Mineralocorticoid Pregnancy: There is evidence of harmful effects in pregnancy in animals; there may be a small risk of cleft palate and intra-uterine growth retardation, and hypoadrenalism may occur in the neonate. A pregnancy may be continued in a woman requiring replacement mineralocorticoid therapy despite the risk to the foetus. Corticosteroids are found in breast milk - observe infants for signs of hypoadrenalism.

Fludrocortisone

Brand names: Florinef

Used in: Syncope

Fludrocortisone is a potent mineralocorticoid used (with a glucocorticoid) for replacement in adrenal insufficiency, and for some forms of postural (orthostatic) hypotension.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.05 mg to 0.3 mg daily

Route: Oral

Frequency: Once daily

Fludrocortisone acetate 0.05 mg tablets. Adults: daily dosage range of 0.05-0.3 mg orally. Supplementary parenteral administration of sodium-retaining hormones is not necessary. When an enhanced glucocorticoid effect is desirable, cortisone or hydrocortisone by mouth should be given concomitantly. Elderly: no specific dosage recommendations. Paediatric population (per SPC): one tablet (0.05 mg) to two tablets (0.1 mg) daily - fixed dose, not weight-based; caution on exposure to chickenpox, measles or other communicable diseases. Use the lowest effective dose for the minimum period and titrate against disease activity.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION Dosage depends on the severity of the disease and the response of the patient. Patients should be continually monitored for signs that indicate dosage adjustment is necessary, such as remission or exacerbations of the disease and stress (surgery, infection, trauma) (see WARNINGS and PRECAUTIONS, General ). Addison's Disease In Addison's disease, the combination of fludrocortisone acetate tablets with a glucocorticoid such as hydrocortisone or cortisone provides substitution therapy approximating normal adrenal activity with minimal risks of unwanted effects. The usual dose is 0.1 mg of fludrocortisone acetate tablets daily, although dosage ranging from 0.1 mg three …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-05-19. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Systemic infections unless specific anti-infective therapy is employed

Side effects

Hypokalaemia (very common); hypokalaemic alkalosis, decreased appetite (uncommon)
Cardiac failure congestive (very common); cardiomegaly (uncommon)
Hypertension (very common)
Oedema, swelling (common)
Headache (common); muscular weakness (common)

Interactions

Amphotericin B or potassium-depleting diuretics (benzothiadiazines, ethacrynic acid, furosemide) - enhanced hypokalaemia
Digitalis glycosides - enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalaemia
Oral anticoagulants - decreased prothrombin time response
Antidiabetic drugs (oral agents and insulin) - diminished antidiabetic effect
Barbiturates, phenytoin or rifampin - increased metabolic clearance of fludrocortisone acetate (hepatic enzyme induction)

Clinical monograph

How it works

It acts on mineralocorticoid receptors to promote renal sodium and water retention and potassium excretion, supporting blood pressure and electrolyte balance.

Prescribing in practice

Monitor for sodium and fluid retention (oedema, raised blood pressure) and for low potassium.
In adrenal insufficiency it is given alongside glucocorticoid replacement; do not omit doses during illness.
Dose is titrated to blood pressure, postural symptoms and electrolytes.

Monitoring

Monitor blood pressure (lying and standing), electrolytes (sodium and potassium) and for fluid overload.

Counselling the patient

Report ankle swelling, breathlessness or marked weakness.
If you have adrenal insufficiency, do not miss doses and seek advice when unwell.

Evidence & guidelines

Standard mineralocorticoid replacement in adrenal insufficiency and an option for orthostatic hypotension.

Reference: Society for Endocrinology Addison's Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Drugs

Fludrocortisone acetate · Mineralocorticoid

Pathways