Description and indication for use
Caffeine is a trimethylxanthine that can be used for the prevention or treatment of apnoea of prematurity or apnoeas associated with respiratory infection or anaesthesia. Caffeine can also be used to aid extubation of ventilated babies.
The pharmacological actions of caffeine in apnoea include stimulation of the medullary respiratory center, increased sensitivity to carbon dioxide, and enhanced diaphragmatic contractility.
Dose
Doses
expressed as caffeine citrate (NB: 20 mg caffeine citrate = 10 mg caffeine
base).
IV/Oral:
Loading dose: 20 mg/kg caffeine citrate
Maintenance dose: 5 mg/kg/dose caffeine citrate once daily*
Maintenance dose can be increased by 5 mg/kg/dose every 24 hours to a maximum of 20 mg/kg/dose if apnoeas persist, unless side effects develop.1
* Maintenance dose should commence at least 24 hours after loading dose.
Reconstitution/Dilution
IV ampoules = 20 mg/mL (caffeine citrate).
For IV use:
Can be given undiluted.
Route and method of administration
IV:
Infuse slowly over 30 minutes.#
# Doses less than/equal to 5 mg/kg caffeine citrate may be infused over 10 minutes.
Side effects
Nausea, vomiting, gastric irritation.
Agitation, irritability, restlessness.
Hypo/hyperglycaemia.
Tachycardia.
Diuresis.
Severe – necrotising enterocolitis.
Overdose – arrhythmias, seizures.
Special precautions
Contraindications
Hypersensitivity to caffeine or citrate.
Precautions
Seizure disorders.
Renal and/or hepatic impairment.
Gastro-oesophageal disease – relaxation of lower oesophageal sphincter may lead to gastro-oesophageal reflux.
Compatible solutions/medications
Sodium chloride 0.9%.
Glucose 5% and 10%.
Morphine sulphate.
Incompatibilities
Incompatible with TPN.
Discoloured or cloudy solutions for injection should
NOT be used.
Contact Pharmacy if further information is required.
Drug interactions
| Inhibitors
or inducers for the Cytochrome P450 1A2 enzyme |
Inhibitors
include |
amiodarone, erythromycin, fluoroquinolone antibiotics. |
Inducers include |
carbamazepine, omeprazole, phenobarbitone, phenytoin, rifampicin. |
Nursing responsibilities
Therapeutic drug monitoring is not routinely required.
Observe for signs of toxicity, including signs of necrotising enterocolitis (see Side Effects).
The IV solution is usually clear and colourless – inspect for signs of discolouration, cloudiness, turbidity or particular matter prior to use. DO NOT use unless solution is clear and colourless.
References:
- Steer PS et al. High dose caffeine citrate for extubation of preterm infants: a randomised controlled trial. ADC Fetal Neo Ed 2004 Nov; 89(6): F499-500. PMID: PMC1721801
- RCH Paediatric Pharmacopoeia, 13th ed. 2002.
- RWH Neonatal Pharmacopoeia, 2nd ed. 2005.
- Natarajan G, Lulic-Botica M, Aranda JV. Clinical Pharmacology of Caffeine in the Newborn. NeoReviews.May 2007, Vol. 8 No.5.
- Lawrence Trissel, Handbook on Injectable Drugs, 17th ed. 2013.
- Caffeine Citrate Sterile Injection Product Information (
http://www.tga.gov.au/pdf/auspar/auspar-cafnea.pdf- accessed 03/10/2013).