Fludrocortisone

Fludrocortisone Brand Name– Florinef

What is Fludrocortisone

Fludrocortisone is an oral synthetic adrenocortical steroid derived from the substitution of a 9alpha-fluoride on the B ring of hydrocortisone.

Fluorination at this position gives rise to potent mineralocorticoid activity. Pharmacologic actions are similar to those of aldosterone, an endogenous mineralocorticoid.

The sodium-retaining activity of fludrocortisone is extremely high compared with other adrenocorticoids such as hydrocortisone.

Although fludrocortisone has significant glucocorticoid activity, it has no appreciable glucocorticoid effects at usual therapeutic doses.

Fludrocortisone is used as mineralocorticoid replacement therapy in patients with adrenocortical insufficiency and salt-losing adrenogenital syndrome.

Fludrocortisone was approved by the FDA in 1954.

Indications

1. Addison’s disease
2. adrenocortical insufficiency
3. adrenogenital syndrome
4. neurogenic orthostatic hypotension

For the treatment of primary and secondary adrenocortical insufficiency in Addison’s disease and salt-losing adrenogenital syndrome

NOTE: Dosage depends on disease severity and patient response. Close monitoring is necessary for signs indicating possible dosage adjustment such as remissions or exacerbations of the disease and stressors like surgery, infection, or trauma.

NOTE: All classic congenital adrenal hyperplasia patients should be treated with fludrocortisone at diagnosis in the newborn period

Side Effects

1. anorexia
2. blurred vision
3. candidiasis
4. cataracts
5. edema
6. exophthalmos
7. headache
8. heart failure
9. hypertension
10. hypokalemia
11. immunosuppression
12. increased intracranial pressure
13. infection
14. metabolic alkalosis
15. muscle cramps
16. nausea
17. neutropenia
18. ocular hypertension
19. ocular infection
20. optic neuritis
21. orthostatic hypotension
22. papilledema
23. pseudotumor cerebri
24. QT prolongation
25. retinopathy
26. sinus tachycardia
27. ST-T wave changes
28. visual impairment
29. vomiting
30. weakness
31. weight gain

Monitoring Parameters

• blood glucose
• blood pressure
• serum electrolytes
• weight

Contraindications

• breast-feeding
• cardiac disease
• cataracts
• children
• coagulopathy
• corticosteroid hypersensitivity
• Cushing’s syndrome
• diabetes mellitus
• diverticulitis
• fungal infection
• geriatric
• GI disease
• heart failure
• hepatic disease
• herpes infection
• hypertension
• hypothyroidism
• infants
• infection
• lactase deficiency
• measles
• myasthenia gravis
• myocardial infarction
• osteoporosis
• pregnancy
• psychosis
• renal disease
• seizure disorder
• surgery
• tuberculosis
• ulcerative colitis
• vaccination
• varicella

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