RT3-Adrenals HC dosing

Fludrocortisone is used to address a deficiency in the mineralocorticoid

• Fludrocortisone is started very low, 1/4 of a 0.1 mg tab, and titrated 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

• 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

doses of potassium are known

• 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

• Once taking fludrocortisone, it is not possible to accurately test

aldosterone and primarily symptoms such as salt craving, blood

pressure (particularly diastolic), electrolyte balance and repeating the

dosage; however, testing plasma renin activity may be helpful

• Bioidentical aldosterone instead of Florinef may be available from

Canadian and possibly Australian compounding pharmacies with a US

doctor's prescription, but at the time of this writing may not be available

in the U.S. It is also extremely expensive

• Blood pressure medications that are ACE (angiotensin-converting

enzyme) inhibitors will affect aldosterone