Does this drug cause the kind of dependency problems seen with prednisone? That drug is really scary, the adverse effects are so bad.
My limited understanding is that florinef (generic = fludrocortisone) is in a different class of steroids from prednisone. It is a steroid but more of its action is in the mineralocorticoid category than glucocorticoid category. So while there may be some weight gain there won't be problems with very large weight gain or "moon face" that are associated with prednisone. And I think that patients who take it for orthostatic intolerance are on lower doses than those who take it for Addison's disease. (or maybe it's just that Addison's patients take other steroids in addition to florinef)
I agree with what Ema said about dosage. Start very small, such as 1/4 of a 0.1 mg tablet, and then work up slowly. The 0.1 mg pills are small. I can just break the pills in half with my fingers (I now take 1/2 of a 0.1 mg tablet each day) but to get quarters you'll need a tablet splitter (found at most pharmacies or look online).
I also agree that I don't think florinef will help much unless you also add extra water and salt. I drink about 3 liters of water and take 5 salt tablets (Bio-Salt, taken with meals) daily. Like the drug, ramp up on the extra water/salt slowly.
Florinef did help me but like others have mentioned the effects wore off after some time (for me it was after a few years). At first I increased the dosage (was at one and a half tablets daily for a while) but that only helped a little bit. And I didn't want to keep increasing the dose. What worked for me was to add a new drug, midodrine (a vasoconstrictor), that worked even better for my specific problems. I kept taking the florinef but reduced it to half of my initial dosage. For me taking both of these drugs together works better.
As others have said, while on this drug you should check your electrolytes (my doctor checks mine once a year) and you may want to take potassium supplements. I take a prescription, time-released version of potassium (some generic version of Klor-Con, 10 meq).
As with so many different problems, treating autonomic dysfunction is difficult. A drug that works well for one patient may have no effect, or have horrible side effects, for another patient. It's up to the individual to experiment to find the right combination.
One thing that I found most interesting is that before I started taking fludrocortisone I would wake up 1-2 times every night to urinate. After adding fludrocortisone, even though I was drinking *a lot* more water, I never got up to go to the bathroom during the night. So, for me, it must be working on that hormone/chemical/? (vasopressin? forgot the name) that helps the body to retain fluids.
Good luck!