Here is a link to info about Florinef (Fludrocortisone).

It apparently peaks 2 hours after ingestion and has a life of 24 hours. 

http://www.home.eznet.net/~webtent/fludrocortisone.html

That possibly confirms what we should be doing replacement wise with Florinef.   If this URL is correct then on the days that the child does  not  receive Florinef or Fludrocortisone, they are literally not retaining any sodium for 24 hours. 

I feel that such an up and down erratic control of electrolyte levels is senseless when you can dose the appropriate dose of florinef by splitting tablets.  The tablets can be split as small as 25mcg, which is a very tiny dose, and you can do as Julia says and spread them out, though I am dubious about the dose last thing at night.

I also feel that the timing of the dose is everything.  We know that dex has a potency of 80:1 and if florinef is a potency of 300:1, given at night it would be certainly twice as potent as during the day surely.  Well that is what Carol’s Doctor claims is the difference between dosing during the day or at night with dex.  So I am naturally assuming that since florinef is far more potent than dex the same rules can be applied.  (Kind of makes me wonder if the Doctor advising doses once every other day is thinking along these lines and thinks it has a life of 24 hours actually).

My problem with dosing every other day is that if this peaks in the blood after two hours, then thereafter it is lessening in the blood levels throughout the whole of that 48 hour period.  this means that at one end we have high levels and at the other very low levels, which seems too erratic, when you can achieve a more constant level of the effects for the child or individual.  It means the renin would be high when taken and very low just before the next dose which seems like a silly situation to be inflicting on someone--especially if they fall ill at the low end of that scenario as I pointed out.  A constant level of the drug in the blood dosed even twice daily is better than a dose every other day in my opinion. :) 

Cheers

 

Anne-Marie