Fludrocortisone

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Fludrocortisone
Fludrocortisone structure.png
Fludrocortisone-from-xtal-1972-3D-balls.png
Clinical data
AHFS/Drugs.com Monograph
Pregnancy
category
  • C
Routes of
administration
by mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Protein binding High
Metabolism liver
Biological half-life 3.5 hours
Identifiers
Synonyms 9α-fluorocortisol, 9α-fluorohydrocortisone
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
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)

Dosing[edit]

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

Chemistry[edit]

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.

References[edit]

  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.