Fludrocortisone

Mineralocorticoid·Endocrinology - Systemic Corticosteroids

Mineralocorticoid replacement in Addison's disease, salt-losing adrenogenital syndrome

Authority requiredPBSSTEROIDFlorinef0.1 mg tablet+2

Max Dose

0.3 mg/day

Half-life

18-36 h

Hypokalemia

CRITICAL RISK

Fluid Retention

POTENT

Rapid Summary

Overview

A purely synthetic mineralocorticoid. Has virtually zero anti-inflammatory effect but is incredibly potent at retaining sodium and water. Acts as a synthetic aldosterone.

Maximum Dose

Max 0.3 mg/day (Usually 0.1 mg/day).

Clinical Focus

Drastically dumps potassium into the urine. Hypokalemia is virtually guaranteed without monitoring or dietary adjustments.

Bottom Line

Fludrocortisone is the only available mineralocorticoid for adrenal insufficiency and orthostatic hypotension, but causes sodium retention and hypokalaemia requiring electrolyte monitoring.

Formulation & Access

Brand Names

Florinef

Oral Routes

Tablets (0.1 mg = 100 mcg). MUST be kept refrigerated.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Mineralocorticoid replacement in Addison's disease, salt-losing adrenogenital syndrome.

Off-Label

OFF

Severe refractory orthostatic hypotension, POTS.

Clinical Place

Mandatory daily life-support drug for patients whose adrenal glands are destroyed (Addison's) and cannot make aldosterone.

Quick reference

Class & Role

Mineralocorticoid — A purely synthetic mineralocorticoid.

Route / Formulation

Tablets (0.1 mg = 100 mcg). MUST be kept refrigerated. (Florinef)

Usual Dose & Max

PO 0.05 - 0.1 mg OD (Given alongside Hydrocortisone). Max 0.3 mg/day (Usually 0.1 mg/day).

Key Indication Doses

Addison's Disease (Primary Adrenal Failure): PO 0.05 - 0.1 mg OD (Given alongside Hydrocortisone). Postural Hypotension / Dysautonomia: PO 0.1 - 0.2 mg OD (Off-label, used to expand blood volume).

Best Uses

Fludrocortisone is the only available mineralocorticoid for adrenal insufficiency and orthostatic hypotension, but causes sodium retention and hypokalaemia requiring electrolyte monitoring.

Avoid / Cautions

Uncontrolled hypertension, congestive heart failure.

Key Risks

Metabolic: Severe hypokalemia (leading to fatal arrhythmias). HIGH — Fluid retention, severe edema, rapid weight gain, hypernatremia. Cardiovascular: Severe hypertension, heart failure exacerbation (due to volume overload).

Key Interactions

Potassium-wasting diuretics (Frusemide, Thiazides) will cause catastrophic, synergistic hypokalemia. Digoxin (Toxicity skyrockets due to the fludrocortisone-induced hypokalemia).

Monitoring

Strict, regular U&E monitoring (Potassium). Monitor BP and daily Weight to track fluid overload.

Clinical Pearl

Fludrocortisone is notoriously unstable at room temperature. It MUST be stored in the fridge. If a patient keeps it in their bathroom cabinet, the drug will degrade, their blood pressure will crash, and they will present in an Addisonian crisis.

Access

Authority requiredFlorinef0.1 mg tablet

Brand: Florinef
PBS status: Authority required
Formulation: Tablets (0

Fludrocortisone

Mineralocorticoid·Endocrinology - Systemic Corticosteroids

Mineralocorticoid replacement in Addison's disease, salt-losing adrenogenital syndrome

Authority requiredPBSSTEROIDFlorinef0.1 mg tablet+2

Max Dose

0.3 mg/day

Half-life

18-36 h

Hypokalemia

CRITICAL RISK

Fluid Retention

POTENT

Rapid Summary

Overview

A purely synthetic mineralocorticoid. Has virtually zero anti-inflammatory effect but is incredibly potent at retaining sodium and water. Acts as a synthetic aldosterone.

Maximum Dose

Max 0.3 mg/day (Usually 0.1 mg/day).

Clinical Focus

Drastically dumps potassium into the urine. Hypokalemia is virtually guaranteed without monitoring or dietary adjustments.

Bottom Line

Fludrocortisone is the only available mineralocorticoid for adrenal insufficiency and orthostatic hypotension, but causes sodium retention and hypokalaemia requiring electrolyte monitoring.

Formulation & Access

Brand Names

Florinef

Oral Routes

Tablets (0.1 mg = 100 mcg). MUST be kept refrigerated.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Mineralocorticoid replacement in Addison's disease, salt-losing adrenogenital syndrome.

Off-Label

OFF

Severe refractory orthostatic hypotension, POTS.

Clinical Place

Mandatory daily life-support drug for patients whose adrenal glands are destroyed (Addison's) and cannot make aldosterone.

Quick reference

Class & Role

Mineralocorticoid — A purely synthetic mineralocorticoid.

Route / Formulation

Tablets (0.1 mg = 100 mcg). MUST be kept refrigerated. (Florinef)

Usual Dose & Max

PO 0.05 - 0.1 mg OD (Given alongside Hydrocortisone). Max 0.3 mg/day (Usually 0.1 mg/day).

Key Indication Doses

Addison's Disease (Primary Adrenal Failure): PO 0.05 - 0.1 mg OD (Given alongside Hydrocortisone). Postural Hypotension / Dysautonomia: PO 0.1 - 0.2 mg OD (Off-label, used to expand blood volume).

Best Uses

Fludrocortisone is the only available mineralocorticoid for adrenal insufficiency and orthostatic hypotension, but causes sodium retention and hypokalaemia requiring electrolyte monitoring.

Avoid / Cautions

Uncontrolled hypertension, congestive heart failure.

Key Risks

Key Interactions

Potassium-wasting diuretics (Frusemide, Thiazides) will cause catastrophic, synergistic hypokalemia. Digoxin (Toxicity skyrockets due to the fludrocortisone-induced hypokalemia).

Monitoring

Strict, regular U&E monitoring (Potassium). Monitor BP and daily Weight to track fluid overload.

Clinical Pearl

Access

Authority requiredFlorinef0.1 mg tablet

Brand: Florinef
PBS status: Authority required
Formulation: Tablets (0