fludrocortisone (Florinef)

Fludrocortisone is a man-made oral corticosteroid. It is derived from hydrocortisone, but is more potent than hydrocortisone. The effects of fludrocortisone including its effect on electrolyte balance and carbohydrate metabolism are stronger and prolonged in comparison to hydrocortisone.

Florinef (fludrocortisone) Acetate is indicated as partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison's disease and for the treatment of salt-losing adrenogenital syndrome.

Fludrocortisone mimics the actions of aldosterone which is a steroid that is naturally produced by the body. The physiological effects of fludrocortisone are dose dependent. Small oral doses of fludrocortisone cause an increase in blood pressure, sodium retention, and increases urinary potassium excretion. Larger doses of fludrocortisone inhibit the secretion of hormones from the adrenal gland. Fludrocortisone was initially approved by the US Food and Drug Administration (FDA) in 1954. The first generic fludrocortisone tablet was approved by the FDA in March 2002.

Is fludrocortisone available as a generic drug?

Yes

Do I need a prescription for fludrocortisone?

Yes

Reported side effects include:

• heart problems,
• fluid retention,
• high blood pressure,
• mood or psychiatric disorders,
• headache,
• trouble sleeping,
• skin problems,
• endocrine disorders,
• hyperglycemia,
• hypokalemia
• (low potassium),
• growth suppression,
• upset stomach,
• stomach ulcers,
• muscle weakness,
• osteoporosis,
• fractures,
• eye problems, and
• sweating.

Fludrocortisone may increase the risk of infections.

• Addison's disease: The usual recommended dose is 0.1 mg by mouth once daily without regard to food. Dose should be reduced to 0.05 mg daily if hypertension develops. Maintenance dosage range is 0.1 to 0.2 mg 3 times weekly. Fludrocortisone is preferably administered with cortisone (10 to 37.5 mg daily) or hydrocortisone (10 to 30 mg daily).
• Salt losing adrenogenital syndrome: The recommended dose is 0.1 to 0.2 mg daily.

: Antacids and bile acid sequestrants (for example, cholestyramine [Questran, Questran Light], colestipol [Colestid], and colesevelam [Welchol]) may decrease the absorption of oral corticosteroids.

Oral corticosteroids may decrease the effectiveness of diabetes medications.

Medications that may decrease blood levels of corticosteroids include barbiturates, isoniazid (Nydrazid, Laniazid, INH), mitotane (Lysodren), rifampin (Rifadin, Rifadin IV), aminoglutethimide (Cytadren), primidone (Mysoline), and others.

Medications that may increase blood levels of corticosteroids include aprepitant (Emend), strong CYP3A4 inhibitors, estrogen derivatives, mifepristone (Mifeprex), and others.

Corticosteroids may increase the risk of adverse effects associated with live vaccine administration.

Although information specific to fludrocortisone is not available, corticosteroids are excreted in breast milk. Due to the risk of adverse effects in the infant, fludrocortisone should be used cautiously in nursing mothers.

What preparations of fludrocortisone are available?

Tablets: 0.1 mg

How should I keep fludrocortisone stored?

Tablets should be stored at room temperature between 2 C and 8 C (36 F and 46 F).