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Caffeine Citrate
Caffeine citrate is a medication commonly used to treat apnea of prematurity in premature infants. Apnea of prematurity occurs when premature babies stop breathing for short periods due to an underdeveloped respiratory system. Caffeine citrate works as a stimulant for the central nervous system, helping to reduce episodes of apnea by stimulating the breathing centers in the brain. It is also sometimes used off-label for other conditions that benefit from increased respiratory drive or stimulation.
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Frequently Asked Questions
How long does it take for caffeine citrate to start working?
Caffeine citrate generally begins to work within 30 minutes to 2 hours after administration, with a peak effect occurring around 2 hours. It helps reduce apnea episodes quickly once therapy is initiated.
Can caffeine citrate be used long-term?
Caffeine citrate is typically used for short-term management of apnea of prematurity until the infant’s respiratory system matures. The duration of treatment is generally a few weeks, depending on the infant’s progress.
What happens if I miss a dose of caffeine citrate?
If a dose is missed, the infant should receive the next dose as soon as possible unless it is close to the time for the next scheduled dose. Do not double the dose to make up for the missed one.
Are there long-term side effects of caffeine citrate?
When used appropriately, caffeine citrate is considered safe for short-term use in premature infants. There is no strong evidence suggesting significant long-term side effects when used under medical supervision.
Can caffeine citrate be used in full-term infants or adults?
Caffeine citrate is primarily used in premature infants for the treatment of apnea. Other forms of caffeine are typically used in adults or full-term infants for different conditions, such as fatigue or respiratory stimulation.
Comprehensive Drug Guide
How Does Caffeine Citrate Work?
Caffeine citrate works by stimulating the central nervous system, particularly the respiratory centers in the brain. It increases respiratory drive, which helps to reduce the frequency and severity of apnea episodes in premature infants. Caffeine also enhances diaphragmatic contractility, improves oxygenation, and increases minute ventilation. Additionally, it has mild diuretic effects.
What is Caffeine Citrate Used For?
Apnea of Prematurity: In premature infants to reduce the frequency of apnea episodes.
Common Dosages
Caffeine citrate is available by prescription only an oral solution and an intravenous injection, primarily for use in neonatal intensive care units (NICUs).
Administration: Caffeine citrate is administered either intravenously or orally. The route of administration depends on the condition of the infant, but the oral solution is often preferred for long-term treatment after initial stabilization.
Duration of Use: Treatment duration depends on the infant’s response and whether their respiratory system matures enough to reduce episodes of apnea. Therapy is typically discontinued once the infant has been apnea-free for 5-7 days.
Typical Dosing
FDA Approved Indications
Pediatric Dosing
The typical dosage of caffeine citrate for apnea of prematurity is based on the infant’s weight:
- Loading Dose: 20 mg/kg (based on the caffeine citrate component) given either intravenously or orally.
- Maintenance Dose: 5-10 mg/kg once daily, starting 24 hours after the loading dose, either intravenously or orally.
The dosage may be adjusted based on the infant's response to therapy and tolerance.
Who Shouldn't Take Caffeine Citrate?
Caffeine citrate is contraindicated in infants with:
- Known hypersensitivity to caffeine or any of the components of caffeine citrate.
- Severe untreated gastrointestinal reflux, as caffeine may worsen reflux symptoms.
- Severe renal or liver impairment without proper monitoring, as it can alter caffeine clearance.
Advice From The Pharmacist
Caregivers and healthcare providers should be advised to:
- Administer caffeine citrate exactly as prescribed, whether intravenously or orally, and monitor the infant’s breathing, heart rate, and general condition while on the medication.
- Watch for signs of caffeine overdose, such as jitteriness, tremors, increased heart rate, vomiting, or irritability.
- Report any signs of gastrointestinal issues, such as increased reflux, feeding intolerance, or vomiting, as caffeine can exacerbate these conditions.
- Ensure proper dosing, especially since the dosage is weight-based and may need adjustment as the infant grows.
- Store the medication properly, and if using an oral solution, follow storage instructions and shake the solution well before administering.
Side Effects of Caffeine Citrate
Common Side Effects
- Jitteriness or restlessness
- Feeding intolerance or vomiting
- Increased heart rate (tachycardia)
- Irritability
- Diuresis (increased urine output)
Uncommon/Severe Side Effects
- Seizures: Rare, but possible with high doses or sensitivity to caffeine.
- Tachyarrhythmias: Abnormal heart rhythms or excessively fast heartbeats, especially in infants with pre-existing heart conditions.
- Necrotizing Enterocolitis (NEC): Though rare, caffeine use has been associated with an increased risk of NEC, a severe intestinal condition in premature infants.
Risks and Warnings of Caffeine Citrate
Caffeine Toxicity: Premature infants are particularly sensitive to caffeine, and too high a dose can cause serious side effects like seizures or abnormal heart rhythms. Blood levels of caffeine should be monitored, particularly if therapy is prolonged.
GI Reflux and Feeding Intolerance: Caffeine citrate can exacerbate gastroesophageal reflux or feeding intolerance, leading to increased vomiting or discomfort in some infants.
Necrotizing Enterocolitis (NEC): There is a small risk of developing NEC in premature infants treated with caffeine, although the benefit of treating apnea generally outweighs this risk. Infants should be monitored for any signs of gastrointestinal distress.
Interactions with Caffeine Citrate
Common Drug Interactions
Caffeine citrate may interact with other medications, including:
- Anticonvulsants: Caffeine can reduce the effectiveness of medications like phenobarbital, which may require dose adjustments.
- Drugs That Affect the CNS: Such as other stimulants or depressants, as they may enhance or counteract the effects of caffeine citrate.
- Cimetidine and Other Drugs That Affect Metabolism: Cimetidine can reduce caffeine metabolism, increasing the risk of side effects.
Caregivers and healthcare providers should inform the prescriber of any other medications or supplements the infant is receiving.
Alternatives to Caffeine Citrate
Alternative treatments for apnea of prematurity include:
- Theophylline: Another methylxanthine used for treating apnea of prematurity, though it is less commonly used than caffeine due to a narrower therapeutic window and more side effects.
- Non-Pharmacological Interventions: Including continuous positive airway pressure (CPAP) or mechanical ventilation for infants with more severe respiratory distress.
The choice of treatment depends on the severity of apnea and the infant’s overall health and response to therapy.
