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Fludrocortisone
📘 About
- Always check the BNF entry for the most up-to-date prescribing advice.
- Fludrocortisone is a potent synthetic corticosteroid with strong mineralocorticoid activity and weak glucocorticoid activity.
- Used mainly for mineralocorticoid replacement and treatment of refractory postural hypotension.
⚙️ Mode of Action
- Binds to mineralocorticoid receptors in the kidney → increases Na⁺ reabsorption and K⁺/H⁺ excretion in the distal tubule.
- Results in expanded extracellular fluid volume, ↑ blood pressure, and improved vascular tone.
💊 Indications & Example Doses
- Addison’s disease (primary adrenal insufficiency): 50–300 micrograms PO daily (in addition to hydrocortisone for glucocorticoid replacement).
- Congenital adrenal hyperplasia: as above, tailored to electrolyte balance.
- Neurogenic / refractory postural hypotension: start 100 micrograms PO daily, titrate by 100 micrograms every 1–2 weeks to max 400 micrograms daily.
⚠️ Always titrate to clinical response and electrolytes. Higher doses increase risk of fluid overload and hypokalaemia.
🔀 Interactions
- See BNF for full list.
- Other corticosteroids → additive effects (fluid retention, hypertension).
- Potassium-wasting diuretics → ↑ risk of severe hypokalaemia.
- Antihypertensives → may blunt effect due to opposing mechanisms.
⚠️ Cautions
- Hypertension, heart failure, renal impairment.
- Diabetes mellitus (may worsen glycaemic control).
- Elderly (more susceptible to adverse effects).
- Monitor electrolytes and BP regularly.
🚫 Contraindications
- See BNF - generally avoid in systemic fungal infections and hypersensitivity to fludrocortisone.
💥 Side Effects
- Short-term: sodium and water retention, oedema, hypokalaemia, hypertension, headache.
- Long-term: osteoporosis, muscle weakness, immunosuppression, glucose intolerance, Cushingoid features.
📚 References
- BNF – Fludrocortisone
- NICE guidance – Postural Hypotension
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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