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Fludrocortisone (Florinef)

Orthostatic h
ypotension
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 (Van Lieshout et al, 2000; Watt
et al, 1981a; Chobanian, 1979a); (Holh et al, 1965).
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 (Van Lieshout et
al, 2000; Watt et al, 1981a; Chobanian, 1979a);
(Holh et al, 1965).
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.
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
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
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
hepatic impairment
Drug Interactions
midodrine
monitor BP: combo may incr. risk of supine HTN (additive effects)
Caution Advised
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