Postural hypotension in adults: fludrocortisone

About fludrocortisone

Fludrocortisone is a type of drug called an oral mineralocorticoid, often shortened to 'steroids'. The drug is licensed for treating a condition called Addison's disease, in which glands attached to the kidneys (called adrenal glands) do not make enough of certain hormones. Fludrocortisone helps to replace these hormones. It is also licensed to treat a condition called 'salt losing adrenogenital syndrome', another form of hormone imbalance. Fludrocortisone is also used to raise blood pressure in people with postural hypotension, but it does not have a UK licence for this, and so its use to treat postural hypotension is called 'off-label'. It raises blood pressure by increasing sodium (salt) levels and affecting blood volume.

There are other treatments that can be tried for postural hypotension which do not involve taking drugs. These include drinking more water, using compression garments, raising the head of the bed, and learning body movements to counteract the drop in blood pressure.

Some other drugs, with UK licences for use in other conditions, are prescribed 'off-label' to treat postural hypotension (these include domperidone and pyridostigmine). Midodrine is another drug that is used to treat postural hypotension, but it does not have a licence for any use in the UK, so use for any condition, including postural hypotension, is 'unlicensed'. Midodrine is licensed for use in postural hypotension in some other countries. NICE has published an evidence summary on the unlicensed use of midodrine for treating postural hypotension in adults.