What is the typical starting dose and management of Florinef (fludrocortisone)?

From the Guidelines

The typical starting dose of Florinef (fludrocortisone) is 50–200 µg as a single daily dose, with most patients requiring between 50–200 µg daily, as recommended by the consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency 1.

Key Considerations for Management

• The dose of fludrocortisone may need to be adjusted based on clinical response, with children and younger adults potentially requiring higher doses 1.
• Patients should be advised to take salt and salty foods ad libitum and avoid liquorice and grapefruit juice 1.
• Regular monitoring of blood pressure, electrolytes (particularly potassium and sodium), and weight is essential to assess for fluid retention and potential side effects such as edema, hypertension, and hypokalemia.
• Potassium supplementation may be necessary if hypokalemia develops.
• During acute illness, surgery, or severe stress, patients may require temporary dose increases or supplementation with additional glucocorticoids if the patient has adrenal insufficiency 1.

Important Safety Information

• Fludrocortisone works by enhancing sodium reabsorption and potassium excretion in the kidneys, thereby increasing blood volume and blood pressure.
• Patients should be educated about potential side effects and the importance of adhering to their prescribed medication regimen.
• The lowest effective dose of fludrocortisone should be used to minimize the risk of adverse effects, and patients should be reviewed at least annually to assess their health and well-being 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Dosage depends on the severity of the disease and the response of the patient. In Addison’s disease, the usual dose is 0.1 mg of fludrocortisone acetate tablets daily, although dosage ranging from 0.1 mg three times a week to 0. 2 mg daily has been employed. The recommended dosage for treating the salt-losing adrenogenital syndrome is 0.1 mg to 0.2 mg of fludrocortisone acetate tablets daily.

The typical starting dose of Florinef (fludrocortisone) is 0.1 mg daily. Management involves continually monitoring patients for signs that indicate dosage adjustment is necessary, such as remission or exacerbations of the disease and stress. The dose may be adjusted based on the patient's response, with a range of 0.1 mg three times a week to 0.2 mg daily for Addison's disease and 0.1 mg to 0.2 mg daily for salt-losing adrenogenital syndrome 2.

From the Research

Typical Starting Dose of Florinef

• The typical starting dose of Florinef (fludrocortisone) for patients with Addison's disease is 0.05 - 0.20 mg once daily 3.
• However, some studies suggest that patients with Addison's disease may be undertreated with fludrocortisone, and the dose may need to be adjusted based on plasma-renin activity and 24-hour urinary sodium excretion 4.
• The dose of fludrocortisone may need to be individualized, with some patients requiring higher doses, such as 0.2 mg/day, to maintain adequate sodium and water balance 4.

Management of Florinef

• Patients with Addison's disease require life-long substitutive therapy with fludrocortisone and glucocorticoids, such as hydrocortisone 5.
• The dose of fludrocortisone should be adjusted based on clinical and biochemical parameters, such as plasma-renin activity, electrolyte levels, and blood pressure 4, 6.
• Patients should be educated to double or triple their hydrocortisone dose in case of fever or infection, and to switch to parenteral hydrocortisone in case of vomiting, diarrhea, or acute hypotension 5.
• Mineralocorticoid substitution in Addison's disease should be monitored by plasma potassium measurement, and hyperkalemia may coexist with normal plasma-renin activity 6.