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Florinef (fludrocortisone acetate) is a corticosteroid usually used to treat low glucocorticoid levels caused by disease of the adrenal gland. Off-label it is used to treat postural hypotension, and it may also be used for other purposes.

Florinef is a very potent medication, as can be seen with its small dosage amounts of 0.1 mg. Patients are advised to consult a doctor prior to administration and follow doctor instructions carefully throughout treatment.

Treating Low Glucocorticoid Levels

Glucocorticoids are vital for a happy, healthy life; they help with a wide range of body functions, including:

• Balancing salt and water levels
• Maintaining healthy blood pressure
• Breaking down protein, fats and carbohydrates
• Responding to stress
• Controlling inflammation
• Maintaining cardiovascular health
• Numerous other functions

Though relatively rare, there are several conditions which can influence the natural occurrence of glucocorticoids in the body, such as Addison's disease, adrenocortical insufficiency, salt-losing adrenogenital syndrome, or others. Many of these conditions can appear at any age, and are often associated with autoimmune disorders or long-lasting diseases, such as tuberculosis or cancer. If severe enough, the condition can have a dramatically negative effect on life, perhaps even ending it.

Florinef can counter the effects of the condition, and it will likely be prescribed---along with hydrocortisone or cortisone---if one of these conditions does develop.

The medication comes in tablets, and treatment can be a little tricky. Doctor instructions may deviate from the guidelines below, and doctor instructions should be followed. In general:

• Patients are started on 0.1 mg Florinef per day. This is adequate for most patients.
• Some patients may be increased to 0.2 mg per day.
• Other patients will be reduced to 0.1 mg three times per week.
• Patients with hypertension will be reduced to 0.05 mg per day.

If taking with cortisone or hydrocortisone, as will likely be the case, dosage for those medications is generally:

• Hydrocortisone - 10 mg to 30 mg per day, divided into two doses.
• Cortisone - 10 mg to 37.5 mg per day, divided into two doses.

Treatment can continue for as long as it provides benefit, and as long as no adverse reactions develop. Patients taking Florinef will need to attend regular doctor checkups---particularly at the start of treatment---to ensure the medication is working correctly and to monitor for developing side effects.

Treating Postural Hypotension

This is an off-label use of Florinef and results can be somewhat variable, perhaps because the dosage advised is relatively variable. In addition, the amount of salt and fluid in a patient's diet can influence effects.

As a rough guideline:

• Patients start with 0.1 mg per day.
• Dosage may be increased by 0.1 mg per week, up to 1 mg per day.
• Most patients find more than 0.3 mg per day provides no significant benefit.

Treatment here may continue for as long as it provides benefit as well. Many patients stop taking the medication around the 6-month mark due to adverse effects, though others continue taking it with little to no adverse reactions.

Warnings & Adverse Reactions

Florinef should not be taken by anyone with a systemic fungal infection.

Florinef can mask the symptoms of other conditions, worsen other conditions, and alter lab screenings; it's important that the prescribing doctor is aware of any other medical condition present, from diabetes or blood clots to mental/mood disorders.

Elderly patients may be more at risk of experiencing side effects and may require closer monitoring.

Children taking Florinef---or any corticosteroid---long-term may be at risk for stunted growth.

Most side effects are relatively mild, including stomach upset, infrequent headaches, and irregular menstruation. Less commonly, though, more serious side effects develop, which call for medical attention:

• Severe or continuous headache
• Rapid, irregular, or slow heartbeat
• Pain or redness in the eyes
• Vision changes
• Mental/mood changes
• Seizures
• Blood in stools or vomit

Florinef can impact how well the immune system works. Do not have immunizations/vaccinations during treatment, and avoid those who have recently had them. Take care to avoid other scenarios in which infection is likely.