Fludrocortisone
FLORINEF
Pronunciation: floo-droe-KOR-ti-soen
What it isPotent mineralocorticoid; adrenal insufficiency and neurogenic orthostatic hypotension.
Why this oneReplaces 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.
Fludrocortisone prescription history
Animated chart of estimated U.S. prescriptions per year, Corticosteroids (systemic) (1950–2026). Fludrocortisone enters in 1955 (estimated).
FDA-approved for
- adrenal insufficiency (~1955)
Principal riskSupine hypertension, edema and hypokalemia
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyperglycemia, infection, osteoporosis and potentially severe mood, sleep or psychotic effects.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- tab 0.1 mg
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
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 0.1 mg | tab | 30 qd | $9.33 | offered |
Generic entry2002
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Self-check
- What hormone does fludrocortisone replace in primary adrenal insufficiency?
Aldosterone. - Which potassium abnormality can fludrocortisone cause?
Hypokalemia.