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| Pronunciation | /ˌfludrəˈkɔːrtəzoʊn/floo-drə-KOR-tih-zone |
| Trade names | Florinef, Astonin, others |
| Other names | StC-1400; 9α-Fluorohydrocortisone; 9α-Fluorocortisol; 9α-Fluoro-17α-hydroxycorticosterone; 9α-Fluoro-11β,17α,21-trihydroxypregn-4-ene-3,20-dione |
| AHFS/Drugs.com | Monograph |
| Routes of administration | By mouth |
| Drug class | Corticosteroid;glucocorticoid;mineralocorticoid |
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| Protein binding | High |
| Metabolism | Liver |
| Eliminationhalf-life | 3.5 hours |
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| ECHA InfoCard | 100.004.395 |
| Chemical and physical data | |
| Formula | C21H29FO5 |
| Molar mass | 380.456 g·mol−1 |
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| Trade names | Cortineff, Florinef, Florinefe, Fludrocortison, others |
| Other names | Fluorohydrocortisone acetate; 9α-Fluorohydrocortisone 21-acetate; 9α-Fluoro-17α-hydroxycorticosterone 21-acetate; 9α-Fluoro-11β,17α,21-trihydroxypregn-4-ene-3,20-dione 21-acetate |
| Routes of administration | By mouth |
| Drug class | Corticosteroid;glucocorticoid;mineralocorticoid |
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| Metabolism | Liver |
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| ECHA InfoCard | 100.004.395 |
| Chemical and physical data | |
| Formula | C23H31FO6 |
| Molar mass | 422.493 g·mol−1 |
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| Melting point | 260 to 262 °C (500 to 504 °F) (dec.) |
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Fludrocortisone, sold under the brand nameFlorinef among others, is acorticosteroid used to treatcongenital adrenal hyperplasia,postural hypotension, andadrenal insufficiency.[3][4][5] In adrenal insufficiency, it is generally taken together withhydrocortisone.[5] Fludrocortisone is taken by mouth[5] and is most commonly used in itsacetate form.[6]
Common side effects of fludrocortisone includehigh blood pressure,swelling,heart failure, andlow blood potassium.[5] Other serious side effects can includelow immune-system function,cataracts, muscle weakness, and mood changes.[5] Whether use of fludrocortisone duringpregnancy is safe for the fetus is unknown.[7] Fludrocortisone is mostly amineralocorticoid, but it also hasglucocorticoid effects.[5]
Fludrocortisone was patented in 1953.[8] It is on theWorld Health Organization's List of Essential Medicines.[9]
Fludrocortisone has been used in the treatment ofcerebral salt-wasting syndrome.[10] It is used primarily to replace the missing hormonealdosterone in various forms ofadrenal insufficiency such asAddison's disease and the classic salt-wasting (21-hydroxylase deficiency) form ofcongenital adrenal hyperplasia. Due to its effects on increasing Na+ levels, and therefore blood volume, fludrocortisone is the first-line of treatment fororthostatic intolerance, andpostural orthostatic tachycardia syndrome (POTS).[11] It can be used to treat low blood pressure.[12]
Fludrocortisone is also a confirmation test for diagnosingConn's syndrome (aldosterone-producing adrenal adenoma), the fludrocortisone suppression test. Loading the patient with fludrocortisone wouldsuppress serum aldosterone level in a normal patient, whereas the level would remainelevated in a Conn's patient. The fludrocortisone suppression test is an alternative to the NaCl challenge (which would use normal saline or salt tablets).[medical citation needed]
Use of fludrocortisone can lead to one or more of the following side effects:[13]
Fludrocortisone is acorticosteroid and acts as a powerfulmineralocorticoid, along with some additional but comparatively very weakglucocorticoid activity.[14] Relative to cortisol, it is said to have 10 times the glucocorticoidpotency but 250 to 800 times the mineralocorticoid potency.[14][15] Fludrocortisone acetate is aprodrug of fludrocortisone, which is the active form of the drug.[16]
Plasma renin, sodium, and potassium are checked through blood tests to verify that the correct dosage is reached.[medical citation needed]
Fludrocortisone, also known as 9α-fluorocortisol (9α-fluorohydrocortisone) or as 9α-fluoro-11β,17α,21-trihydroxypregn-4-ene-3,20-dione, is asyntheticpregnanesteroid and ahalogenatedderivative ofcortisol (11β,17α,21-trihydroxypregn-4-ene-3,20-dione).[3][4] Specifically, it is a modification of cortisol with afluorine atomsubstituted in place of onehydrogen atom at the C9α position.[3][4] Fluorine is a goodbioisostere for hydrogen because it is similar in size, with the major difference being in itselectronegativity. The acetate form of fludrocortisone, fludrocortisone acetate, is the C21acetateester of fludrocortisone,[3][4] and ishydrolyzed into fludrocortisone in the body.[16]
Fludrocortisone was described in the literature in 1953[17] and was introduced for medical use (as the acetate ester) in 1954.[15][18] It was the first synthetic corticosteroid to be marketed, and followed the introduction ofcortisone in 1948 andhydrocortisone (cortisol) in 1951.[17][19] Fludrocortisone was also the first fluorine-containing pharmaceutical drug to be marketed.[20]
Fludrocortisone is thegeneric name of fludrocortisone and itsINNTooltip International Nonproprietary Name,USANTooltip United States Adopted Name,BANTooltip British Approved Name,DCFTooltip Dénomination Commune Française, andDCITTooltip Denominazione Comune Italiana, whereasfludrocortisone acetate is the generic name of fludrocortisone acetate and itsUSPTooltip United States Pharmacopeia,BANMTooltip British Approved Name, andJANTooltip Japanese Accepted Name.[3][4][21]
Fludrocortisone is marketed mainly under the brand names Astonin and Astonin-H, whereas the more widely used fludrocortisone acetate is sold mainly as Florinef, but also under several other brand names including Cortineff, Florinefe, and Fludrocortison.[4][21]
Fludrocortisone is marketed in Austria, Croatia, Denmark, Germany, Luxembourg, Romania, and Spain, whereas fludrocortisone acetate is more widely available throughout the world and is marketed in the United States, Canada, the United Kingdom, various other European countries, Australia, Japan, China, Brazil, and many other countries.[4][21]
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