Fludrocortisone (Florinef) Pharmacology

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist

Education, Health & Fitness, Medicine

5 • 716 Ratings

🗓️ 6 November 2025

⏱️ 15 minutes

🔗️ Recording | iTunes | RSS

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Summary

On this podcast episode, I cover fludrocortisone. Fludrocortisone is a synthetic corticosteroid with potent mineralocorticoid activity and minimal glucocorticoid effects. It works primarily by promoting sodium reabsorption and potassium excretion in the distal renal tubules, leading to increased water retention and expansion of extracellular fluid volume. This pharmacologic action helps maintain blood pressure and electrolyte balance.

Fludrocortisone is most commonly indicated for the treatment of adrenocortical insufficiency, such as Addison’s disease, and for managing orthostatic hypotension by enhancing vascular tone and volume status.

Adverse effects are typically related to its mineralocorticoid potency and may include hypertension, edema, hypokalemia, and weight gain. Long-term use can also lead to complications such as heart failure exacerbation, osteoporosis, and mood changes. Because of its sodium-retaining effects, careful monitoring of blood pressure, electrolytes, and signs of fluid overload is recommended during therapy.

Transcript

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0:00.0	Hey, all, welcome back to the Real Life Pharmacology podcast. I'm your host,
0:04.1	pharmacist Eric Christensen. Thank you so much for listening today. As always, if you want
0:09.6	updates when we've got new podcasts available, as well as you can get your digital hands,
0:17.0	if you will, on a free 31-page PDF. I've got that on the top 200 drugs. Definitely a no-brainer.
0:24.7	Lots of stuff on there that will show up on board exams and pharmacology exams throughout your
0:30.3	career. Tons of stuff on there, too, that you'll actually see in clinical practice. So,
0:35.7	definitely a no-brainer to go snag that 31-page PDF on the top 200 drugs.
0:40.8	Simply an email will get you access to that. All right, the drug of the day today is flutri-corrhizone.
0:49.3	Brand name of this medication is Florinef. This is a mineral corticoid. It's a synthetic corticosteroid with
0:59.8	stronger mineral corticoid activity and weak glucocorticoid activity. So we think of, you know,
1:09.8	comparing this to a medication like prednisone.
1:13.1	Prednisone's much, much stronger on the glucocorticoid activity. So again, kind of a varying range here.
1:22.9	Mechanistically, flugure cortisone, the biggest effect that it's going to have in relation to its
1:30.6	indication is that it mimics aldosterone.
1:35.4	And if you remember a medication like spiroin lactone, if you don't go back and listen to it
1:41.2	on a previous podcast, spironal lactone is an aldosterone antagonist.
1:46.5	So if you have spironylactone and its effects memorized,
1:50.8	you can anticipate that fludricortosone is going to do the opposite.
1:56.1	So this medication mimics aldosterone where spirylactone blocks the action of aldosterone.
2:04.2	So fluidicortosone, what does it do?
2:07.0	So it mimics elastron and physiologically what's going to happen is that's going to promote sodium reabsorption.
2:16.6	And it also promotes potassium excretion in the kidney.
	...

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