Relevance to NICE guidance programmes

Advice

This off-label use of fludrocortisone for postural hypotension is not appropriate for referral for a NICE technology appraisal and is not currently planned into any other work programme. No NICE guidance specifically on postural hypotension was identified.

Other NICE guidance related to postural hypotension includes:

Transient loss of consciousness ('blackouts') management in adults and young people (NICE clinical guideline 109). This guideline includes recommendations on assessment and referral for suspected postural hypotension and safety advice for people with the condition.
Parkinson's disease: diagnosis and management in primary and secondary care (NICE clinical guideline 35). This guideline includes a recommendation on managing autonomic disturbances, including postural hypotension.
Falls: the assessment and prevention of falls in older people (NICE clinical guideline 161). This guideline does not specifically refer to managing postural hypotension, but is included as a related guideline because having a fall is a possible outcome of postural hypotension.

One of the RCT's included in this evidence summary was carried out in a population with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). NICE has published a clinical guideline on Chronic fatigue syndrome / myalgic encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults and children (NICE clinical guideline 53). The guideline recommends that mineralocorticoids, such as fludrocortisone, should not be used for treating CFS/ME.

This is discussed in more detail in the intervention and alternatives section.