Pharm

Fludrocortisone

search

Fludrocortisone, Florinef

  • See Also
  1. Systemic Corticosteroid
  2. Topical Corticosteroid
  3. Inhaled Corticosteroid
  4. Intranasal Steroid
  5. Intra-articular Corticosteroid
  6. Corticosteroid Associated Osteoporosis
  7. Stress Dose Steroid
  8. Steroid-Induced Hyperglycemia
  • Indications
  1. Adrenal Insufficiency (in combination with Glucocorticoids)
  2. Orthostatic Hypotension (some forms, off-label)
  • Mechanism
  1. See Systemic Corticosteroid
  2. Synthetic, halogenated Mineralocorticoid (with some Glucocorticoid activity)
    1. Acts at renal distal tubules and collecting ducts
      1. Induces permease, an enzyme regulator of cell permeability of Sodium
      2. Increases Sodium reabsorption and water retention
      3. Increases Potassium and Hydrogen Ion excretion
    2. Increases Sodium and water retention and expands intravascular volume
    3. Increases vascular alpha-adrenergic Receptor Sensitivity resulting in Vasoconstriction
  • Medications
  1. Fludrocortisone (Florinef) Tablet 0.1 mg
  • Dosing
  • Adult
  1. Adrenal Insufficiency: 0.1 mg orally three times weekly up to 0.2 mg orally daily
    1. Administer in combination with Glucocorticoids (e.g. Hydrocortisone)
  2. Salt-Losing Adrenogenital Syndrome: 0.1 to 0.2 mg orally daily
  3. Orthostatic Hypotension (off-label)
    1. Start at 0.1 mg daily
    2. Titrate weekly by 0.1 mg to maximum of 1mg daily
    3. Target improved symptoms
    4. Limit dosing if significant edema or weight gain >3.6 kg
  • Precautions
  1. Monitor for Hypokalemia and Hypertension
  2. Risk of edema and Congestive Heart Failure exacerbation
  3. Risk of longterm Left Ventricular Hypertrophy and Renal Failure
  • Adverse Effects
  1. See Systemic Corticosteroid
  2. Volume overload
  3. Hypokalemia
  4. Hypomagnesemia
  5. Headache
  6. Edema
  7. Weight gain
  8. Supine Hypertension
  • Safety
  1. See Systemic Corticosteroid
  2. Pregnancy Category C
  3. Unknown safety in Lactation
  • Resources
  1. Fludrocortisone Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=198278e7-9a6d-4a9a-bb47-3589f35939da
  • References
  1. (2003) Lexi-comp Drug Database
  2. Kim (2022) Am Fam Physician 105(1): 39-49 [PubMed]