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Mineralocorticoid Pregnancy: C

Fludrocortisone

Brand names: Florinef

Adult dose

Dose: 50–200 micrograms once daily
Route: Oral
Frequency: Once daily in the morning
Addison's disease: usually 100 mcg OD with hydrocortisone. Postural hypotension: 100–200 mcg OD. Dose adjusted by electrolytes and blood pressure.

Clinical pearls

  • Tight mineralocorticoid with no anti-inflammatory activity at physiological doses
  • ALWAYS combine with hydrocortisone in Addison's disease (glucocorticoid replacement)
  • Dose adequacy measured by renin levels (suppressed = adequate), not cortisol
  • Sick day rules: increase hydrocortisone dose, NOT fludrocortisone during illness
  • Postural hypotension from autonomic neuropathy is another indication

Contraindications

  • Systemic fungal infections
  • Hypokalaemia (relative)
  • Hypertension not controlled

Side effects

  • Hypertension
  • Oedema
  • Hypokalaemia
  • Headache
  • Sodium retention
  • Suppression of HPA axis

Interactions

  • Loop/thiazide diuretics — additive hypokalaemia
  • NSAIDs — fluid retention
  • Digoxin — hypokalaemia increases toxicity

Monitoring

  • Blood pressure (supine and standing)
  • Serum sodium and potassium
  • Plasma renin activity (to guide dose)

Reference: Society for Endocrinology Addison's Guidelines; BNF. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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