Adrenal Insufficiency-Florinef?

[amyrerickson890]

Hello,

I suffer from Adrenal insufficiency. I am taking 17.5 mg per day of hydrocortisone (in three doses throughout the day), but I have symptoms of salt/water imbalance. Would Florinef be safe to take while breastfeeding?

[cpride]

Dear amyrerickson890,

Fludrocortisone (Florinef) is a halogenated derivative of hydrocortisone with very potent mineralocorticoid activity and is generally used to treat Addison's disease. Although its glucocorticoid effect is 15 times more potent than hydrocortisone, it is primarily used for its powerful ability to retain sodium in the vascular compartment (mineralocorticoid activity). It is not known if fludrocortisone penetrates into milk but if it is similar to other corticosteroids, it is very unlikely the amounts in milk will be clinically relevant unless extremely high doses are used, but caution is recommended. The normal dose is 0.1 to 0.4 mg daily. Have your pediatrician monitor your infant's growth and blood pressure, but the risk is likely low. You may call the InfantRisk Center at 806-352-2519, if you have further questions. We are open 8 to 5, CDT, Monday through Friday.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Bstreetmba]

I am taking fludrocortisone and trying to decide whether to breastfeed. Would monitoring the baby's growth and blood pressure be proactive, or only show a problem with the baby's adrenals after damage had been done? I live with adrenal insufficiency and would never want to increase the risk of chronic disease to my child. Thank you, it's been extremely difficult to find good information on this medication due to the rarity of use.

[admin]

Bstreetmba:

Again, we don't know if fludrocortisone enters milk. I would imagine levels are extremely low and subclinical. Further, while this corticosteroid increases fluid loss in individuals where it is needed, I really doubt it will cause this in your infant. Further, it would not at all likely be 'damaging' to your infants kidneys. I'd simply monitor and record your infants urine production somewhat, and then see if it changes any at all following the use of this drug.
Might give you some comfort.



Tom Hale Ph.D.