Caffeine Citrate

Caffeine Citrate – intravenous

Administered intravenously, caffeine citrate is used in premature babies as a treatment for short-term apnea to ensure proper and safe breathing.

Overview

Caffeine citrate is a medication that is given to treat short-term apnea in newborn babies. It is administered when a premature baby (those born between 28 and 32 weeks into gestation) temporarily stops breathing, in order to help the baby learn to breathe normally.

For at least a decade, doctors have been giving caffeine to newborn babies to stimulate breathing where there are problems. It works by helping the immature lungs of the infant to learn and remember how to breathe. Caffeine citrate is a relatively low-risk drug that is designed as a short- to medium-term treatment for apnea and breathing difficulties.

The medication is given by a doctor to the baby via the intravenous (injection) route into a vein every 24 hours until either the symptoms have improved, or the drug has been deemed to be ineffective. During this treatment time, the infant will usually be required to stay under medical supervision. This is because many side effects in babies are difficult to determine; therefore, a trained pediatric professional will be experienced in detecting these before they become serious.

The drug is also marketed and sold under the brand name Cafcit in the United States.

Conditions treated

  • Short-term apnea of prematurity

Type of medicine

  • Central nervous system stimulant

Side effects

As with most drugs, there are various side effects that can be experienced by patients taking this medication. If you are experiencing any side effects that become particularly persistent or uncomfortable, you should ask your doctor for advice and potentially seek another treatment.

You should closely monitor your baby through its treatment, although it is likely the infant will be required to stay in the hospital while the treatment is taking place so that he or she can be closely monitored. Common side effects to look out for, if possible, include:

  • Nausea and vomiting
  • Upset tummy
  • Trouble sleeping or irregular sleep patterns
  • Excessive crying or whimpering
  • Loss of appetite or poor feeding habits
  • Restlessness
  • Dry skin
  • Rash or spots on the skin in various places
  • Headache
  • Inability to gain weight at the normal pace

More serious side effects to look out for in infants taking caffeine citrate include:

  • Difficulty breathing
  • Irregular heartbeat
  • Change in the speed of the heartbeat
  • Change in the amount of urine passed - more or less than usual
  • Changes in vision, such as blurriness

Some conditions can also develop as a result of taking caffeine citrate. Your doctor will be able to monitor for signs of these during the treatment of your baby. The course will be stopped if any of the following are noticed and are thought to be a greater risk than the health benefits of taking the drug. The conditions include:

  • Hyperglycemia, hypoglycaemia3
  • Gastrointestinal disturbances (symptomized by vomiting, abdominal pain or distension)
  • Seizures, febrile convulsions
  • Necrotising enterocolitis2
  • Tachypnoea
  • Tachycardia
  • Hypertension (high blood pressure)
  • Hyperreflexia
  • Cardiac arrhythmias
  • Diuresis and dehydration
  • Bradycardia

Dosage

The dosage given to each baby will depend on individual weight. The first dose is usually 20 mg per kg of body weight, which is then administered to the baby over a 30-minute period. Following this, a maintenance dose of 5 mg per kg of body weight will be applied over a ten minute period every 24 hours until the baby shows signs of improved breathing, or until the medication has been deemed ineffective.

The administration must be performed by a trained doctor or health care professional, who should monitor the baby closely for signs of toxicity. There is a serious risk of toxicity for dosages with serum levels that are greater than 50 mg/l. The current caffeine levels in the baby should be monitored before the treatment begins.

Major drug interactions

As with any drug, there are the possibilities of interactions when taken at the same time as some other medications. You should always tell your doctor about any other medications that are being taken. There are certain drugs that cause a major reaction when taken together and therefore should never be taken by a patient at the same time. There are 88 drugs (446 generic and brand names) that have some level of interaction with caffeine citrate. Several of these drugs have been found to have a major reaction with caffeine citrate. These are:

  • Phenobarbital
  • Phenytoin
  • Theophylline
  • Tizanidine
  • Zanaflex (tizanidine)
  • Cimetidine
  • Ketoconazole

You should always tell your doctor about any other medications that have been prescribed to your baby. Not doing so could be very dangerous to your baby’s health and safety.

Warnings

Food, nicotine and alcohol interactions

There are several foods and other substances that can interact with caffeine. In general, any products that contain nicotine and alcohol could react with the drug. If you are a smoker, it is especially important that you do not smoke around a newly born baby, particularly one that is being treated with caffeine citrate.

Any products that contain alcohol (ethanol) should also be avoided in those taking caffeine citrate or other caffeine-based drugs. Those that take both at the same time risk heightened symptoms such as headaches, nausea, vomiting, faint feeling, dizziness, light-headedness, loss of judgment and confusion.

High blood pressure/hypertension

Caffeine is a central nervous system (CNS) stimulant. CNS stimulants put patients at increased risk of developing high blood pressure. Where high blood pressure is already present, patients should be prescribed an alternative treatment. Those who are also at risk of developing high blood pressure – or those that have suffered from it in the past – should not take this or any other medication containing caffeine.

Pregnancy and caffeine citrate

If you are pregnant or breastfeeding, you must let your doctor know before taking this drug yourself. The drug can be used during pregnancy, but there are certain complications that women may experience during pregnancy that may render the drug unsuitable.

Breastfeeding

This medication should not be used by mothers who are breastfeeding as the substance can get into the breast milk and therefore can be consumed by a nursing baby. If consumed orally by a nursing baby, the medication can cause side effects in the baby.

Storage

This medication should be kept at between 20 to 25 degrees centigrade. Once the solution has been diluted ready for injection, it should be administered immediately.

If there is any excess solution left over after treatment sessions, you should discard immediately by flushing and rinsing the area thoroughly. As with any medicine, caffeine citrate should be kept in a secure and locked medical cabinet to prevent it from getting into the wrong hands. Always keep caffeine citrate solution clearly marked and labeled in the packaging with which it was supplied.

Do not use after 24 hours of mixing the solution.

Caffeine citrate should be disposed of safely at all times. The safest way to do this is by calling a drug take-back scheme. These are available to both medical professionals and the general public and are an easy way to get rid of unwanted or expired medication. Initiated by the FDA, these schemes will pick up old medication and recycle or dispose of them properly so that you don’t have to worry.

Summary

Caffeine citrate has been used for several years now as an effective treatment to aid breathing in premature babies. There have been various animal studies that have not shown there to be a serious risk in administering this drug to infants; therefore, it has become a popular and relatively safe treatment that is often used in the first instance of breathing problems in prematurely born infants.

There are of course some risks and possible side effects that could result from using this treatment. Most side effects, however, are minor and are considered to be less of a risk to the baby than not taking the medication in most cases. Due to the difficulty of identifying side effects and symptoms like headaches and stomach pains in babies, it is important that the infant is closely monitored throughout the treatment by an experienced pediatric health care professional in order to detect any potentially dangerous health implications.

Provided all usage instructions are adhered to, and the patient’s parents or guardians are open and honest about any other medications that have been given to the baby, the overwhelming majority of patients who are treated with caffeine citrate will experience success in treating their breathing problems without any severe side effects or discomforts. Parents and guardians should also let their doctors known of any other conditions that the infant has suffered from.

The treatment is not intended as a long-term medication. If improvements in the condition are not seen within a few days of the treatment course starting, an alternative medication may be recommended for your baby.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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