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Mineralocorticoid

Fludrocortisone acetate

Brand names: Florinef

Used in: Syncope

A synthetic corticosteroid with potent mineralocorticoid activity, used mainly for mineralocorticoid replacement in adrenal insufficiency (such as Addison's disease and salt-losing congenital adrenal hyperplasia) and for orthostatic hypotension.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Fludrocortisone activates renal mineralocorticoid receptors to promote sodium and water retention and potassium excretion, restoring electrolyte and volume balance.

Prescribing in practice

  • The most important safety point is mineralocorticoid excess causing sodium and fluid retention, hypertension, oedema, and hypokalaemia, which require monitoring and dose adjustment.
  • It is used alongside glucocorticoid replacement in adrenal insufficiency and does not replace the need for stress-dose glucocorticoid cover during illness.
  • Effects may be potentiated or opposed by drugs affecting potassium or fluid balance, including diuretics and NSAIDs.

Monitoring

Monitor blood pressure, serum electrolytes (especially sodium and potassium), and signs of fluid overload, adjusting dose accordingly.

Counselling the patient

  • Do not stop this medicine suddenly and carry steroid emergency information at all times.
  • Report ankle swelling, breathlessness, or significant weight gain.
  • Continue your separate glucocorticoid and follow sick-day rules during illness.

Evidence & guidelines

Fludrocortisone is the standard mineralocorticoid replacement in primary adrenal insufficiency as set out in endocrine society guidance.

Reference: Endocrine Society guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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