Fludrocortisone

Aka: Fludrocortisone, Florinef

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II. Indications

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

III. 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

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

  1. See Systemic Corticosteroid
  2. Volume overload
  3. Hypokalemia
  4. Hypomagnesemia
  5. Headache
  6. Edema
  7. Weight gain
  8. Supine Hypertension

VIII. Safety

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

IX. Resources

  1. Fludrocortisone Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=198278e7-9a6d-4a9a-bb47-3589f35939da

X. References

  1. (2003) Lexi-comp Drug Database
  2. Kim (2022) Am Fam Physician 105(1): 39-49 [PubMed]

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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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Ontology: Fludrocortisone (C0016280)

Definition (NCI) A synthetic corticosteroid with antiinflammatory and antiallergic properties. Fludrocortisone is a mineralocorticoid receptor and glucocorticoid receptor agonist that binds to cytoplasmic receptors, translocates to the nucleus and subsequently initiates the transcription of glucocorticoid-responsive genes such as lipocortins to inhibit phospholipase A2. This prevents the release of arachidonic acid, a precursor to prostaglandins and leukotrienes, both important mediators in the pro-inflammatory response mechanism. In addition, this agent exerts its mineralocorticoid effect on the distal tubules and collecting ducts of the kidney by inducing permease, an enzyme that regulates Na+ permeability in cells, thereby enhancing Na+ reabsorption and water retention as well as increasing K+, H+ excretion.
Definition (NCI_NCI-GLOSS) A synthetic corticosteroid. It is used to replace steroid hormones normally produced by the adrenal gland.
Definition (MSH) A synthetic mineralocorticoid with anti-inflammatory activity.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Steroid (T110)
MSH D005438
SnomedCT 116586002, 89192008
LNC LP35868-6, MTHU018755
English 9 alpha-Fluorohydrocortisone, 9-Fluorocortisol, 9-Fluorohydrocortisone, Fludrocortisone, 9 Fluorocortisol, 9 Fluorohydrocortisone, 9 alpha Fluorohydrocortisone, fludrocortisone, Pregn-4-ene-3,20-dione, 9-fluoro-11,17,21-trihydroxy-, (11beta)-, 9 Fluoro 17 Hydroxycortisone, 9 alpha Fludrohydrocortisone, 9 alpha Fluoro 17 Hydroxycorticosterone, 9 alpha-Fluoro-17-Hydroxycorticosterone, 9-Fluoro-17-Hydroxycortisone, FLUOROCORTISOL 09, Fludrocortisone [Chemical/Ingredient], 9-fluorohydrocortisone, FLUDROCORTISONE, Fludrocortisone preparation, Fludrocortisone (substance), Fludrocortisone preparation (product), Fludrocortisone preparation (substance)
Swedish Fludrokortison
Czech fludrokortison
Finnish Fludrokortisoni
Russian FLUDROKORTIZON, 9-FLUOROKORTIZOL, 9-FTORKORTIZOL, 9-ФЛУОРОКОРТИЗОЛ, 9-ФТОРКОРТИЗОЛ, ФЛУДРОКОРТИЗОН
Spanish fludrocortisona (producto), preparado con fludrocortisona (producto), preparado con fludrocortisona, fludrocortisona (sustancia), fludrocortisona, preparado de fludrocortisona (producto), preparado de fludrocortisona (sustancia), preparado de fludrocortisona, 9-Fluorocortisol, Fludrocortisona
Italian 9 alfa-Fluoro-17-idrossicortisone, 9-Fludro-idrocortisone, 9 alfa Fludro-idrocortisone, 9-Fluoro-17-idrossicortisone, 9-Fluorocortisolo, 9-Fluoro-17-idrocortisone, Fludrocortisone
German FLUORCORTISOL 09, 9-Fluorcortisol, Fludrocortison
Polish Fludrokortyzon
Japanese 酢酸フルドロコルチゾン, フルドロコルチゾン, 9-フルオロコーチゾル, フロリネフ
French Fludrocortisone
Portuguese Fludrocortisona, 9-Fluorcortisol
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Florinef (C0060486)

Concepts Pharmacologic Substance (T121) , Steroid (T110)
MSH C034635
English Florinef Acetate, Florinef, florinef, florinef acetate, acetate florinef, Florinef acetate, Bristol-Myers Squibb brand of fludrocortisone 21-acetate, Monarch brand of fludrocortisone 21-acetate, Shire brand of fludrocortisone 21-acetate
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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