HWN Suggests

Florinef, Oh Florinef, How I Love Thee...

When I started the drug, I was told it would take a few weeks before I noticed any difference, and that it could take up to 6 months to get the full benefit. However, I started feeling better within 48 hours. I had such low aldosterone when they started me on it, and was having such low BP at the time that I thought I was going to die. I was 80/30 laying down flat with my feet elevated, and they couldn't even get a BP reading on me if I stood up - because I would either pass out or it would be so low the BP machine couldn't detect it. Within 48 hours of starting the Flourinef, I felt like someone had plugged in my battery and given me some juice. I contiuned to improve and feel better…

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Articles of Interest

Concise Critical Appraisal: Hydrocortisone and Fludrocortisone Versus Hydrocortisone Only

Is hydrocortisone for septic shock best used alone or in combination with fludrocortisone? This Concise Critical Appraisal explores a retrospective cohort study that found that treatment with hydrocortisone plus fludrocortisone led to lower rates of mortality or discharge to hospice, hospital deaths, and fewer days on vasopressors than treatment with hydrocortisone alone.

Florinef (Fludrocortisone) for Chronic Fatigue Syndrome (ME/CFS)

Florinef is.. a synthetically produced analogue of aldosterone – an adrenal corticosteroid that plays a key role in regulating blood volume and blood pressure. It’s often used to treat neurally mediated hypotension (reduced blood pressure when standing) and POTS (increased heart rate when standing) as well as low blood volume. It’s the only drug to receive significant testing in chronic fatigue syndrome (ME/CFS) patients with orthostatic intolerance. Fludrocortisone’s ability to decrease HPA activity (ACTH and cortisol) should be noted given that ME/CFS is characterized by at least mildly reduced HPA axis activity.

Fludrocortisone

Fludrocortisone is a mineralocorticoid that can cause sodium and thus water resorption for patients who have orthostatic hypotension, including neurogenic orthostatic hypotension. It has also been considered useful in some instances of vasovagal syncope and, perhaps, postural orthostatic tachycardia syndrome. The drug has not been rigorously tested for the latter conditions. Nevertheless, because there are few drugs that are effective for these particular conditions, fludrocortisone may be tried when other drugs have not been effective or even as an initial therapy.

Fludrocortisone - why it is prescribed and different brands

Here we explain more about why there are now new brands of fludrocortisone available on the market and the impact of tablet splitting and scoring lines on the new brand Mylan.

Fludrocortisone for orthostatic hypotension

Fludrocortisone is considered the first‐ or second‐line pharmacological therapy for orthostatic hypotension alongside mechanical and positional measures such as increasing fluid and salt intake and venous compression methods. However, there has been no Cochrane Review of the benefits and harms of this drug for this condition.

Why Salt?

As well as fludrocortisone, it is sometimes necessary to prescribe salt tablets for people, known as ‘slow sodium’ tablets. However, each slow sodium tablet contains only 0.6g (600mg) of salt, meaning that to get to the basic ‘RDA’ you need to take ten per day (of course we mostly get more than the RDA from our food alone).

Resources

StatPearls

Normally prescribed for adrenocortical insufficiency, its versatile off-label applications extend to managing orthostatic hypotension and postural orthostatic tachycardia syndrome.