ADMINISTRATION ROUTES:
PO, NG, IV
ALTERNATIVE NAMES:
Caffeine Citrate (Biomed)
ICU INDICATIONS:
- Apnoea of prematurity in neonates
PRESENTATION AND ADMINISTRATION:
IV:
10 mg/mL (caffeine base) clear colourless solution in a glass vial [2.5 mL vial]
Prepare immediately before use.
-
Ensure solution in the vial is clear and free of any particulate matter.
-
Open the vial and withdraw the required dose using a filter needle.
-
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 1 mg/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, 5% dextrose, D10W, D50W
PO:
10 mg/mL (caffeine base) clear colourless solution in an amber bottle [25 mL bottle]
Give dose with feeds closest to dose time. Administer prescribed dose by mouth using an oral syringe / teat.
DOSAGE:
See DOSAGE IN PAEDIATRICS
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
No data available. See PRECAUTIONS
DOSAGE IN PAEDIATRICS:
IV and Oral:
Loading Dose:
10 mg/kg as a single dose
Maintenance Dose:
5 mg/kg as a single dose at 1300 hrs to start 24 hours after loading dose. For babies >28 days old the dose may have to be increased to 5 mg/kg/dose BD
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 5 mg/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
CLINICAL PHARMACOLOGY:
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 necrotising 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 metabolise theophylline to caffeine
Paediatric Use:
See DOSAGE IN PAEDIATRICS
IMPORTANT DRUG INTERACTIONS IN ICU:
Theophylline is metabolised to caffeine; therefore, these drugs should not be co- administered due to the potential for additive toxicity. See Laboratory Tests
ADVERSE REACTIONS:
Nervous System:
Agitation & restlessness
Digestive System:
Feeding intolerance
Cardiovascular System:
Tachycardia
Renal System:
Renal failure
Skin:
Rash