fludrocortisone acetate

(Trade name: Florinef Acetate)

Translated and edited by: Joe Hing Kwok Chu

Characteristics: White or light yellow crystallized powder. It has no smell or taste. It is not water soluble. It is slightly soluble in alcohol or in formaldehyde.

Medical functions and uses:

It is a pharmaceutically produced adrenocortical steroid possessing very potent mineralocorticoid properties and high glucocorticoid activity.

The metabolism of sugar and anti inflammation function is 15 times of that of hydrocortisone, but the sodium retention is more than 100 times of that of hydrocortisone. It can be used for idiopathic type of adrenocortical hormone insufficiency together with other  glucocorticoid types of drugs. It can be used in postural hypotension caused by low renin and low aldosterone.  When taken orally, it  causes edema easily, so it is mainly used in external application for skin inflammation, and itchiness in anus and vulva areas.

Dosage:

adult oral dosage: 0.1~0.2 mg daily, divided into 2 doses a day. External application for the skin: 2~4 times a day.

Warning: use care for patients who are pregnant, or have liver diseases. The effectiveness of this drug can be lingering, so the dosage has to be lowered as needed to prevent excessive retention of sodium and water (edema), high blood pressure and hypokalemia. During this drug therapy, monitor the potassium and sodium levels and provide a low sodium and high potassium diet.

A glucocorticoid type of drug can lower the gama aminobutyric acid of the central nervous system, so it might cause the outbreak of seizures.  

It can cause excessive water retention, sodium retention, and hypokalemia, because of  the very potent mineralocorticoid properties of fludrocortisone acetate.

Long term usage of a glucocorticoid type of drug causes osteoporosis which can lead to compression of vertebrae, fractures and back problems, ulcers, memory impairment, loss of muscle mass, systemic yeast infection, psychic derangement, and cataracts.

Care should be used when using the digitalis group of drugs, like Digoxin with fludrocortisone acetate because of the risk of hypokalemia. In patients with hypokalemia, toxicity may occur even though the serum digoxin is within the normal range because  hypokalemia sensitizes the heart muscles to digoxin. Using diuretics to solve the water retention problem created by fludrocortisone acetate can also cause the depletion of potassium which might have the same effect on digoxin.

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