From the Guidelines
Fludrocortisone is a synthetic mineralocorticoid medication primarily used to treat conditions involving low aldosterone levels, such as Addison's disease and certain types of adrenal insufficiency, with a typical starting dose of 50–200 µg taken orally once daily, as recommended by the consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency 1.
Key Points
- The medication works by promoting sodium retention and potassium excretion in the kidneys, helping to maintain proper fluid balance and blood pressure.
- Patients taking fludrocortisone should monitor for side effects including edema, hypertension, hypokalemia, and heart failure.
- Regular blood pressure checks and electrolyte monitoring are essential during treatment.
- Patients should not abruptly discontinue fludrocortisone as this could precipitate an adrenal crisis.
- The medication is often used alongside glucocorticoids like hydrocortisone in complete adrenal insufficiency treatment.
- Patients should maintain adequate salt intake while taking fludrocortisone and may need dose adjustments during periods of illness, surgery, or significant stress.
Important Considerations
- Fludrocortisone dose may need to be reduced if essential hypertension develops, but it should not be stopped 1.
- Patients should avoid certain medications that interact with fludrocortisone, such as diuretics, acetozolamide, carbenoxolone, liquorice, and grapefruit juice 1.
- Mineralocorticoid replacement with fludrocortisone should be restarted when the hydrocortisone dose falls to <50 mg day1 1.
- The formulation instructions for fludrocortisone require patients to keep the medication refrigerated, but the actual decay rate is only 0.1% in the first 6 months at room temperature 1.
From the FDA Drug Label
INDICATIONS & USAGE Fludrocortisone acetate tablets, 0.1 mg are indicated as partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease and for the treatment of salt-losing adrenogenital syndrome. The use of Fludrocortisone (Florinef) is for:
- Replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease
- Treatment of salt-losing adrenogenital syndrome 2
From the Research
Use of Fludrocortisone (Florinef)
- Fludrocortisone is used for substitution in mineralocorticoid deficiency, aiming at normotension, normokalaemia, and a plasma renin activity in the upper normal range 3.
- The standard dose of fludrocortisone is 0.05-0.2 mg/day 3, 4, 5.
- Fludrocortisone is used to replace mineralocorticoids in patients with primary adrenal insufficiency, who require both glucocorticoid and mineralocorticoid replacement therapy 6, 4, 5.
- The mineralocorticoid activity of fludrocortisone is dose-dependent, with a positive linear correlation between fludrocortisone dose and sodium, and a negative linear correlation between fludrocortisone and potassium or renin 7.
- Renin and electrolytes can indicate the mineralocorticoid activity of fludrocortisone treatment and should be routinely evaluated to titrate its dose 7.
- Fludrocortisone dose may need to be adjusted in patients with primary adrenal insufficiency, with some patients requiring higher doses, especially those with low-normal renin 7.