Adult Dosing
Adrenocortical insufficiency in Addison's disease
- 0.1 mg PO qd; dose range 0.1 mg 3 times/wk to 0.2 mg qd
- If transient hypertension occurs as a consequence of fludrocortisone therapy, reduce the dose to 0.05 mg/day
Note:
- Administer fludrocortisone tablets in conjunction with cortisone (10-37.5 mg daily in divided doses) or hydrocortisone (10-30 mg daily in divided doses)
Salt-losing forms of congenital adrenogenital syndrome
Postural hypotension [Non-FDA Approved]
- 0.1-0.4 mg PO daily
- Postural hypotension secondary to levodopa therapy: 0.05-0.2 mg PO qd
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Syncope [Non-FDA Approved]
See Supplemental Patient Information
- Corticosteroids may mask certain signs of infection, which results in decreased resistance and inability to localize infection
- Prolonged use may cause posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may potentiate the development of secondary ocular infections due to fungi or viruses
- Elevation of blood pressure, salt and water retention, and increased excretion of potassium and calcium may occur with average and large doses of fludrocortisone. Monitor serum electrolyte levels regularly during prolonged therapy; may require dietary salt restriction and potassium supplementation
- Administration of live virus vaccines, such as smallpox vaccines, is contraindicated in patients receiving immunosuppressive doses of fludrocortisone
- Children receiving drugs that suppress the immune system are more prone to infections than healthy children; avoid exposure of children or adults who have not suffered from chickenpox/measles. Start prophylaxis with varicella zoster immune globulin (VZIG) if exposed to chickenpox or measles and with pooled intravenous immunoglobulin (IVIG) if indicated
- Patients with latent tuberculosis or tuberculin reactivity treated with corticosteroids should be closely monitored, as reactivation of the disease may occur
- Avoid rapid withdrawal of the drug as it may cause secondary adrenocortical insufficiency; this may be minimized by gradually tapering the dose. Use the lowest effective dose to control the condition being treated
- Institute supportive dosage in stress situations such as trauma, surgery, or severe illness to avoid drug-induced adrenal insufficiency, both during therapy and for a year afterwards
- There may be an enhanced corticosteroid effect in patients with cirrhosis and those with hypothyroidism
- Psychic derangements, ranging from euphoria, insomnia, mood swings, and severe depression to frank psychotic manifestations, may occur during treatment; existing emotional instability or psychotic tendencies may be aggravated
Cautions: Use cautiously in
- Hepatic impairment
- Renal insufficiency
- Hypertension
- Congestive heart failure
- Diabetes mellitus
- Adrenal insufficiency
- Systemic viral or parasitic infections
- Ocular herpes simplex infections
- Seizure disorder
- Nonspecific ulcerative colitis
- Fluid and electrolyte imbalance
- Patients with a known hypersensitivity reaction
- Concurrent use of aspirin in hypoprothrombinemia patients
- Diverticulitis
- Fresh intestinal anastomoses
- Active or latent peptic ulcer
- Osteoporosis
- Myasthenia gravis
Supplemental Patient Information
- Advise patients about the need for regular follow-up visits to check their progress, and instruct them to promptly notify their physicians if any dizziness, severe or continuing headaches, swelling of the feet or lower legs, or unusual weight gain occurs
- Inform patients to carry medical identification indicating his/her dependence on steroid medication; and instruct them to carry an adequate dose of medication for use in emergencies
Pregnancy Category:C
Breastfeeding: Manufacturer advises caution when administered to a nursing woman.
US Trade Name(s)
US Availability
fludrocortisone (generic)
Canadian Trade Name(s)
Canadian Availability
Florinef
UK Trade Name(s)
UK Availability
Florinef
Australian Trade Name(s)
Australian Availability
Florinef