From the Guidelines
Do not stop Florinef (fludrocortisone) abruptly if you've been taking it for orthostatic hypotension, as this can lead to worsening symptoms and potential complications. According to the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1, fludrocortisone is beneficial in patients with syncope due to neurogenic OH, increasing plasma volume and improving symptoms of OH. However, supine hypertension may be a limiting factor, and other side effects commonly seen include edema, hypokalemia, and headache.
To taper off Florinef, a gradual reduction in dose is recommended under medical supervision. A typical tapering schedule might involve reducing the dose by 50% for 1-2 weeks, then reducing it again before stopping completely. During this process, it is essential to:
- Monitor blood pressure regularly in both sitting and standing positions
- Increase salt and fluid intake, as encouraged by the guideline for selected patients with neurogenic OH 1
- Continue using other non-pharmacological measures like compression stockings if prescribed, as these can be beneficial in patients with syncope and OH 1
If severe symptoms occur during tapering, such as worsening orthostatic hypotension, dizziness, lightheadedness, or fainting, it is crucial to contact your healthcare provider immediately, as your tapering schedule may need adjustment. The goal is to minimize potential complications and ensure a smooth transition off the medication while maintaining adequate blood pressure control and preventing orthostatic hypotension symptoms.
From the Research
Stopping Florinef for Orthostatic Hypotension
- There is no direct evidence in the provided studies on how to stop Florinef (fludrocortisone) for orthostatic hypotension, specifically whether it should be stopped abruptly or tapered off.
- However, the studies suggest that fludrocortisone is associated with a higher risk of all-cause hospitalizations compared to midodrine in patients with orthostatic hypotension 2.
- The management of orthostatic hypotension is aimed at improving quality of life and reducing symptoms rather than normalizing blood pressure, and nonpharmacologic measures are the key to success 3.
- Fludrocortisone is considered a first- or second-line pharmacological therapy for orthostatic hypotension, but there is very low-certainty evidence about its effects on blood pressure, orthostatic symptoms, or adverse events in people with orthostatic hypotension and diabetes or Parkinson disease 4.
- Other studies have investigated the efficacy of midodrine and pyridostigmine in treating orthostatic hypotension, with some suggesting that these medications may be effective in improving orthostatic blood pressure and symptoms 5, 6.
Tapering Off Florinef
- While there is no specific guidance on tapering off Florinef, it is generally recommended to taper off medications gradually to minimize the risk of withdrawal symptoms or rebound effects.
- The decision to stop or taper off Florinef should be made under the guidance of a healthcare professional, taking into account the individual patient's condition and response to treatment 3, 4.