caffeine citrate

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caffeine citrate

(ka-feensi-trate) ,

Cafcit

(trade name)

Classification

Therapeutic: central nervous system stimulants
Pharmacologic: respiratory stimulants
Pregnancy Category: C

Indications

Short-term treatment of idiopathic apnea of prematurity in infants between 28 and <33 wk gestational age.

Action

Increases levels of cyclic AMP by inhibiting phosphodiesterase.
Acts as a bronchial smooth muscle relaxant.
Suggested mechanisms of action include:
  • Stimulation of the respiratory center,
  • Increased minute ventilation,
  • Decreased threshold to hypercapnea,
  • Increased response to hypercapnea,
  • Increased skeletal muscle tone,
  • Decreased diaphragmatic fatigue,
  • Increased metabolic rate,
  • Increased oxygen consumption.

Therapeutic effects

Decrease in periods of apnea.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability; also absorbed after oral administration.
Distribution: Rapidly distributes to the brain; CSF levels in neonates are similar to plasma levels.
Metabolism and Excretion: Mostly metabolized by the liver (cytochrome P450 1A2) enzymes; 3–8% converted to theophylline.
Half-life: Infants >9 mo, Children, and Adults: 5 hr; Neonates—3–4 days.

Time/action profile

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr
POrapid30 min–2 hr24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: History of seizure disorders;History of cardiovascular disease; Pediatric: Increased risk of toxicity in neonates with impaired hepatic or renal function.

Adverse Reactions/Side Effects

Central nervous system

  • insomnia
  • irritability
  • jitteriness
  • restlessness

Cardiovascular

  • tachycardia

Gastrointestinal

  • necrotizing enterocolitis (life-threatening)
  • feeding intolerance
  • gastritis
  • GI bleeding

Genitourinary

  • increased urine output

Dermatologic

  • dry skin
  • rash
  • skin breakdown

Endocrinologic

  • hypoglycemia
  • hyperglycemia

Musculoskeletal

  • muscle tremors
  • twitches

Interactions

Drug-Drug interaction

Cimetidine, fluconazole, and ketoconazole ↓ metabolism (dose reduction of caffeine may be necessary).Phenobarbital and phenytoin may ↑ caffeine metabolism (↑ doses of caffeine may be necessary).Because caffeine is a significant metabolite of theophylline, concurrent administration is not recommended.

Route/Dosage

Intravenous (Neonates) Loading dose—20 mg/kg caffeine citrate (10 mg/kg caffeine base).
Intravenous Oral (Neonates) Maintenance dose—starting 24 hr after loading dose 5 mg/kg caffeine citrate (2.5 mg/kg caffeine base) q 24 hr.

Availability (generic available)

Solution for injection: 20 mg/mL caffeine citrate (10 mg/mL caffeine base) in 3-mL vials
Oral solution: 20 mg/mL caffeine citrate (10 mg/mL caffeine base) in 3-mL vials

Nursing implications

Nursing assessment

  • Assess respiratory status frequently throughout therapy.
  • Monitor patient for signs of necrotizing enterocolitis (abdominal distension, vomiting, bloody stools, lethargy). May be fatal.
  • Lab Test Considerations: Monitor serum caffeine levels before and periodically during therapy in infants previously treated with theophylline or in infants whose mothers consumed caffeine before delivery.
    • Monitor serum glucose levels. May cause hypoglycemia or hyperglycemia.
  • Lab Test Considerations: Therapeutic range: 8–20 mcg/mL.
  • Serum caffeine levels of >50 mcg/mL have been associated with serious toxicity. Monitor serum levels and adjust dose in neonates with impaired hepatic or renal function to avoid toxicity.

Potential Nursing Diagnoses

Ineffective breathing pattern (Indications)

Implementation

  • Oral: Maintenance doses may also be administered orally.
  • Intravenous Administration
  • pH: 4.7.
  • Intermittent Infusion: Solution should be clear, without particulate matter.
  • Rate: Initial loading dose should be administered over 30 min. Maintenance doses may be administered over 10 min every 24 hr beginning 24 hr after loading dose. Syringe pump should be used to ensure accurate delivery.
  • Syringe Compatibility: alprostadil, amikacin, aminophylline, calcium gluconate, cefotaxime, cimetidine, clindamycin, dexamethasone, dobutamine, dopamine, epinephrine, fentanyl, gentamicin, heparin, isoproterenol, lidocaine, metoclopramide, morphine, nitroprusside, pancuronium, penicillin G, phenobarbital, phenylephrine, sodium bicarbonate, vancomycin
  • Syringe Incompatibility: acyclovir, furosemide, lorazepam, nitroglycerin, oxacillin, pantoprazole
  • Y-Site Compatibility: doxapram, levofloxacin
  • Additive Compatibility: amino acids, calcium gluconate, D5W, D50W, dopamine, fat emulsion, heparin, fentanyl

Patient/Family Teaching

  • Instruct parent on correct technique for administration. Measure oral dose accurately with a 1-mL syringe. If apnea events continue, consult health care professional; do not increase dose.
  • Advise parent to consult health care professional immediately if signs of necrotizing enterocolitis occur.

Evaluation/Desired Outcomes

  • Decrease in apneic episodes in premature infant.

caf·feine cit·rate

citrated caffeine, a mixture of equal parts of caffeine and citric acid; more water soluble than caffeine.
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References in periodicals archive ?
Cafcit was developed and marketed by OPR in close collaboration with Boehringer Ingelheim Pharmaceuticals, Inc.
We look forward to utilizing the company's expertise to educate physicians and patients regarding the use of Cafcit in treating infants in the U.
Cafcit Injection received FDA approval in November 1999 and Cafcit Oral Suspension received FDA approval in April 2000.
CAFCIT treatment, which was studied for a maximum of 10 to 12 days, significantly eliminated apnea of prematurity events on day two of treatment.
Overall, this double-blind clinical trial found that adverse events were similar between CAFCIT and placebo.
This study has shown that CAFCIT is significantly more effective than placebo in reducing the number of apneic episodes by at least 50%, as well as eliminating apnea in more than 25% of treated infants.
COLUMBUS) New Study Shows CAFCIT (Caffeine Citrate) Safe and
COLUMBUS) FDA Approves CAFCIT Oral Solution To Treat Pre-Term
Given once daily, CAFCIT has been shown to reduce the frequency of apnea spells in pre-term babies," said Adam A.
The long half-life (~3-4 days in neonates) of CAFCIT allows for once daily dosing.
CAFCIT is the only product approved for the treatment of AOP, a condition in which cessation of breathing in preterm infants can cause dangerously low levels of blood oxygen.
However, until the introduction of CAFCIT, it was necessary to prepare caffeine citrate solution in the hospital pharmacy -- a practice that requires time and precise compounding.