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Side Effects of Florinef (fludrocortisone)
Florinef (fludrocortisone) is a potent corticosteroid used for partial replacement therapy in primary and secondary adrenocortical insufficiency in Addison’s disease and salt-losing adrenogenital syndrome.
Derived from hydrocortisone, Florinef has stronger and longer-lasting effects on electrolyte balance and carbohydrate metabolism.
Florinef mimics aldosterone, a naturally produced steroid, in its physiological effects.
Small oral doses of Florinef increase blood pressure, retain sodium, and excrete urinary potassium. Larger doses inhibit adrenal gland hormone secretion.
Common side effects of Florinef include:
- fluid retention
- high blood pressure
- mood or psychiatric disorders
- headache
- trouble sleeping
- skin problems
- endocrine disorders
- high blood sugar (hyperglycemia)
- hypokalemia (low potassium)
- growth suppression
- upset stomach
- stomach ulcers
- muscle weakness
- eye problems
- sweating
Serious side effects of Florinef include:
- heart problems
- osteoporosis
- fractures
- increased risk of infections
Drug interactions include antacids and bile acid sequestrants, which may decrease oral corticosteroid absorption.
- Oral corticosteroids may decrease diabetes medication effectiveness.
- Medications that may decrease corticosteroid blood levels include barbiturates, isoniazid, and others.
- Medications that may increase corticosteroid blood levels include aprepitant, strong CYP3A4 inhibitors, estrogen derivatives, mifepristone, and others.
- Corticosteroids may increase the risk of adverse effects from live vaccines.
The effect of Florinef on pregnancy and breastfeeding is unclear.
Important side effects of Florinef (fludrocortisone)
Reported side effects include:
- heart problems
- fluid retention
- high blood pressure
- mood or psychiatric disorders
- headache
- trouble sleeping
- skin problems
- endocrine disorders
- hyperglycemia
- hypokalemia (low potassium)
- growth suppression
- upset stomach
- stomach ulcers
- muscle weakness
- osteoporosis
- fractures
- eye problems
- sweating
Fludrocortisone may increase the risk of infections.
Florinef (fludrocortisone) side effects for healthcare professionals
Most adverse reactions are caused by the drug’s mineralocorticoid activity and include:
- hypertension
- edema
- cardiac enlargement
- congestive heart failure
- potassium loss
- hypokalemic alkalosis
When used in recommended dosages, Florinef typically avoids glucocorticoid side effects. However, the following effects should be considered, especially with prolonged use or in combination with cortisone or similar glucocorticoids:
- Musculoskeletal-muscle weakness, loss of muscle mass, osteoporosis, fractures
- Gastrointestinal-peptic ulcer, pancreatitis, abdominal distention, ulcerative esophagitis
- Dermatologic-impaired wound healing, thin fragile skin, bruising, petechiae and ecchymoses, facial erythema, increased sweating, subcutaneous fat atrophy, purpura, striae, hyperpigmentation, hirsutism, acneiform eruptions, hives
- Neurological-convulsions, increased intracranial pressure, vertigo, headache, mental disturbances
- Endocrine-menstrual irregularities, cushingoid state, growth suppression, adrenal and pituitary unresponsiveness, decreased carbohydrate tolerance, diabetes mellitus, increased insulin requirements
- Ophthalmic-posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos
- Metabolic-hyperglycemia, glycosuria, negative nitrogen balance
- Allergic Reactions-skin rash, urticaria
Other adverse reactions may include:
- necrotizing angiitis
- thrombophlebitis
- aggravation or masking of infections
- insomnia
- syncopal episodes
- anaphylactoid reactions
Drug interactions with Florinef (fludrocortisone)
The following drugs may interact with adrenal corticosteroids:
- Amphotericin B or potassium-depleting diuretics-enhanced hypokalemia. Monitor serum potassium levels; use supplements if necessary.
- Digitalis glycosides-enhanced possibility of arrhythmias or digitalis toxicity. Monitor serum potassium levels; use supplements if necessary.
- Oral anticoagulants-decreased prothrombin time response. Monitor prothrombin levels; adjust dosage accordingly.
- Antidiabetic drugs-diminished antidiabetic effect. Monitor for hyperglycemia symptoms; adjust dosage if necessary.
- Aspirin-increased ulcerogenic effect; decreased pharmacologic effect. Monitor therapeutic effect; adjust dosage if needed.
- Barbiturates, phenytoin, or rifampin-increased metabolic clearance of fludrocortisone acetate. Observe for diminished steroid effect; increase dosage accordingly.
- Anabolic steroids-enhanced edema tendency. Use caution, especially in patients with hepatic or cardiac disease.
- Vaccines-neurological complications and lack of antibody response.
- Estrogen-increased corticosteroid-binding globulin levels; adjust corticosteroid dosage when initiating or terminating estrogen therapy.
Drug/Laboratory Test Interactions
- Corticosteroids may affect the nitrobluetetrazolium test for bacterial infection and produce false-negative results.
Summary
Florinef (fludrocortisone) is a potent corticosteroid used for partial replacement therapy in primary and secondary adrenocortical insufficiency in Addison’s disease and salt-losing adrenogenital syndrome. Common side effects of Florinef include fluid retention, high blood pressure, mood or psychiatric disorders, headache, trouble sleeping, skin problems, endocrine disorders, high blood sugar (hyperglycemia), hypokalemia (low potassium), growth suppression, upset stomach, stomach ulcers, muscle weakness, eye problems, and sweating. Its effect on pregnancy and breastfeeding is unknown, but corticosteroids are excreted in breast milk.
