By Marcello Cherchi, MD PhD
For patients
Fludrocortisone is a medication that you take as a pill. It sometimes helps patients whose blood pressure switches between being too high and too low.
For clinicians
Overview
Fludrocortisone is thought to have glucocorticoid and mineralocorticoid mechanisms of action. It is used in the treatment of orthostatic hypotension.
Pharmacology
Fludrocortisone has glucocorticoid and mineralocorticoid effects. Specifically:
“Fludrocortisone acetate alters BP through a variety of mechanisms including mineralocorticoid-induced sodium and water retention. Fludrocortisone binds to the aldosterone receptor, which increases activity of the distal tubule of the kidney, causing enhanced sodium ion and water transport into the plasma, and increasing urinary excretion of potassium and hydrogen ions. Its effect on alleviating orthostatic hypotension is largely thought to be modulated through these actions” (Veazie et al. 2021)
Adverse effects
A commonly encountered adverse effect is supine hypertension.
Cautions and contraindications
Fludrocortisone should be tapered up and tapered down.
Relevance in otoneurology
Fludrocortisone is used in the management of orthostatic hypotension, though a Cochrane review concluded that the evidence in support of its efficacy is weak (Veazie et al. 2021).
Other notes
Fludrocortisone is sometimes used in conjunction with other medications in the management of orthostatic hypotension, such as midodrine.
References
Veazie S, Peterson K, Ansari Y, Chung KA, Gibbons CH, Raj SR, Helfand M (2021) Fludrocortisone for orthostatic hypotension. Cochrane Database Syst Rev 5: CD012868. doi: 10.1002/14651858.CD012868.pub2
