Praxis Medical Insights

Mechanism of Action and Efficacy

Fludrocortisone acts through sodium retention, direct constricting effect on partially denervated blood vessels, and increasing water content of vessel walls, leading to reduced distensibility, as supported by the American College of Cardiology 1, 2, 3
Evidence supports fludrocortisone as a level B recommendation (moderate evidence) for treating symptomatic orthostatic hypotension, according to the American College of Cardiology 1, 4

The initial dose of fludrocortisone should be 0.05–0.1 mg daily, with individual titration to 0.1–0.3 mg daily as needed, as recommended by the European Society of Cardiology 2, 3
Fludrocortisone should be used in conjunction with non-pharmacological measures for optimal effect, as suggested by the American Heart Association 1, 4

The American College of Cardiology recommends a first-line approach of non-pharmacological measures, including physical counter-maneuvers, compression garments, and head-up position during sleep 3, 5, 6, 1
Fludrocortisone 0.05-0.1 mg daily, titrated up to 0.1-0.3 mg daily as needed, is a first-line pharmacological therapy for symptomatic orthostatic hypotension, as recommended by the European Society of Cardiology 2, 3
Combination therapy with fludrocortisone plus midodrine may be considered for inadequate response to monotherapy, as suggested by the American College of Cardiology 1, 4

The American College of Cardiology notes that fludrocortisone may be poorly tolerated in patients with cardiac involvement or restrictive physiology due to risk of fluid retention 6, 7
Supine hypertension is a major concern with fludrocortisone treatment, as reported by the American Heart Association 1
Hypokalemia is a potential adverse effect of fludrocortisone, as noted by the European Society of Cardiology 2