RT3-Adrenals HC dosing

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

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