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Fludrocortisone

    Brands

    DEA Class; Rx

    Common Brand Names; Florinef, Florinef Acetate

    • Corticosteroids

    Potent oral synthetic fluorinated mineralocorticoid; no appreciable glucocorticoid activity
    Actions are similar to those of aldosterone
    Used for conditions of adrenocortical insufficiency and orthostatic hypotension

    Indicated for Primary and secondary adrenocortical insufficiency in Addison disease

    For the treatment of primary adrenocortical insufficiency (e.g., Addison’s Disease, congenital adrenal hyperplasia or CAH), secondary adrenocortical insufficiency, or salt-losing adrenogenital syndrome.
    For the treatment of neurogenic orthostatic hypotension, including due to diabetic cardiovascular autonomic neuropathy or Parkinson’s disease dysautonomia.

    Systemic fungal infection

    Documented hypersensitivity

    Receipt of live or attenuated live vaccine; Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term (<2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in maintenance of physiologic dosages (replacement therapy)

    • Acne
    • Adrenal suppression
    • Change in spermatogenesis
    • Delayed wound healing
    • Diabetes mellitus
    • GI perforation
    • Glucose intolerance
    • Hepatomegaly
    • Hypokalemic alkalosis
    • Increased transaminases
    • Insomnia
    • Menstrual irregularity
    • Myopathy
    • Neuritis
    • Osteoporosis
    • Peptic ulcer
    • Perianal pruritus
    • Pituitary adrenal axis suppression
    • Pseudotumor cerebri (on withdrawal)
    • Psychosis
    • Seizure
    • Ulcerative esophagitis
    • Urticaria
    • Vertigo
    • Weight gain

    Use with caution in diabetes mellitus, hypertension, hypothyroidism, electrolyte abnormalities, sodium and water retention, infections, immunizations, ocular herpes simplex, myasthenia gravis, peptic ulcer disease, psychosis, renal insufficiency

    Thromboembolic disorders and myopathy may occur

    Delayed wound healing is possible

    Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated

    Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)

    Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy

    Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts and has been associated with development of Kaposi sarcoma

    Myopathy has been reported

    Pregnancy category: C

    Lactation: Unknown whether drug is excreted in milk; use with caution

    Adults

    Maintenance therapy usual max: 0.2 mg/day PO.

    Geriatric

    Maintenance therapy usual max: 0.2 mg/day PO.

    Adolescents

    Safety and efficacy have not been established, but doses of up to 0.3 mg/day PO have been used.

    Children

    Safety and efficacy have not been established, but doses of up to 0.3 mg/day PO have been used.

    Infants

    Safety and efficacy have not been established, but doses of up to 0.3 mg/day PO have been used.

    Neonates

    Safety and efficacy have not been established, but doses of up to 0.3 mg/day PO have been used.

    Fludrocortisone acetate

    tablet

    • 0.1mg