract. The plasma half-life is about 3.5 hours, but fludrocortisone has a more prolonged biological half-life of 18 to 36 hours.

== Drug Management ==
===Monitoring===
*Elderly (close supervision required particularly on long-term treatment)
*Frequent monitoring required if history of tuberculosis (or X-ray changes)
*Blood sugar level, blood pressure, mood change
*Monitoring of the fluid intake and output, and daily weight records may give early warning of fluid retention
*Sodium intake may need to be reduced and calcium and potassium supplements may be necessary
*Back pain may signify osteoporosis
*Plasma renin, sodium, and potassium is checked through blood tests to verify that the correct dosage is reached

=== Drug interaction ===
Interactions do not generally apply to steroid used for topical action including inhalation, unless specified.
{| class = "wikitable"
!Drugs given with steroid
!Potential adverse drug interactions
|-
| NSAIDs
| Increased risk of gastro-intestinal bleeding
|-
| Rifampicin
| Accelerate metabolism of fludrocortisone so reduce its effects
|-
| Antidiabetics
| Antagonize hypoglycemic effect, so may need to increase antidiabetic dosage
|-
| Antiepileptics such as carbamazepine, phenobarbitone, phenytoin
| Accelerate metabolism of fludrocortisone so reduce its effects
|-
| Antifungal e.g. amphotericin
| Increased risk of hypokalaemia
|-
| Antiviral e.g ritonavir
| Increase plasma concentration of steroid – increased risk of adrenal suppression
|-
| Digoxin
| Increased risk of hypokalaemia
|-
| Diuretics e.g. frusemide, hydrochlorothiazide
| Antagonize diuretic effect; increased risk of hypokalaemia
|-
| Oral contraceptive (oestrogens)
| Increase plasma concentration of steroid
|-
| Theophylline
| Increased risk of hypokalaemia
|}

=== Caution ===
*Osteoporosis (post-menopausal women at special risk)
*Recent myocardial infarction, congestive heart failure
*Glaucoma (including family history)
*Ocular herpes simplex – risk of corneal perforation
*Psychiatric disorders (particularly if history of steroid-induced psychosis)
*Epilepsy
*Peptic ulcer
*Hypothyroidism
*Ulcerative colitis
*Diverticulitis
*Thromboembolic disorders

=== Contraindication ===
*Acute infections
*Patients with active or doubtfully quiescent tuberculosis
*Concurrent treatment live virus vaccines for at least 3 months afterwards
=== Hepatic impairment ===
When steroids are administered orally or parenterally, the plasma-drug concentration may be increased in patients with hepatic impairment. The patient should be monitored closely.
=== Renal impairment ===
Should be used with caution in patients with renal impairment.

=== Pregnancy ===
It is not yet clear if use of fludrocortisone during pregnancy is safe for the fetus.

=== Note ===
{| class = "wikitable"
! Prolonged use of steroid
! Advice to patient
|-
| Increase susceptibility to infection
| Avoid contact with people who have chickenpox, shingles, or measles.
|-
| Suppresses the endogenous secretion of corticotrophin by the anterior pituitary, resulting the adrenal cortex becomes atrophied.
If given for more than 3 weeks, treatment MUST be stopped gradually.
| Patient must mention the course of steroid when receiving treatment for intercurrent illnesses or going through trauma such as surgery.
|}
== FAQ ==
=== How should I take the tablet? ===
The tablet MUST be taken with or after food to help reduce GI side-effects.
=== What should I avoid while taking? ===
Avoid abruptly discontinue the medication.
Should not be taken with NSAIDs.
=== What happen if I overdose? ===
Contact your primary care doctor.
If emergency situation, call 999
=== What happen if I miss a dose? ===
Take it as soon as you
remember. If it is near the time
of the next dose, skip the missed
dose. Take your next dose at the
regular time. Do not double the
dose to catch up.
IV, IM and IA: administered by professionals

2020-09-05T11:18:56Z

Annayung:

Fludrocortisone

2020-09-05T11:04:15Z

Annayung: