Can fludrocortisone be administered on an every other day schedule?

From the Guidelines

Fludrocortisone should not be taken every other day, as it is typically prescribed to be taken daily to maintain consistent hormone levels and prevent fluctuations in blood pressure and electrolyte imbalances. This medication is crucial for replacing aldosterone, a hormone that regulates sodium and potassium balance in the body 1. The standard dosing for fludrocortisone is 0.05 to 0.2 mg once daily, and some patients may require doses up to 0.3 mg daily. Taking fludrocortisone on an every-other-day schedule could lead to inconsistent hormone levels, potentially causing symptoms of adrenal insufficiency on days without medication. Some key points to consider when taking fludrocortisone include:

• The medication is usually taken in one dose upon awakening 1
• Mineralocorticoid replacement is evaluated clinically by asking the patient about salt cravings or lightheadedness, measuring blood pressure in the supine and standing positions, and identifying the presence of peripheral oedema 1
• The formulation instructions 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 If you're experiencing side effects or have concerns about your current dosing regimen, it's essential to consult with your healthcare provider before making any changes 1. Your doctor might adjust your dose based on your blood pressure, electrolyte levels, and symptoms rather than changing to an alternate-day schedule. Fludrocortisone works by promoting sodium retention and potassium excretion in the kidneys, which helps maintain proper fluid balance and blood pressure, making consistent daily levels important for stable management of conditions like adrenal insufficiency 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Dosage depends on the severity of the disease and the response of the patient. ... 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 FDA drug label does mention that a dosage of 0.1 mg three times a week has been employed, which is essentially an every other day schedule, but for a specific dosage, not the standard daily dose.

• The standard dose is 0.1 mg daily.
• A dose of 0.1 mg three times a week is also mentioned, which could be interpreted as every other day, but with a lower frequency than daily. Given the information, it appears that every other day dosing may be considered in certain cases, but with a lower dose, such as 0.1 mg three times a week 2.

From the Research

Dosage Frequency of Fludrocortisone

• The provided studies do not directly address the question of whether fludrocortisone can be taken every other day 3, 4, 5, 6, 7.
• However, the studies suggest that fludrocortisone is typically taken once daily, with doses ranging from 0.05-0.20 mg per day 4, 5.
• The studies also emphasize the importance of monitoring plasma-renin activity and adjusting the dose of fludrocortisone accordingly to maintain adequate sodium and water balance 3, 7.
• There is no evidence to suggest that taking fludrocortisone every other day is a recommended or common practice for patients with Addison's disease 3, 4, 5, 6, 7.

Treatment of Addison's Disease

• The treatment of Addison's disease typically involves replacement therapy with glucocorticoids and mineralocorticoids, such as fludrocortisone 4, 5, 6.
• The goal of treatment is to restore normal hormone levels and improve symptoms, and the dose of fludrocortisone may need to be adjusted based on individual patient response 3, 7.
• Monitoring of plasma-renin activity and other hormone levels is important to ensure that the patient is receiving the correct dose of fludrocortisone 3, 7.