CAFFEINE

Background and Date of Approval

Caffeine citrate is a central nervous system stimulant that received approval for medical use on 21st September 1999. It is used primarily in the treatment of apnea in premature infants, where it functions to stimulate breathing.

Uses

Caffeine citrate is used primarily to treat apnea of prematurity in newborns, particularly premature infants. It helps stimulate the central nervous system to promote regular breathing patterns and prevent respiratory issues.

How is it administered?

Caffeine citrate is administered either as an oral solution or as an injection. For oral administration, the usual dose is based on the infant's weight, typically starting with a loading dose followed by maintenance doses. For injection, it is usually given intravenously, with similar dosing protocols involving a loading dose followed by maintenance doses, depending on the patient's response. The exact dosage and frequency are determined by the healthcare provider based on the infant's condition and weight. Both forms should be administered under medical supervision.

Side Effects

Side effects are unwanted symptoms caused by medicines. Although all drugs can cause side effects, not everyone experiences them. Common side effects of Caffeine citrate: Irritability Restlessness Jitteriness Feeding intolerance Increased gastric aspirate Tachycardia Increased urine flow rate Rash Dry skin Serious side effects of Caffeine citrate: Necrotizing enterocolitis Cerebral hemorrhage Sepsis Kidney failure Acidosis Disseminated intravascular coagulation

Warnings

Necrotizing Enterocolitis: Use with caution as it has been associated with a higher risk, particularly in preterm infants. Monitor for signs of this condition. Seizures: Use with caution in infants with seizure disorders due to the risk of caffeine overdose causing seizures. Cardiovascular Disease: Caffeine increases heart rate and stroke volume; use with caution in infants with cardiovascular conditions. Renal and Hepatic Impairment: Administer with caution in infants with impaired renal or hepatic function and monitor caffeine serum levels to avoid toxicity. Caffeine Toxicity: Monitor caffeine serum levels to prevent toxicity, especially if levels exceed 50 mg/L. Use in Preterm Infants: Carefully assess and rule out other causes of apnea before using caffeine citrate for apnea of prematurity.

Precautions

Caffeine citrate should only be used for apnea of prematurity after other possible causes like brain disorders, anaemia, or infections have been ruled out. It should be used carefully in infants with a history of seizures, as too much caffeine can trigger seizures. Infants with heart, kidney, or liver problems need special care, and caffeine levels should be checked to avoid toxicity. Also, infants who were treated with theophylline or whose mothers consumed caffeine during pregnancy should have their caffeine levels tested before starting treatment.

Word of Advice

Caffeine citrate requires careful monitoring, particularly in infants with seizure disorders or cardiovascular conditions. Renal and hepatic function should be assessed before initiating treatment. During therapy, regular monitoring of caffeine serum levels and glucose concentration is recommended to prevent potential toxic effects.

References

1. KD Tripathi, Essentials of Medical Pharmacology, CNS stimulants and cognition enhancers7th edition, 2013, 488 2. Abdel-Hady H, Nasef N, Shabaan AE, Nour I. Caffeine therapy in preterm infants. https://pmc.ncbi.nlm.nih.gov/articles/PMC4637812/ 3. Evans J, Richards JR, Battisti AS. Caffeine. [Updated 2024 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519490/ 4. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020793s019lbl.pdf 5. https://www.ema.europa.eu/en/documents/product-information/peyona-epar-product-information_en.pdf

Frequently Asked Questions

What is caffeine citrate used for?

Caffeine citrate is used to treat apnea of prematurity in newborns, particularly premature infants, by stimulating regular breathing.

Is caffeine citrate a stimulant?

Yes, caffeine citrate is a central nervous system stimulant. It helps stimulate breathing and increases respiratory drive in premature infants.

How to give IV caffeine citrate?

IV caffeine citrate is given as an injection or infusion, typically starting with a loading dose followed by maintenance doses. The exact dosage and frequency depend on the infant’s weight and response, as determined by a healthcare provider.

Is caffeine citrate the same as caffeine?

Caffeine citrate is a specific form of caffeine combined with citric acid, making it more suitable for medical use in neonates. While both are derived from caffeine, caffeine citrate is used in lower doses for treating apnea in premature infants.

What is the role of caffeine citrate in neonates or babies?

Caffeine citrate helps stimulate the central nervous system in neonates, particularly premature babies, to regulate their breathing. It is mainly used to treat apnea of prematurity, a condition where infants temporarily stop breathing.

Available Brands 8

Written By: Muskan Patel, M.Pharm

Reviewed By: Dr. Vishwa Patel, MBBS