Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
PERCORTEN vs FLORINEF
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Percorten (desoxycorticosterone pivalate) is a synthetic mineralocorticoid that binds to and activates the mineralocorticoid receptor (MR) in the renal distal tubule, leading to increased sodium reabsorption, increased potassium and hydrogen ion excretion, and water retention, thereby expanding extracellular fluid volume and increasing blood pressure.
Fludrocortisone is a synthetic corticosteroid with predominantly mineralocorticoid activity, promoting sodium retention and potassium excretion in the distal renal tubules, thereby increasing extracellular fluid volume and blood pressure.
Adjunctive therapy in adrenocortical insufficiency (Addison's disease) for mineralocorticoid replacement,Off-label: Treatment of orthostatic hypotension due to autonomic dysfunction
Partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison's disease,Salt-losing congenital adrenal hyperplasia,Postural hypotension (off-label)
1-5 mg intramuscularly or subcutaneously daily with dose adjusted based on clinical response and electrolyte monitoring.
0.1 mg orally once daily, with range 0.1-0.2 mg/day. Dose may be divided twice daily if needed.
Terminal elimination half-life is approximately 30-40 minutes. Clinically, the short half-life necessitates frequent dosing (e.g., every 6-12 hours) to maintain therapeutic effect in mineralocorticoid replacement.
Terminal elimination half-life: 3.5 hours; clinical effect half-life due to mineralocorticoid activity is longer (~12-24 hours), allowing once-daily dosing.
Primarily hepatic via reduction and conjugation; excreted in urine as metabolites. Desoxycorticosterone pivalate is a prodrug that is hydrolyzed to desoxycorticosterone, which is then metabolized.
Primarily hepatic via CYP3A4-mediated metabolism; also metabolized by 11β-hydroxysteroid dehydrogenase to inactive metabolites.
Renal (biliary/fecal negligible). Approximately 50-70% of a dose is excreted as metabolites in urine; <5% unchanged.
Renal: ~80% as metabolites, ~20% unchanged; minimal biliary/fecal elimination.
Approximately 90-94% bound to albumin and corticosteroid-binding globulin (CBG).
~90% bound to corticosteroid-binding globulin (CBG) and albumin.
Vd approximately 0.5-0.8 L/kg. Clinical meaning: Distributes primarily into extracellular fluid; low Vd indicates limited tissue penetration.
Vd: ~0.3 L/kg; distributes mainly into extracellular fluid and binds to renal mineralocorticoid receptors.
Oral: Approximately 50-70% (high first-pass metabolism). IM/SC: 100% (assumed).
Oral: ~100% (well absorbed); no significant first-pass metabolism.
No specific GFR-based dose adjustments established; use with caution in renal impairment due to potential for fluid retention and hypertension.
No specific dose adjustment recommended based on GFR; use with caution in severe renal impairment due to sodium retention.
No specific Child-Pugh based dose adjustments; caution in severe hepatic impairment due to reduced metabolism and increased risk of adverse effects.
No specific adjustment for Child-Pugh; monitor for fluid overload in severe hepatic impairment.
0.1-0.3 mg/kg intramuscularly or subcutaneously daily, divided every 12-24 hours, with titration based on clinical response.
0.05-0.1 mg orally once daily; titrate based on response.
Initiate at lower end of adult dose (1 mg daily) with careful monitoring for fluid overload and electrolyte disturbances due to age-related renal and cardiovascular changes.
Initiate at lower dose (0.05 mg daily) and titrate slowly; monitor for hypertension, hypokalemia, and fluid overload.
None
None
May cause severe hypertension, edema, congestive heart failure, hypokalemia, or metabolic alkalosis. Monitor blood pressure, serum electrolytes, and body weight. Use with caution in patients with cardiac disease, renal impairment, or hepatic disease. Avoid excessive sodium intake.
May cause sodium retention and edema, especially in patients with cardiac disease,Monitor for hypokalemia and hyperglycemia,Increased risk of infections due to immunosuppression,May mask symptoms of infection,Do not use in patients with systemic fungal infections,Avoid abrupt discontinuation after prolonged therapy due to risk of adrenal insufficiency
Hypersensitivity to desoxycorticosterone or any component,Severe hypertension,Hyperkalemia,Edema or fluid overload states,Congestive heart failure,Severe renal impairment
Systemic fungal infections,Hypersensitivity to fludrocortisone or any component of the formulation,Concurrent live or attenuated virus vaccines (relative)
Avoid high-potassium foods (e.g., bananas, oranges, salt substitutes) as Percorten increases potassium retention. Limit sodium intake to manage fluid balance.
