Caffeine

Caffeine

[1 vial $10.14]

ADMINISTRATION ROUTES:

  • IV, PO

ALTERNATIVE NAMES:

  • Caffeine Citrate (Biomed)

ICU INDICATIONS:

  1. Apnoea of prematurity

PRESENTATION AND ADMINISTRATION:

  • IV:
    10mg/mL (caffeine base) clear colourless solution in a glass ampoule [2.5mL ampoule] Prepare immediately before use.
    1. Ensure solution in the ampoule is clear and free of any particulate matter.
    2. Open the ampoule 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
  • PO:
    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.

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: 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)

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:

  1. 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 PAEDIATRIC DOSAGE

IMPORTANT DRUG INTERACTIONS FOR THE 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

  • Body as a Whole:
    Restlessness
  • Nervous System:
    Agitation.
  • Digestive System:
    Feeding intolerance
  • Cardiovascular System:
    Tachycardia
  • Renal System:
    Renal failure
  • Skin:
    Rash

Critical Care Drug Manual

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