Mineralocorticoid therapy (Formulary) | Right Decisions

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Corticosteroids
Mineralocorticoid therapy (Formulary)

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card. This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids. For more information, including which patients should receive the card, see HIS for details. Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.

See Peri-operative guidelines for patients with or at risk of adrenal insufficiency

FLUDROCORTISONE

Important: Therapy notes

The tablets should be stored in the refrigerator between 2 and 8˚C.

Important: Formulation and dosage details

Formulation:

Tablets 100 micrograms

Dosage:

50 to 200 micrograms daily.

Patients with Addison’s disease (primary adrenocortical insufficiency) require mineralocorticoid replacement with fludrocortisone normally in a dose of 50 to 200 micrograms daily. The adequacy of replacement can be assessed by measurement of plasma renin activity and clinically through postural blood pressure measurement and assessment of oedema.

For use in orthostatic hypotension off-label refer to Parkinson's Disease guideline.