Fludrocortisone

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Fludrocortisone
Systematic (IUPAC) name
9-fluoro-11,17-dihydroxy-17- (2-hydroxyacetyl)- 10,13-dimethyl- 1,2,6,7,8,9,10,11,12, 13,14,15,16,17- tetradecahydrocyclopenta[a]phenanthren-3-one
Clinical data
AHFS/Drugs.commonograph
Pregnancy cat.C
Legal status ?
RoutesOral
Pharmacokinetic data
Protein bindingHigh
MetabolismHepatic
Half-life3.5 hours
Identifiers
CAS number127-31-1 YesY
ATC codeH02AA02
PubChemCID 31378
IUPHAR ligand2873
DrugBankDB00687
ChemSpider29111 YesY
UNIIU0476M545B YesY
KEGGD07967 YesY
ChEBICHEBI:50885 YesY
ChEMBLCHEMBL1201388 N
Chemical data
FormulaC21H29FO5 
Mol. mass380.45 g/mol
 N (what is this?)  (verify)
 
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Fludrocortisone
Systematic (IUPAC) name
9-fluoro-11,17-dihydroxy-17- (2-hydroxyacetyl)- 10,13-dimethyl- 1,2,6,7,8,9,10,11,12, 13,14,15,16,17- tetradecahydrocyclopenta[a]phenanthren-3-one
Clinical data
AHFS/Drugs.commonograph
Pregnancy cat.C
Legal status ?
RoutesOral
Pharmacokinetic data
Protein bindingHigh
MetabolismHepatic
Half-life3.5 hours
Identifiers
CAS number127-31-1 YesY
ATC codeH02AA02
PubChemCID 31378
IUPHAR ligand2873
DrugBankDB00687
ChemSpider29111 YesY
UNIIU0476M545B YesY
KEGGD07967 YesY
ChEBICHEBI:50885 YesY
ChEMBLCHEMBL1201388 N
Chemical data
FormulaC21H29FO5 
Mol. mass380.45 g/mol
 N (what is this?)  (verify)

Fludrocortisone (also called 9α-fluorocortisol or 9α-fluorohydrocortisone) is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. The brand name in the U.S. and Canada is Florinef.

Uses[edit]

Fludrocortisone has been used in the treatment of cerebral salt wasting.[1] 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).[2] It can be used to treat low blood pressure.

Fludrocortisone is also a confirmation test for diagnosing Conns 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.

Dosing[edit]

Fludrocortisone is available in 0.1 mg tablets. Typical daily doses for mineralocorticoid replacement are between 0.05 mg - 0.2 mg. Renin plasma, sodium, and potassium is checked through blood tests in order to verify that the correct dosage is reached.

Chemical properties[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.

Side effects[edit]

References[edit]

  1. ^ 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. 
  2. ^ Freitas J, Santos R, Azevedo E, Costa O, Carvalho M and 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.