Florinef

Flor·i·nef (flôr-nf)

A trademark for the drug fludrocortisone acetate.

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fludrocortisone acetate

Florinef (UK), Florinef Acetate

Pharmacologic class: Adrenocorticoid

Therapeutic class: Synthetic mineralocorticoid and glucocorticoid

Pregnancy risk category C

Action

Acts on renal distal tubule, increasing sodium reabsorption and potassium excretion

Availability

Tablets: 0.1 mg

⊘Indications and dosages

➣ Addison's disease (adrenocortical insufficiency)

Adults: 0.1 mg P.O. daily

➣ Salt-losing adrenogenital syndrome

Adults: 0.1 to 0.2 mg P.O. daily

Off-label uses

• Hyponatremia
• Severe orthostatic hypotension

Contraindications

• Hypersensitivity to drug, tartrazine (some products), or sulfites (some products)
• Systemic fungal infection

Precautions

Use cautiously in:
• cardiovascular disease, cirrhosis, diverticulitis, ulcerative colitis, peptic ulcer, renal insufficiency, hypertension, myasthenia gravis, adrenal insufficiency
• pregnant or breastfeeding patients.

Administration

• Know that typical dosage may range from 0.1 mg three times weekly to 0.2 mg daily.
• Give with food to reduce GI upset.
☞ Reduce dosage, as ordered, if transient hypertension develops.
☞ Avoid abrupt discontinuation. Taper dosage gradually when withdrawing.

Route	Onset	Peak	Duration
P.O.	Variable	2 hr	1-2 days

Adverse reactions

CNS: headache, vertigo, seizures

CV: hypertension, cardiac hypertrophy, increased blood volume, heart failure

GU: glycosuria

Metabolic: hypernatremia, hypokalemia, hyperglycemia

Musculoskeletal: joint pain, tendon contractures, arm and leg weakness

Skin: urticaria, allergic rash, bruising, diaphoresis

Other: edema, infection, impaired wound healing, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Amphotericin B, potassium-depleting diuretics: enhanced hypokalemia

Anabolic steroids: increased risk of edema

Aspirin: increased ulcerogenic effect; decreased pharmacologic effect of aspirin; rarely, salicylate toxicity (in patients who discontinue fludrocortisone after concurrent high-dose aspirin therapy)

Barbiturates, phenytoin, rifampin: decreased fludrocortisone effects

Cardiac glycosides: increased risk of arrhythmias or digitalis toxicity associated with hypokalemia

Estrogen: increased risk of toxicity

Insulin, oral hypoglycemics: decreased hypoglycemic effect

Oral anticoagulants: decreased prothrombin time

Drug-diagnostic tests. Cholesterol, urine glucose: increased levels

Nitroblue tetrazolium test (for bacterial infection): false-negative result

Potassium, thyroxine, thyroid hormones: decreased levels

Drug-food. Sodium-containing foods: increased blood pressure

Drug-herbs . Echinacea: antagonism of fludrocortisone's immunosuppressive effect

Patient monitoring

☞ Monitor blood pressure. Report hypertension immediately.
• Assess for serious adverse reactions, particularly hypersensitivity and cardiovascular problems.
• Monitor sodium, potassium, and glucose levels carefully.
• Assess for signs and symptoms of infection.
• Weigh patient daily; report sudden gain.

Patient teaching

• Tell patient to take with meals or snack to minimize GI upset.
☞ Caution patient on long-term therapy not to stop taking drug abruptly.
• Advise patient on long-term therapy to wear or carry identification stating that he is receiving this drug.
☞ Teach patient to recognize and immediately report signs and symptoms of adrenal insufficiency (fatigue, appetite loss, nausea, vomiting, diarrhea, weight loss, weakness, dizziness, and low blood glucose level).
• Advise patient to consume a diet low in sodium and high in potassium and protein.
• Tell female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.