Monday, October 20, 2014

Florinef and Addison's Disease

A woman wrote in saying that she having trouble with her Florinef medication. She complained of side effects -- gaining weight, feeling bloated, puffy in the face, hands shaking, chest beating hard, sweating, thirsty, low sodium levels, potassium high, craves salt. She says that Florinef is salt tablets and thinks is is causing her symptoms. She also states that she is starting menopause.

I think several things are happening here. First look at my post on Learning to Use My Medicine

Fludrocortisone (or Fludrocort or Floroinef- brand name) is NOT a salt pill. It is a synthetic adrenal hormone. It is used to replace one of the major adrenal hormones, aldosterone. Most people with Addison's Disease need to take Fludrocort (1 pill .1mg) daily. Aldosterone controls mineral balances in our bodies, mainly the salt and potassium balance. Aldosterone therefore regulates your blood pressure and water retention levels in your body. It also regulates nerve impulses. Most people have to take potassium pills when they take Fludrocort since Fludrocort causes the body to retain salt and dump potassium.

Symptoms of Too Little Aldosterone or Fludrocort

  • low blood pressure (110/70 or less)
  • extreme fatigue
  • pain with movement
  • nauseous
  • dizzy and lightheaded
  • crave salt (low salt) 
  • high potassium
  • drink excessive amounts of water
  • excessive urination (15 to 20 times a day)
  • low hydration (sign of dehydration - rough tongue, dry skin)
  • excessive perspiration
  • weak leg muscles
  • difficult to move
  • muscle twitches 
  • heart palpitations (pounding or racing)
  • symptoms worse after drinking coffee or alcohol (increases dehydration)

Symptoms of Too Much Fludrocort
  • high blood pressure (140/90 or more) 
  • puffy feet and hands (swelling from water retention)
  • low potassium
  • high salt 
  • sudden weight gain
  • short of breath
  • uneven heart rate
  • muscle pain or weakness
  • confusion
  • increased thirst or urination 

Yes, some of the symptoms are the same. That is because any mineral imbalance causes problems. For instance you can have too much salt or too much potassium in your blood and the body tries to re-balance by causing you to drink more water or eliminate water. 

You do not need to guess if you are too high or low in fludrocort.  Just check your blood pressure with a monitor (available at most drug stores). If your blood pressure is high your fludrocort is too high. If your blood pressure is too low your fludrocort is too low. Fludrocort levels are directly related to blood pressure. 

There are also blood tests that will directly measure the level of fludrocort in your blood. 

Most people who have Addison's disease must take fludrocort because our bodies do not produce aldosterone which regulates mineral balance. Therefore most people take .1 mg  (one pill) each morning. This dose usually stays constant.  


  1. Cherry, as I said in a common on another of your post, my blood pressure is spiking very high once a week. My sodium and potassium are always normal. I take 0.5 mg of florineff daily and have never been told to take potassium. I've been taking that side for 2 years now. Do you think it could suddenly be too much and the cause of the episodes of high blood pressure?

  2. see my answer on the Hydrocortisone and Adrenal Disease and on Low Adrenal and low blood pressure
    Overdose is consistent. It will keep rising. You blood pressure will keep rising. It will not come down until you cut your dose of florineff.