II. Indications
- Adrenal Insufficiency (in combination with Glucocorticoids)
- Orthostatic Hypotension (some forms, off-label)
III. Mechanism
- See Systemic Corticosteroid
- Synthetic Mineralocorticoid (with some Glucocorticoid activity)
- Acts at renal distal tubules and collecting ducts
- Induces permease, an enzyme regulator of cell permeability of Sodium
- Increases Sodium reabsorption and water retention
- Increases Potassium and Hydrogen Ion excretion
- Increases Sodium and water retention and expands intravascular volume
- Increases vascular alpha-adrenergic Receptor Sensitivity resulting in Vasoconstriction
- Acts at renal distal tubules and collecting ducts
IV. Medications
- Fludrocortisone (Florinef) Tablet 0.1 mg
V. Dosing: Adult
-
Adrenal Insufficiency: 0.1 mg orally three times weekly up to 0.2 mg orally daily
- Administer in combination with Glucocorticoids (e.g. Hydrocortisone)
- Salt-Losing Adrenogenital Syndrome: 0.1 to 0.2 mg orally daily
-
Orthostatic Hypotension (off-label)
- Start at 0.1 mg daily
- Titrate weekly by 0.1 mg to maximum of 1mg daily
- Target improved symptoms
- Limit dosing if significant edema or weight gain >3.6 kg
VI. Precautions
- Monitor for Hypokalemia and Hypertension
- Risk of edema and Congestive Heart Failure exacerbation
- Risk of longterm Left Ventricular Hypertrophy and Renal Failure
VII. Adverse Effects
- See Systemic Corticosteroid
- Volume overload
- Hypokalemia
- Hypomagnesemia
- Headache
- Edema
- Weight gain
- Supine Hypertension
VIII. Safety
- See Systemic Corticosteroid
- Pregnancy Category C
- Unknown safety in Lactation
IX. Resources
- Fludrocortisone Tablet (DailyMed)
X. References
- (2003) Lexi-comp Drug Database
- Kim (2022) Am Fam Physician 105(1): 39-49 [PubMed]
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| fludrocortisone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FLUDROCORTISONE 0.1 MG TABLET | Generic | $0.41 each |