Doses - FLUDROCORTISONE ACETATE

Dogs:

For hypoadrenocorticism:
a) Maintenance therapy: Initial dosage of 0.1 - 0.3 mg PO daily, either as a single dose ordivided. Monitor serum sodium and potassium values every 1-2 weeks and adjustdosage by 0.05 - 0.1 mg per day. Once electrolytes have stabilized, monitor BUN, creatinine, and electrolytes every 3-4 months. Many patients require gradual increase indosage over the first 6-18 months of therapy. Average long-term maintenance dosage isapproximately 0.1 mg per 5 kg of body weight. Adjunctive therapy with oral sodiumchloride supplementation (1 - 5 grams per day PO) may also be useful. (Schrader 1986)
b) For maintenance: Usually 0.05 mg/kg divided bid daily; 20 kg dog usually requires 2 - 4 tablets daily. Only 50% of dogs receiving fludrocortisone require supplemental glucocorticoids chronically. Oral salt supplementation may lessen the amount of fludrocortisone required. (Feldman and Nelson 1987a)
c) For chronic or subacute therapy: Begin at 0.1 mg PO daily for small dogs to 0.5 mg POdaily for large dogs; adjust based on serial electrolytes. Also give glucocorticoidsupplementation (prednisone/- prednisolone 0.2 - 0.4 mg/kg/day) and IV fluid therapyif required (see reference for more information). (Feldman, Schrader, and Twedt 1988)
For adjunctive therapy of hyperkalemia:
a) 0.1 - 1.0 mg per day PO; may induce iatrogenic hyperadrenocorticism. (Wheeler 1986)

Cats:

For maintenance therapy of hypoadrenocorticism:
a) Once stabilized, 0.1 mg per day PO. Monitor serum electrolytes every 1-2 weeks initially and adjust dosage as necessary. For additional glucocorticoid supplementation, give either oral prednisolone or prednisone at 1.25 mg per day or monthly injections of methylprednisolone acetate 10 mg IM monthly. (Greco and Peterson 1989), (Peterson and Randolph 1989)
Monitoring Parameters -

1) Serum electrolytes, BUN, creatinine; initially every 1-2 weeks, then every 3-4 months once stabilized

2) Weight, PE for edema
Client Information - Clients should be familiar with the symptoms associated with both hypoadrenocorticism (e.g., weakness, depression, anorexia, vomiting, diarrhea, etc.) and fludrocortisone overdosage (e.g., edema) and report these to the veterinarian immediately.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products: None

Human-Approved Products:

Fludrocortisone Acetate Tablets 0.1 mg; Florinef® Acetate (Apothecon); (Rx)