fludrocortisone (floo-droe-kor-ti-sone) Florinef

 Indications

Sodium loss and hypotension associated with adrenocortical

insufficiency (given with hydrocortisone or

cortisone). Management of sodium loss due to congenital

adrenogenital syndrome (congenital adrenal hyperplasia).

Unlabeled Use: Idiopathic orthostatic hypotension

(with increased sodium intake). Type IV renal

tubular acidosis.

Action

Causes sodium reabsorption, hydrogen and potassium

excretion, and water retention by its effects on the distal

renal tubule. Therapeutic Effects: Maintenance of sodium balance and BP in patients with adrenocortical

insufficiency.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed; probably enters

breast milk.

Protein Binding: High.

Metabolism and Excretion: Mostly metabolized

by the liver.

Half-life: 3.5 hr.

TIME/ACTION PROFILE (mineralocorticoid

activity)

ROUTE ONSET PEAK DURATION

PO unknown unknown 1–2 days

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: HF; Addison’s disease (patients

may have exaggerated response); OB, Lactation, Pedi:

Safety not established.

Adverse Reactions/Side Effects

CNS: dizziness, headache. CV: HF, arrhythmias,

edema, hypertension. GI: anorexia, nausea. Endo:

adrenal suppression, weight gain. F and E: hypokalemia,

hypokalemic alkalosis. MS: arthralgia, muscular

weakness, tendon contractures. Neuro: ascending paralysis.

Misc: hypersensitivity reactions.

Interactions

Drug-Drug: Use with thiazide or loop diuretics,

piperacillin, or amphotericin B mayqrisk of hypokalemia.

Hypokalemia mayqrisk of digoxin toxicity.

May produce prolonged neuromuscular blockade following

the use of nondepolarizing neuromuscular

blocking agents. Phenobarbital or rifampin may

qmetabolism andpeffectiveness.

Drug-Food: Large amounts of salt or sodium-containing

foods may cause excessive sodium retention

and potassium loss.

Route/Dosage

PO (Adults): Adrenocortical insufficiency—100

mcg/day (range 100 mcg 3 times weekly—200 mcg

daily). Doses as small as 50 mcg daily may be required

by some patients. Use with 10–37.5 mg cortisone daily

or 10–30 mg hydrocortisone daily. Adrenogenital

syndrome—100–200 mcg/day. Idiopathic hypotension—

50–200 mcg/day (unlabeled).

PO (Children): 50–100 mcg/day.

Availability (generic available)

Tablets: 100 mcg (0.1 mg).