Avoid excessive licorice (glycyrrhizin) which can enhance mineralocorticoid effects and worsen hypokalemia. Maintain a low-sodium diet to reduce fluid retention and hypertension. Increase potassium-rich foods if not contraindicated.
Percorten (desoxycorticosterone pivalate) is a mineralocorticoid. Data in pregnant women are limited. In animal studies, corticosteroids have been shown to be teratogenic. Use during pregnancy only if clearly needed. First trimester: Possible increased risk of cleft palate and intrauterine growth restriction. Second and third trimesters: Potential for adrenal suppression in the fetus/newborn.
Fludrocortisone (Florinef) is a corticosteroid with mineralocorticoid activity. In animal studies, corticosteroids have been associated with cleft palate and other malformations. Human data are limited. First trimester exposure may slightly increase risk of oral clefts. Second and third trimester use may suppress fetal adrenal function, leading to neonatal adrenal insufficiency. Overall risk is low with short-term use, but chronic high doses should be avoided.
Corticosteroids are excreted in breast milk in small amounts. Desoxycorticosterone pivalate specific data are lacking. M/P ratio not determined. At high maternal doses, monitor infant for signs of adrenal suppression. Use with caution.
Fludrocortisone is excreted into breast milk in small amounts. The milk-to-plasma ratio is unknown. At typical doses, the amount ingested by the infant is likely to be low and not expected to cause adverse effects. However, monitor infant for signs of adrenal suppression. Use with caution, especially with high maternal doses.
Pregnancy may increase clearance of corticosteroids, potentially requiring dose adjustments. However, specific pharmacokinetic data for Percorten are lacking. Use lowest effective dose and monitor clinical response and serum levels if available.
Pharmacokinetic changes in pregnancy (increased volume of distribution, increased renal clearance) may reduce fludrocortisone levels, potentially requiring dose adjustment to maintain desired effect. Dose should be titrated based on clinical response (e.g., blood pressure, electrolyte levels). No specific dosing guidelines; individualize therapy.
Percorten (desoxycorticosterone pivalate) is a mineralocorticoid used for adrenal insufficiency. Monitor for hypertension, hypokalemia, and edema. Titrate dose based on blood pressure and serum potassium. Use with caution in heart failure or renal impairment.
Monitor for signs of edema, hypertension, and hypokalemia. Use lowest effective dose. Caution in patients with heart failure, hypertension, or renal impairment. Do not abruptly discontinue; taper slowly. May interfere with cortisol assays.
Take exactly as prescribed; do not miss doses.,Report rapid weight gain, swelling, or shortness of breath.,Avoid excessive salt intake; follow a low-sodium diet if advised.,Do not stop abruptly; taper under medical supervision.
Take exactly as prescribed; do not stop suddenly without doctor's advice.,Weigh yourself daily and report rapid weight gain or swelling.,Monitor blood pressure regularly.,Eat a low-salt diet to help control fluid retention.,Report signs of high potassium (muscle weakness, irregular heartbeat) or low potassium (cramps, fatigue).,Carry medical ID indicating you take fludrocortisone.,Avoid excessive licorice intake (can worsen potassium loss).,May cause increased thirst and urination.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about PERCORTEN vs FLORINEF, answered by our medical review team.
PERCORTEN is a Mineralocorticoid that works by Percorten (desoxycorticosterone pivalate) is a synthetic mineralocorticoid that binds to and activates the mineralocorticoid receptor (MR) in the renal distal tubule, leading to increased sodium reabsorption, increased potassium and hydrogen ion excretion, and water retention, thereby expanding extracellular fluid volume and increasing blood pressure.. FLORINEF is a Corticosteroid (Mineralocorticoid) that works by Fludrocortisone is a synthetic corticosteroid with predominantly mineralocorticoid activity, promoting sodium retention and potassium excretion in the distal renal tubules, thereby increasing extracellular fluid volume and blood pressure.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between PERCORTEN and FLORINEF depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of PERCORTEN is: 1-5 mg intramuscularly or subcutaneously daily with dose adjusted based on clinical response and electrolyte monitoring.. The standard adult dose of FLORINEF is: 0.1 mg orally once daily, with range 0.1-0.2 mg/day. Dose may be divided twice daily if needed.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between PERCORTEN and FLORINEF in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. PERCORTEN is classified as Category C. Percorten (desoxycorticosterone pivalate) is a mineralocorticoid. Data in pregnant women are limited. In animal studies, corticosteroids have been shown to be teratogenic. Use duri. FLORINEF is classified as Category C. Fludrocortisone (Florinef) is a corticosteroid with mineralocorticoid activity. In animal studies, corticosteroids have been associated with cleft palate and other malformations. H. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.