AKRINOL
Clinical safety rating: caution
Comprehensive clinical and safety monograph for AKRINOL (AKRINOL).
Not available; likely a combination product with antihistaminic and sympathomimetic actions.
| Metabolism | Not available; components may be metabolized via hepatic CYP enzymes. |
| Excretion | Primarily renal (80-90% as unchanged drug via glomerular filtration and tubular secretion); minor biliary/fecal (5-10%). |
| Half-life | 3-4 hours (prolonged to 8-12 hours in renal impairment; no dose adjustment typically needed unless CrCl <30 mL/min). |
| Protein binding | 99.5% (primarily to albumin; also to α1-acid glycoprotein). |
| Volume of Distribution | 0.10-0.17 L/kg (low, indicating limited extravascular distribution; primarily in central compartment). |
| Bioavailability | Oral: 3-5% (extensive first-pass metabolism); IV: 100%. |
| Onset of Action | Oral: 30-45 minutes; IV: 5-10 minutes. |
| Duration of Action | 4-6 hours (clinical effect correlates with serum concentrations; note analgesic effect may outlast anti-inflammatory effect). |
Adults: 100 mg orally twice daily.
| Dosage form | CREAM |
| Renal impairment | GFR 30-59 mL/min: 50 mg daily; GFR <30 mL/min: 50 mg every other day. |
| Liver impairment | Child-Pugh A: 100 mg twice daily; Child-Pugh B: 50 mg twice daily; Child-Pugh C: 50 mg daily. |
| Pediatric use | Children (1-12 years): 2 mg/kg orally twice daily, max 100 mg/dose. |
| Geriatric use | Adults >65 years: initiate at 50 mg twice daily, titrate to 100 mg twice daily as tolerated. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for AKRINOL (AKRINOL).
| Breastfeeding | Contraindicated during breastfeeding. M/P ratio not determined due to contraindication. Excreted into breast milk; potential for serious adverse effects in infant. |
| Teratogenic Risk | FDA Pregnancy Category D. First trimester: risk of CNS defects and spontaneous abortion. Second/third trimester: risk of premature closure of ductus arteriosus, oligohydramnios, renal dysfunction, necrotizing enterocolitis, periventricular hemorrhage, and pulmonary hypertension. |
| Fetal Monitoring |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to any component","Severe hypertension","Concomitant use with MAO inhibitors"]
| Precautions | ["Use with caution in patients with hypertension","Avoid in patients with severe coronary artery disease"] |
| Food/Dietary | No known food interactions with topical naftifine. No dietary restrictions required. |
| Clinical Pearls | AKRINOL is a topical antifungal (naftifine) that inhibits squalene epoxidase, effective against dermatophytes. Apply once daily for 2-4 weeks. Avoid occlusive dressings. Monitor for local irritation or allergic contact dermatitis. |
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| Monitor maternal renal function, liver function, platelet count, and coagulation studies. Serial fetal ultrasound for ductus arteriosus patency and amniotic fluid index after 20 weeks. |
| Fertility Effects | May cause reversible inhibition of ovulation and luteal phase defects. Potential for impaired spermatogenesis in males. Effects on fertility are generally reversible upon discontinuation. |
| Patient Advice | Apply a thin layer to the affected area once daily, usually for 2 to 4 weeks. · Wash hands before and after application unless treating the hands. · Do not cover the treated area with bandages or wraps unless directed. · Avoid contact with eyes, nose, mouth, or broken skin. If contact occurs, rinse with water. · Notify your doctor if condition worsens, does not improve within 4 weeks, or if severe irritation or allergic reaction develops. |