caffeine citrate

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caffeine citrate

(ka-feensi-trate) ,


(trade name)


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


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


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.


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

IVrapidend of infusion24 hr
POrapid30 min–2 hr24 hr


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


  • tachycardia


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


  • increased urine output


  • dry skin
  • rash
  • skin breakdown


  • hypoglycemia
  • hyperglycemia


  • muscle tremors
  • twitches


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.


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)


  • 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.
Drug Guide, © 2015 Farlex and Partners

caf·feine cit·rate

citrated caffeine, a mixture of equal parts of caffeine and citric acid; more water soluble than caffeine.
Farlex Partner Medical Dictionary © Farlex 2012
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References in periodicals archive ?
Theophylline (given intravenously in 30 minutes) loading doses 4.8 mg/kg (related to 6 mg/kg) and maintenance dose 2 mg/kg (up to 2.8 mg/kg) every 12 hour (related to 2.5-3.5 mg/kg) - caffeine citrate: loading dose 20 mg/kg (complementary to 10 mg/kg caffeine-base) given IV in 30 minutes and maintenance doses 5 mg/kg (up to 10 mg/kg) (consonant to 2.5-5 mg/kg caffeine-base) given IV in 30 minutes.
Anesthesiologist was called and she was treated for PDPH with analgesics, caffeine citrate and hydration, with symptomatic improvement in the following days.
Harer, M.D., from the University of Wisconsin in Madison, and colleagues conducted a secondary analysis of the Assessment of the Worldwide Acute Kidney Injury Epidemiology in Neonates study to examine the association between caffeine citrate administration and AKI in 675 preterm neonates (55.4 percent male; mean gestational age of 28.9 weeks) in the first seven days after birth (neonates born from Jan.
Shearman, "Caffeine citrate treatment for extremely premature infants with apnea: population pharmacokinetics, absolute bioavailability, and implications for therapeutic drug monitoring," Therapeutic Drug Monitoring, vol.
A loading dose of caffeine citrate in a dose of 20 mg/kg was administered intravenously over 30 mins with maintenance dose of 5-10 mg/kg/day IV once daily.
The product portfolio consists of caffeine citrate injection and caffeine citrate oral solution for apnoea of prematurity in pre-term babies, sodium chloride oral solution for correction of hypernatremia in infants, sodium citrate oral solution for the prevention of respiratory complications in women undergoing caesarean sections and peppermint water for symptomatic relief of minor upper digestive complaints.
Cipla Limited introduced a number of new drugs and formulations, such as Adgain (vital nutritional supplement for hair loss); Capnea (caffeine citrate injection and oral solution) for apnoea of prematurity in infants; Caspogin (caspofungin acetate injection) for new antifungal for life-threatening fungal infections; Endobloc (ambrisentan tablets); Esomac (esomeprazole tablets); Evocort (formoterol and mometasone rotacaps)-new once-daily asthma controller therapy; Isablac (lactulose and isphaghula husk granules), and Ivabeat (ivabradine tablets) drug for coronary artery disease and chronic heart failure.
Experts say they have no reports of Askit ingredients - aspirin, caffeine citrate and the antiinflammatory drug aloxiprin - causing physical addiction.
M2 PHARMA-October 4, 2012-Sagent Pharmaceuticals unveils nervous system stimulants Caffeine Citrate Injection USP and Caffeine Citrate Oral Solution USP(C)2012 M2 COMMUNICATIONS
Caffeine citrate has proven to be of short- and long-term benefit in treating the breathing disorders of apnea of pre-maturity and bronchopulmonary dysplasia in premature infants.
Theophylline has been most extensively used, but it has been suggested that caffeine citrate may be the agent of choice.
* Caffeine citrate (Cafcit) for short-term treatment of apnea.