JoanV. posted in relation to depression and florinef on the Addisons board but I also thought the general info would be useful since most of our worries regard hydrocortisone. I found the potassium lose as an effect of florinef knew info to me and the use of lactose in the pill something I did not know.  Lactose intolerance is becoming more common and could cause some kids problems if an endo is not clued up on the formulation of florinef.

Ha anyones endo brought up the potassium lose link and the recommendation below to supplement it.

Thanks to those who have written re: my question about Florinef causing depression. As far as I know my thyroid is OK, but I'm about to get some blood work done so I will find out. I doubt if it's my thyroid because it definitely is associated with the Florinef.I'm going to stay on the .025 dose but go to every other day and see what that does. It has also made me much more tired and increased the feeling of a watery puffinesss in my head.

Joan V.

Here is the link and the info: From http://www.med.jhu.edu/peds/cfs.html FLORINEF Formal (generic) name: fludrocortisone Type of drug: a mineralocorticoid steroid Action: Florinef acts in the kidney to help the kidney retain sodium that would otherwise be lost in the urine. It helps the body avidly retain the salt you eat. It does so at the expense of losing potassium into the urine, so it is important to take in adequate amounts of potassium each day (a list of foods high in potassium is appended). In addition, we now recommend potassium supplements when people start on Florinef, regardless of the serum potassium level, and especially if individuals remain on the drug for several months. A sustained release potassium preparation (such as K-Dur 10 mEq or K-Dur 20 mEq, or Slow-K 8 mEq) given once daily has been well tolerated by our patients. Common confusions: Cortisone and fludrocortisone differ. Florinef has none of the anti-inflammatory properties of cortisone or prednisone, and it has no effect on blood sugar as cortisone does. Florinef is not a muscle building (anabolic) steroid. Common side effects: To reduce the chance of Florinef causing an elevated blood sodium level, make sure to drink lots of fluids while taking Florinef. Some individuals complain of headache after Florinef and some develop worse CFS symptoms (more lightheadedness or fatigue), abdominal discomfort of a new type or severity, new chest discomfort, or tearfulness and depression. The latter occurs in fewer than 1 in 20 patients, but patients need to be aware of this when they start on the drug, and to know to stop Florinef if such depressed mood occurs. Some have found that minor side effects will disappear after a couple of weeks, and it is worth persevering with the medication provided that the side effects are minor. Some develop worse acne on Florinef. The tablet has a tiny amount of lactose in it, and may cause discomfort to those who are extremely allergic to milk protein. Special pharmacies can compound the drug without lactose (we refer patients to Abrams Royal Pharmacy, 8220 Abrams Rd., Dallas, TX 75231; Tel: 214-349-8000; Fax: 214-341-7966; e-mail: bscarbro@ix.netcom.com). With high doses, or even low doses over a long period of time, Florinef can lead to an elevation of blood pressure (BP). For this reason, we recommend that BP be monitored carefully, especially in the weeks after starting on the drug, and monthly once a stable dose is achieved. Suggested doses for CFS patients: Patients with chronic fatigue syndrome who also have neurally mediated hypotension often have medication sensitivities and appear to benefit from a gradual increase in their Florinef dose. We recommend beginning with a week of increasing salt and fluid after tilt testing before starting on Florinef to ensure better tolerance of the drug. Once you are ready to start, begin with 1/4 tablet per day (0.025 mg). If the 1/4 tablet dose is tolerated for 4-7 days, increase to 2 tablet for 4-7 days, then to 3/4 tablet or a full 0.1 mg tablet. Doses above this amount may be necessary, but we usually do not increase the dose to more than 0.2 mg per day. Some patients report that splitting the dose (half in the morning and half with the evening meal) provides a more even effect, but occasionally people have to return to a once a day morning dose because the Florinef causes them to develop insomnia. Comments: It is important to be sure that you are taking an adequate amount of fluid. We recommend checking the serum electrolytes about 2-4 weeks after each dosage increase. Use in pregnancy: consult with your doctor.

ShaunP.