Fludrocortisone
FLORINEF
What it isPotent mineralocorticoid; adrenal insufficiency and neurogenic orthostatic hypotension.
Why this oneIt replaces aldosterone, which hydrocortisone alone does not do adequately in primary adrenal insufficiency.
What limits itSupine hypertension, edema and hypokalemia. Titrate against renin, postural blood pressure and potassium.
FDA-approved for
- adrenal insufficiency (~1955)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Addison's disease (with a glucocorticoid) | Adults | 0.1 mg QD | 0.1 mg 3×/week to 0.2 mg QD | 0.2 mg QD |
| Salt-losing adrenogenital syndrome | Adults | 0.1 mg QD | 0.1–0.2 mg QD | 0.2 mg QD |
Renal Undefined
Hepatic Undefined
Instructions
- In Addison's disease, administer with cortisone (10–37.5 mg/day) or hydrocortisone (10–30 mg/day) in divided doses
- Reduce to 0.05 mg daily if transient hypertension develops
Contraindications
- Systemic fungal infections
Cautions
- Mineralocorticoid effects: hypertension, edema, CHF, hypokalemia
- Immunosuppression / masking of infection
- Adrenal-pituitary suppression, especially under stress
- Growth suppression in children
Adverse reactions
- Hypertension
- Edema
- Congestive heart failure
- Potassium loss / hypokalemic alkalosis
- (with glucocorticoid/prolonged use) muscle weakness, osteoporosis, peptic ulcer, cushingoid state
Pregnancy Category C; give only if clearly needed. Observe infants of treated mothers for hypoadrenalism.
Lactation Undefined
NO BOXED WARNINGS
Principal riskSupine hypertension, edema and hypokalemia
Cost, est. cash$4–$300/month
Generic entry2002
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyperglycemia, infection, osteoporosis and potentially severe mood, sleep or psychotic effects.
Mechanism of action: Fludrocortisone ballicule
