Fludrocortisone

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Fludrocortisone is used to address a deficiency in the mineralocorticoid
aldosterone (brand name Florinef is no longer manufactured).

Fludrocortisone Dosing
• Start very low at 1/4 of a 0.1 mg tab, and titrate up slowly at the rate
of 1/4 tab every ten to 14 days
  
• Most people need one to two tabs, but it is possible to need as much
as three
  
• When doses are above 3/4 tab, split morning and afternoon with a
larger dose in the morning

Potassium
• Fluodrocortisone moves sodium from serum into cells and this can
result in a wasting of potassium; it is important to have
sustained-release potassium on hand before beginning fludrocortisone
  
• Sodium and potassium must be tested before each increase to
ensure that potassium does not go below 4. Address lower levels with
sustained-release potassium
  
• Continue to test sodium and potassium every ten to 14 days until
necessary doses of potassium are known

Evaluating dosage
• Once taking fludrocortisone, it is not possible to accurately test
aldosterone
  
• Use symptoms such as salt craving, blood pressure (particularly
diastolic), and electrolyte balance
  
• Repeating the pupil and orthostatic hypotension tests can be used to
evaluate the dosage
  
• Testing plasma renin activity may be helpful

Bioidentical aldosterone
• Bioidentical aldosterone instead of Fludrocortisone may be available
from Canadian and possibly Australian compounding pharmacies with
a US doctor's prescription
  
• It may also be available in the U.S. through Dr. Jonathan Wright
and/or the Tahoma Clinic

Other considerations
• The action of aldosterone is primarily mineralocorticoid, but it does
have some of the glucocorticoid properties of cortisol. For those taking
HC, adding fludrocortisone may require a slight reduction in the HC
dose
  
• Blood pressure medications that are ACE (angiotensin-converting
enzyme) inhibitors will affect aldosterone