II. Indications

  1. Adrenal Insufficiency (in combination with Glucocorticoids)
  2. Orthostatic Hypotension (some forms, off-label)

III. Mechanism

  1. See Systemic Corticosteroid
  2. Synthetic 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

IV. Medications

  1. Fludrocortisone (Florinef) Tablet 0.1 mg

V. 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

VI. 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

VII. Adverse Effects

VIII. Safety

  1. See Systemic Corticosteroid
  2. Pregnancy Category C
  3. Unknown safety in Lactation

X. References

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Related Studies

Cost: Medications

fludrocortisone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
FLUDROCORTISONE 0.1 MG TABLET Generic $0.41 each