1 vial

$11.15

Caffeine Citrate (Biomed)

  • Apnoea of prematurity

PO / NG:
10mg/mL (caffeine base) clear colourless solution in an amber bottle [25mL bottle]
Give dose with feeds closest to dose time. Administer prescribed dose by mouth using an oral syringe / teat.


IV:
10mg/mL (caffeine base) clear colourless solution in a glass vial [2.5mL vial]
Prepare immediately before use.
1. Ensure solution in the vial is clear and free of any particulate matter.
2. Open the vial and withdraw the required dose using a filter needle.
3. Administer via IV infusion or push no further dilutions are required but dilution preferred with 0.9% sodium chloride (undiluted can cause discomfort for infant). The solution can be diluted to 1mg/ml.
Loading dose to be given via a 30-minute infusion using a syringe pump
Maintenance dose can be given as a slow push over 5 minutes
Compatible with:
0.9% sodium chloride, D5W, D10W, D50W


ADULT DOSE
See PAEDIATRIC DOSE

PAEDIATRIC DOSE
IV and Oral/NG:
Loading Dose:
10mg/kg as a single dose
Maintenance Dose:
5mg/kg as a single dose at 1300hrs to start 24 hours after loading dose. For babies >28 days old the dose may have to be increased to 5mg/kg/dose q12H.
In babies with a post natal/gestational age of more than 52 weeks who require treatment it is often necessary to give a maintenance dose of 5mg/kg four times a day.
Doses should be reviewed weekly with respect to changes in weight
Note: 0.5mg of caffeine base = 1mg of caffeine citrate. (all dosing in this monograph is for citrate)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
No data available. See PRECAUTIONS.

Caffeine is widely used to manage recurrent central or “mixed” apnoea when other causes such as subtle seizures, sepsis, hypoglycaemia or respiratory exhaustion have

been excluded. Caffeine citrate is a general stimulant of the central nervous system, which increases metabolic rate, central chemoreceptor sensitivity to CO2, and inspiratory drive. Caffeine is well absorbed by mouth, and IV treatment is seldom necessary. It is mostly excreted, unchanged, in the urine in the first month of life. Clearance rises, as a result of increased liver metabolism, and approaches the rate found in adults and in infants more than 4 months old.

CONTRAINDICATIONS:

  • Hypersensitivity to caffeine


WARNINGS
Necrotising enterocolitis
Reports in the published literature have raised a question regarding the possible association between the use of caffeine and the risk of developing necrotising enterocolitis. Although a causal relationship between methylxanthine use and necrotizing enterocolitis has not been established, patients being treated with caffeine citrate should be carefully monitored for the development of necrotising enterocolitis.

PRECAUTIONS
General
Studies examining the pharmacokinetics of caffeine in neonates with hepatic or renal insufficiency have not been conducted. Caffeine citrate should be administered with caution in preterm neonates with impaired renal or hepatic function.
Apnea of prematurity is a diagnosis of exclusion. Other causes of apnea (e.g., central nervous system disorders, primary lung disease, anaemia, sepsis, metabolic disturbances, cardiovascular abnormalities, or obstructive apnoea) should be ruled out or properly treated prior to initiation of caffeine citrate.
Caffeine citrate should be used with caution in infants with seizure disorders.

Laboratory Tests:
Prior to initiation of caffeine citrate, baseline serum levels of caffeine should be measured in infants previously treated with theophylline, since preterm infants metabolize theophylline to caffeine.
Paediatric Use
See DOSAGE IN PAEDIATRICS

Theophylline is metabolised to caffeine; therefore, these drugs should not be co-administered due to the potential for additive toxicity. See Laboratory Tests.

Nervous System:
Agitation & restlessness
Digestive System:
Feeding intolerance
Cardiovascular System:
Tachycardia
Renal System:
Renal failure
Skin:
Rash

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