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Fludrocortisone structure.png
Clinical data
AHFS/Drugs.com Monograph
  • C
Routes of
by mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Protein binding High
Metabolism liver
Biological half-life 3.5 hours
Synonyms 9α-fluorocortisol, 9α-fluorohydrocortisone
CAS Number
PubChem CID
ECHA InfoCard 100.004.395
Chemical and physical data
Formula C21H29FO5
Molar mass 380.45 g/mol
3D model (Jmol)
 NYesY (what is this?)  (verify)

Fludrocortisone, sold under the brand name Florinef among others, is a corticosteroid used to treat adrenogenital syndrome, postural hypotension, and adrenal insufficiency. In adrenal insufficiency it is generally taken together with hydrocortisone. It is taken by mouth.[1]

Common side effects include high blood pressure, swelling, heart failure, and low blood potassium. Other serious side effects include low immune system function, cataracts, muscle weakness, and mood changes.[1] It is unclear if use during pregnancy is safe for the baby.[2] Fludrocortisone is mostly a mineralocorticoid; however, also has glucocorticoid effects.[1]

Fludrocortisone was patented in 1953.[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[4] In the United Kingdom it costs the NHS about 1.52 pounds per month.[5] In the United States the wholesale cost of a month of medications is about 11.96 USD.[6]

Medical uses[edit]

Fludrocortisone has been used in the treatment of cerebral salt wasting syndrome.[7] It is used primarily to replace the missing hormone aldosterone in various forms of adrenal insufficiency such as Addison's disease and the classic salt wasting (21-hydroxylase deficiency) form of congenital adrenal hyperplasia. Due to its effects on increasing Na+ levels, and therefore blood volume, fludrocortisone is the first line of treatment for orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS).[8] It can be used to treat low blood pressure.

Fludrocortisone is also a confirmation test for diagnosing Conn's syndrome (aldosterone producing-adrenal adenoma), the fludrocortisone suppression test. Loading the patient with fludrocortisone would suppress serum aldosterone level in a normal patient, whereas the level will not be altered in a Conns patient.

Side effects[edit]

  • Sodium and water retention
  • Swelling due to fluid retention (edema)
  • High blood pressure (hypertension)
  • Headache
  • Low blood potassium level (hypokalemia)
  • Muscle weakness
  • Fatigue
  • Increased susceptibility to infection
  • Impaired wound healing
  • Increased sweating
  • Increased hair growth (hirsutism)
  • Thinning of skin and stretch marks
  • Disturbances of the gut such as indigestion (dyspepsia), distention of the abdomen and ulceration (peptic ulcer)
  • Decreased bone density and increased risk of fractures of the bones
  • Difficulty in sleeping (insomnia)
  • Depression
  • Weight gain
  • Raised blood sugar level
  • Changes to the menstrual cycle
  • Partial loss of vision due to opacity in the lens of the eye (cataracts)
  • Raised pressure in the eye (glaucoma)
  • Increased pressure in the skull (intracranial pressure)


Renin plasma, sodium, and potassium is checked through blood tests in order to verify that the correct dosage is reached.


Chemically, fludrocortisone is identical to cortisol except for the substitution of fluorine in place of one hydrogen. Fluorine is a good bioisostere for hydrogen because it is similar in size. The major difference is in its electronegativity.


  1. ^ a b c "Florinef Acetate". The American Society of Health-System Pharmacists. Retrieved 8 December 2016. 
  2. ^ "Fludrocortisone Use During Pregnancy | Drugs.com". www.drugs.com. Retrieved 24 December 2016. 
  3. ^ Fischer, Janos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 484. ISBN 9783527607495. 
  4. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016. 
  5. ^ British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 494. ISBN 9780857111562. 
  6. ^ "NADAC as of 2016-12-21 | Data.Medicaid.gov". Centers for Medicare and Medicaid Services. Retrieved 24 December 2016. 
  7. ^ Taplin CE, Cowell CT, Silink M, Ambler GR (December 2006). "Fludrocortisone therapy in cerebral salt wasting". Pediatrics. 118 (6): e1904–8. doi:10.1542/peds.2006-0702. PMID 17101713. 
  8. ^ Freitas J, Santos R, Azevedo E, Costa O, Carvalho M, Falcão de Freitas A (2000). "Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone". Clinical Autonomic Research. 10 (5): 293–299. doi:10.1007/BF02281112.