What is the use of Fludrocortisone (a synthetic corticosteroid)?

From the Guidelines

Fludrocortisone is a synthetic corticosteroid primarily used to treat conditions involving low levels of the hormone aldosterone, such as Addison's disease and certain types of adrenal insufficiency, by mimicking aldosterone's effects and helping the body retain sodium and excrete potassium. The typical adult dosage ranges from 50–200 µg daily, as a single dose, with children and younger adults potentially requiring higher doses 1. Patients taking fludrocortisone should monitor their blood pressure regularly and watch for signs of excessive sodium retention, such as swelling, weight gain, or hypertension, as well as monitoring potassium levels due to the risk of hypokalemia 1. Fludrocortisone is sometimes used to treat orthostatic hypotension and salt-losing forms of congenital adrenal hyperplasia, and its use may be beneficial in patients with syncope due to neurogenic orthostatic hypotension, as it increases plasma volume and improves symptoms of orthostatic hypotension 1. The medication should not be stopped abruptly, as this could precipitate an adrenal crisis, especially in patients with adrenal insufficiency, and patients should carry medical identification indicating they are on corticosteroid therapy in case of emergencies. Key considerations in the management of patients on fludrocortisone include avoiding certain medications that interact with fludrocortisone, such as diuretics and liquorice, and monitoring for potential side effects, including edema, hypokalemia, and headache 1. In pregnancy, the dose of fludrocortisone may need to be increased due to the anti-mineralocorticoid effects of serum progesterone, and during delivery, a bolus parenteral dose of hydrocortisone should be given, with the oral dose doubled for 24–48 hours postpartum 1. Overall, the use of fludrocortisone requires careful monitoring and management to minimize the risk of adverse effects and ensure optimal treatment outcomes. Some key points to consider when prescribing fludrocortisone include:

• Monitoring blood pressure and potassium levels regularly
• Avoiding certain medications that interact with fludrocortisone
• Adjusting the dose as needed during pregnancy and in other special situations
• Educating patients on the importance of carrying medical identification and seeking emergency care if necessary
• Regular follow-up to assess the effectiveness of treatment and minimize the risk of adverse effects.

From the FDA Drug Label

Fludrocortisone acetate tablets USP, 0.1 mg contain fludrocortisone acetate, a synthetic adrenocortical steroid possessing very potent mineralocorticoid properties and high glucocorticoid activity; it is used only for its mineralocorticoid effects. The main use of Fludrocortisone is for its mineralocorticoid effects 2.

• It has very potent mineralocorticoid properties.
• It is used to treat conditions that require mineralocorticoid replacement, although the specific conditions are not listed in the provided drug labels.
• The drug labels do not provide a full list of indications, but they do provide warnings and precautions for its use 2.

From the Research

Use of Fludrocortisone

Fludrocortisone is a synthetic corticosteroid used for various medical conditions. The key uses of fludrocortisone include:

• Replacement therapy in mineralocorticoid deficiency, aiming to achieve normotension, normokalaemia, and a plasma renin activity in the upper normal range 3
• Treatment of primary adrenal insufficiency (Addison's disease), often in combination with hydrocortisone 4, 5
• Management of adrenal insufficiency in different clinical settings, including septic shock 3, 6

Dosage and Administration

The dosage of fludrocortisone varies depending on the condition being treated. Common dosages include:

• 0.05-0.2 mg/day for substitution in mineralocorticoid deficiency 3
• 0.1 mg once daily for the treatment of primary adrenal insufficiency 4, 5
• 50-microg tablet once daily in combination with hydrocortisone for the treatment of septic shock 6

Clinical Effects

Fludrocortisone has been shown to:

• Improve symptoms of primary adrenal insufficiency, such as cutaneous hyperpigmentation and fatigue 4
• Reduce the risk of death in patients with septic shock and relative adrenal insufficiency 6
• Help achieve normotension, normokalaemia, and a plasma renin activity in the upper normal range in patients with mineralocorticoid deficiency 3