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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.
Adverse reactions to corticosteroids may be produced by too rapid withdrawal or by continued use of large doses.
In larger dosesfludrocortisone acetate inhibits endogenous adrenal cortical secretionthymic activityand pituitary corticotropin excretionpromotes the deposition of liver glycogenandunless protein intake is adequateinduces negative nitrogen balance.
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