Fludrocortisone

(Florinef)
Fludrocortisone (Florinef)

FLUDROCORTISONE 0.1
MG TABLET

Identification
Color: white
Shape: round
Imprint: 7033
This medicine is a white,
round, scored tablet
imprinted with "7033".
What is fludrocortisone?
Fludrocortisone is in a class of drugs called steroids.
Fludrocortisone prevents the release of substances in
the body that cause inflammation.
Fludrocortisone is used to treat conditions in which
the body does not produce enough of its own steroids,
such as Addison's disease, and salt-losing adrenogenital
syndrome.
Fludrocortisone may also be used for other purposes not
listed in this medication guide.
 Clinical Applications
A potent oral mineralocorticoid
FDA Approved Indications
Addisons disease-Adrenal
insufficency
Adrenogenital disorder
Effective in treating orthostatic
hypotension
 Fludrocortisone has been effective in the
treatment of hypotension, achieving clinical
improvement in 84.3% of patients with
doses as high as 2mg/d (Frick, 1966).

The initial dose is usually 0.1 mg daily,

increased by 0.1 mg every 5 to 7 days as
needed. The usual maintenance dose ranges
from 0.1 to 1.0 mg/day because treatment
limit its side effect.
Mechanism of Action
Fludrocortisone binds the mineralocorticoid
receptor (aldosterone receptor). This binding (or
activation of the mineralocorticoid receptor by
fludrocortisone) in turn causes an increase in ion
and water transport and thus raises extracellular
fluid volume and blood pressure and lowers
potassium levels.
 the resorption of Na+ and increase the urinary
excretion of K+ and H+ at the distal tubule in the
kidney
plasma volume (a increases in blood pressure due
to Na+ retaining-effects)
the sympathetic response to norepinephrine
increased peripheral resistance
 Pharmacokinetics
Absorbed from the GI: 100%
Peak blood levels : 1.7 hours after P.O.
Protein bounding: 42%
Metabolized: liver , primary site
Half-life: 3.5 hours
 Dose
In severe orthostatic hypotension :
0.1 mg P.O. bid to tid
Higher dose: 0.4 to 2 mg daily P.O.
Low doses and long-term fludrocortisone
was shown to be poorly tolerated in elderly
patients being treated for hypotensive
disorders (Hussain et al, 1996)
 Precautions

Serum electrolytes
Blood glucose
Blood pressure, standing and recumbent
Muscle strength
Contraindications/Cautions
hypersens. to drug/class/compon.
systemic fungal infxn
CHF
seizure disorder
diabetes mellitus
HTN
TB infxn
osteoporosis
renal impairment
 Drug Interactions
o midodrine
Caution Advised monitor BP: combo may incr. risk of supine
HTN (additive effects)
desmopressin
caution advised: combo may potentiate antidiuretic response
(additive effects)
[desmopressin: desmopressin, desmopressin nasal]
vasopressin
caution advised: combo may potentiate antidiuretic response
(additive effects)
 Adverse Reactions

Hypernaltremia, hypokalemia
High doses may cause suppression of
hypophyseal corticotropin secretuon
Significant fluid retention
(edema, dyspnea, weight gain, and CHF)
 Adverse Reactions
Serious Reactions
adrenal insufficiency
steroid psychosis
immunosuppression (long-term use)
peptic ulcer
CHF
anaphylaxis
osteoporosis (long-term use)
pseudotumor cerebri (peds)
pancreatitis (peds)
others
 Common Reactions
nausea
vomiting
dyspepsia
appetite change
edema
headache
dizziness
mood swings
insomnia
anxiety
hypokalemia
HTN
hyperglycemia
Cushing syndrome (long-term use)
menstrual irregularities
ecchymosis
acne
skin atrophy (long-term use)
impaired wound healing (long-term use)
others