Section 03 · Monograph
Fludrocortisone
Reviewed Nov 2026FDA label
FlorinefMineralocorticoid
- Forms
- Tab: 0.1mg
- Dose
- 0.1-0.3mg/day (off-label, neurogenic orthostatic hTN)
- MOA
- ↑Na+ retention and plasma volume
Indications
- Addison disease and salt-losing adrenogenital syndrome (FDA-labeled)FDA-labeled
Off-Label Uses
- Neurogenic orthostatic hypotension (Parkinson's disease, multiple system atrophy, pure autonomic failure)Off-label
Mechanism of Action
- Synthetic mineralocorticoid that promotes renal sodium retention and plasma volume expansion; may also sensitize vascular alpha-adrenergic responses
Full Dosing
Adult / usual
- Neurogenic orthostatic hypotension (off-label): start 0.1mg daily; increase by 0.1mg as tolerated to a maximum of about 0.3mg/day
- Take in the morning; liberalize salt and fluids as appropriate
- Watch for supine hypertension
Contraindications
- Systemic fungal infections
- Known hypersensitivity
Drug Interactions
- Diuretics and amphotericin B: additive hypokalemia
- Hypokalemia increases digoxin toxicity
- Phenytoin and rifampin increase clearance
Adverse Effects
- Hypokalemia and edema
- Supine hypertension
- Headache
- Heart failure exacerbation
- Adrenal suppression
Monitoring Parameters
- Potassium
- Supine and standing blood pressure
- Edema, weight and cardiac status
Pregnancy & Lactation
- Limited data; use if benefit justifies risk
- Small amounts in milk