What are the brand names of mineralocorticoids (Mineralocorticoid) and glucocorticoids (Glucocorticoid) used to treat primary adrenal insufficiency (Addison's disease)?

From the Guidelines

For primary adrenal insufficiency, the most commonly used medications are fludrocortisone (brand name Florinef) as the mineralocorticoid replacement and hydrocortisone (brand names Cortef, Solu-Cortef) as the glucocorticoid replacement. The typical regimen includes hydrocortisone 15-25 mg daily divided into 2-3 doses (usually higher dose in morning and smaller doses later in day) and fludrocortisone 0.05-0.2 mg once daily, as recommended by the consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency 1. Other available glucocorticoids include prednisone (Deltasone, Rayos), prednisolone (Millipred, Orapred), methylprednisolone (Medrol), and dexamethasone (Decadron), but these are less preferred for routine replacement due to their longer half-lives and greater potency which can increase side effect risk, as outlined in the treatment guidelines 1. Hydrocortisone is preferred because it most closely mimics the body's natural cortisol rhythm. Patients should be educated about stress dosing during illness or surgery, typically doubling or tripling their glucocorticoid dose, and the importance of carrying an emergency injection kit with hydrocortisone and wearing medical alert identification, as emphasized in the consensus statement 1. Treatment efficacy is monitored through clinical symptoms, electrolyte levels, blood pressure, and plasma renin activity rather than cortisol levels. Some key points to consider in the management of primary adrenal insufficiency include:

• The dose of hydrocortisone may need to be adjusted during pregnancy, particularly during the last trimester, and parenteral doses of hydrocortisone should be given during delivery 1
• Patients should be advised to take salt and salty foods ad libitum and avoid liquorice and grapefruit juice, as recommended in the treatment guidelines 1
• The annual consultation should include questions regarding family relationships and professional duties, self-esteem and possible complaints due to PAI, as well as questions about the quality of the daily replacement therapy, self-medication during intercurrent illness and previous adrenal crises 1

From the FDA Drug Label

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. PredniSONE Tablets are indicated in the following conditions: 1 Endocrine Disorders Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the first choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance) Dexamethasone sodium phosphate injection has a rapid onset but short duration of action when compared with less soluble preparations. Because of this, it is suitable for the treatment of acute disorders responsive to adrenocortical steroid therapy

The brand names of the mineralcorticoids and glucocorticoids are not explicitly mentioned in the provided drug labels. However, the drug names mentioned are:

• Fludrocortisone (mineralcorticoid)
• Prednisone (glucocorticoid)
• Dexamethasone (glucocorticoid)

The most used glucocorticoids for primary adrenal insufficiency are hydrocortisone or cortisone as the first choice, according to 2. Fludrocortisone is used as partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease, as mentioned in 3.

From the Research

Mineralcorticoids and Glucocorticoids

• The brand names of mineralcorticoids and glucocorticoids are not explicitly mentioned in the provided studies.
• However, the studies mention the following medications:
  • Fludrocortisone (mineralcorticoid) 4, 5, 6
  • Hydrocortisone (glucocorticoid) 4, 7, 8, 6
  • Dehydroepiandosterone (not a traditional glucocorticoid, but mentioned as a potential addition to standard treatment) 4
  • Prednisolone (glucocorticoid) 8
  • Cortisone acetate (glucocorticoid) 6

Treatment of Primary Adrenal Insufficiency

• The most commonly used medications for primary adrenal insufficiency are:
  • Fludrocortisone (0.05-0.2 mg/day) for mineralocorticoid replacement 4
  • Hydrocortisone (15-25 mg/day) for glucocorticoid replacement 4, 8, 6
• The treatment regimen typically involves once-daily fludrocortisone and hydrocortisone or cortisone acetate replacement in two to three daily doses 6
• The goal of treatment is to achieve normotension, normokalemia, and a plasma renin activity in the upper normal range 4, 5