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Akrinor – Effects, Uses & Dosage

Akrinor is a combination cardiovascular drug containing cafedrine and theodrenaline, used to treat acute drops in blood pressure, especially during anaesthesia and in obstetrics.

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Things worth knowing about "Akrinor"

Akrinor is a combination cardiovascular drug containing cafedrine and theodrenaline, used to treat acute drops in blood pressure, especially during anaesthesia and in obstetrics.

What is Akrinor?

Akrinor is a cardiovascular medication used in clinical medicine to treat acute hypotension (low blood pressure). It is a fixed-dose combination of two active substances: cafedrine and theodrenaline in a ratio of 200:1. Akrinor is intended exclusively for intravenous or intramuscular administration and is used primarily in hospital settings.

Active Substances and Mechanism of Action

The combination of cafedrine and theodrenaline exerts its effects through several pharmacological mechanisms:

Cafedrine is a xanthine derivative (structurally related to theophylline and caffeine) that inhibits the enzyme phosphodiesterase. This slows the breakdown of cAMP (cyclic adenosine monophosphate), resulting in increased heart rate and cardiac output.
Theodrenaline is a sympathomimetic amine that stimulates both α- and β-adrenergic receptors. This leads to an increase in peripheral vascular resistance and a positive inotropic as well as chronotropic effect on the heart.

Together, the two substances act synergistically: blood pressure is stabilised by increasing cardiac output and by mild vasoconstriction.

Indications

Akrinor is primarily used in the following clinical situations:

Hypotension during spinal or epidural anaesthesia (neuraxial anaesthesia)
Circulatory depression in obstetrics, for example during anaesthesia for a caesarean section
Acute hypotension in the perioperative period (before, during, or after surgery)
Hypotensive states caused by medication effects (e.g. potent analgesics or anaesthetic agents)

Dosage and Administration

Akrinor is typically administered as an intravenous injection, usually in a titrated manner – meaning the dose is adjusted stepwise until the desired increase in blood pressure is achieved. The precise dosage depends on the clinical condition of the patient and must be determined exclusively by qualified medical personnel. A typical single dose is 0.5–2 ml (corresponding to 100–400 mg cafedrine / 0.5–2 mg theodrenaline), administered slowly.

Side Effects

Like all medicines, Akrinor can cause side effects, although these are rare when used as directed:

Palpitations (tachycardia) or cardiac arrhythmias
Nausea and vomiting
Headache
Restlessness and tremor
Severe increase in blood pressure (hypertension) in case of overdose
Chest pain (angina pectoris) in patients with coronary artery disease

Contraindications

Akrinor should not be used in patients with:

Known hypersensitivity to cafedrine, theodrenaline, or any of the excipients
Severe hypertension (high blood pressure)
Hypertrophic obstructive cardiomyopathy (HOCM)
Tachycardic cardiac arrhythmias
Narrow-angle glaucoma
Pheochromocytoma (adrenal medulla tumour)

Special Considerations in Obstetrics

Akrinor is considered the preferred agent for treating spinal anaesthesia-induced hypotension in obstetrics in Germany. Unlike pure vasopressors such as phenylephrine, Akrinor increases cardiac output and is therefore preferred in obstetric anaesthesia to preserve adequate blood supply to the uterus and the unborn child. The evidence base, however, continues to be a subject of scientific discussion.

References

Prescribing information Akrinor® ampoules – ratiopharm GmbH, current approval status (BfArM / AMIS database).
Ngan Kee W.D. – The use of vasopressors during spinal anaesthesia for caesarean section. Best Practice & Research Clinical Anaesthesiology, 2017.
Butterworth J.F., Mackey D.C., Wasnick J.D. – Morgan & Mikhail's Clinical Anesthesiology, 6th edition, McGraw-Hill Education, 2018.

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