Cafedrine and theodrenaline

from Wikipedia, the free encyclopedia

The fixed combination of the two active ingredients cafedrine and theodrenaline in a ratio of 20: 1 (trade name: Akrinor ) is a drug used to raise blood pressure . It is mainly used in anesthesiology during operations. For example Akrinor regularly in the cesarean section in spinal anesthesia used to correct the often resulting drop in blood pressure. It is also widely used in emergency medicine.

Structural formula of cafedrin
Structural formula of theodrenaline

effect

The effect consists of a rapidly occurring and relatively long-lasting increase in arterial blood pressure. The blood flow to the coronary arteries and uterus is not impaired.

The effect of cafedrine / theodrenaline cannot be explained solely by the sum of the individual effects of the two active ingredients. A stimulation of beta receptors is heart strength (positive inotropic increased). The increase in heartbeat and minute volume is further promoted by mobilizing blood reserves from the capacitive venous system. The peripheral resistance is practically unchanged and the heart rate is moderately reduced. The stimulation of alpha receptors by theodrenaline is opposed to an inhibition by cafedrine. Over time, this becomes noticeable in the first phase of alpha-receptor-mediated vasoconstriction ( vasoconstriction ), which increases blood pressure. In a second phase, these arterial resistance vessels expand again, with an increase in venous tone at the same time, which increases the preload on the heart and thus increases blood pressure.

Distribution and alternatives

Akrinor is only approved in Germany. Here the drug has been used to treat hypotension for over 50 years. In the USA and England, cafedrine / theodrenaline is not approved. There ephedrine , phenylephrine and norepinephrine are used.

1 ampoule of Akrinor with 2 ml solution for injection contains 200 mg cafedrine hydrochloride and 10 mg theodrenaline hydrochloride .

history

The launch of Akrinor in Germany was in 1963 by the chemical plant Homburg , a branch of Degussa AG. In 2000, the distribution was transferred to the Arzneimittelwerk Dresden (AWD.pharma). In 2005, AWD.pharma announced the discontinuation of sales, giving the reasons for the costs of the legally required reauthorisation procedure. Since many anesthesiologists in Germany did not want to do without cafedrine / theodrenaline and no other manufacturer offered this in Germany, the German Society for Anesthesiology and Intensive Care Medicine got involved . Together with the manufacturer, the Federal Institute for Drugs and Medical Devices (BfArM) was able to extend the marketability. In 2008 AWD.pharma was taken over by the Teva Group and with the acquisition of ratiopharm in 2010, Akrinor fell to this new manufacturer, from whom it was first produced in its own factory in 2013. In June 2012, Arkrinor received the status of regular approval from the BfArM (approval number 78450.00.00). In 2018, the University of Marburg published the study design for a multicenter, non-interventional comparative study of cafedrine / theodrenaline with ephedrine: In collaboration with Teva , the speed and precision of the rise in blood pressure and the patient outcome are to be examined.

literature

  • AR. Heller, J Heger, M. Gama de Abreu, MP Müller: "Cafedrine / theodrenaline in anaesthesia: Influencing factors in restoring arterial blood pressure." In: "Anaesthesist. 2015 Mar; 64 (3): 190-6. Doi: 10.1007 / s00101-015-0005-y .
  • KE. Clemens, I. Quednau, AR. Heller, E. Klaschik: "Impact of cafedrine / theodrenaline (Akrinor®) on therapy of maternal hypotension during spinal anesthesia for Cesarean delivery: a retrospective study." In: "Minerva Ginecol. 2010 Dec; 62 (6): 515-24."
  • N. Sternitzke; H. Schieffer; G. Rettig; L. Bette: "The influence of the theophylline compounds cafedrine and theodrenaline on the cardiovascular dynamics and their combination", In: "Herz /kreis" 8/84: 401, 1984.
  • S. Kampe, H. Nori, PM Schneider, R. Krott: Unclear mydriasis during an oesophagectomy with an inconspicuous course of anesthesia - drug effects of Akrinor® ?. In: anesthesiology, intensive care medicine, emergency medicine, pain therapy. 38, 2003, pp. 165-167, doi: 10.1055 / s-2003-37776 .
  • Old drugs and new approval processes: Akrinor remains marketable and a reauthorization application for arginine vasopressin has been submitted. In: Emergency + Rescue Medicine. 9, 2006, pp. 553-555, doi: 10.1007 / s10049-006-0840-0 .
  • L. Aniset, C. Konrad, M. Schley: Ephedrine as an alternative to Akrinor® in regional obstetric anesthesia . In: The anesthesiologist. 55, 2006, pp. 784-790, doi : 10.1007 / s00101-006-1033-4 .

Individual evidence

  1. ↑ a b Technical information Akrinor 200 mg / 2 ml + 10 mg / 2 ml solution for injection , (ratiopharm GmbH, Ulm). Status: August 2019 ( PDF ).
  2. ↑ a b www.akrinor.de: The contribution from ratiopharm in modern anesthesia. , "History" subpage. Retrieved July 21, 2020.
  3. ↑ hypotension.online.uni-marburg.de , accessed on July 21, 2020.