Caffeine Citrate is used for the management of apnea in premature infants.

Caffeine is chemically related to other methylxanthines such as theophylline and theobromine. It acts as a bronchodilator, central nervous system stimulant, cardiac stimulant, and mild diuretic. Although the exact mechanism in treating apnea of prematurity is not fully understood, several proposed actions include:

• stimulation of the respiratory center
• increased minute ventilation
• reduced sensitivity threshold to carbon dioxide (hypercapnia)
• enhanced response to elevated carbon dioxide levels
• increased skeletal muscle tone
• reduced diaphragm fatigue
• increased metabolic rate
• increased oxygen consumption

These effects are mainly due to the blocking of adenosine receptors (A1 and A2 subtypes) by caffeine.

Loading Dose: Dose of Caffeine Citrate-20 mg/kg. Route-Intravenous infusion (over 30 minutes) by using a syringe infusion pump. Frequency- One Time.

Maintenance Dose: Dose of Caffeine Citrate-5 mg/kg. Route-Intravenous infusion (over 10 minutes) by using a syringe infusion pump. Frequency-Every 24 hours (beginning 24 hours after the loading dose).

The duration of treatment of apnea of prematurity in the clinical trial was limited to 10 to 12 days. The safety and efficacy of caffeine citrate for longer periods of treatment have not been established. Vials containing visible particulate matter should be discarded. For single use only. Any unused solution should be discarded.

Limited information is available regarding drug interactions of caffeine in premature infants. Based on adult data, lower doses of caffeine may be required when used with drugs that reduce caffeine clearance (e.g., cimetidine, ketoconazole), while higher doses may be needed with drugs that enhance its clearance (e.g., phenobarbital, phenytoin). Conversion between caffeine and theophylline has been observed in preterm neonates; therefore, their combined use is not advised.

Reported adverse effects include rare cases of sepsis, bleeding, necrotizing enterocolitis, gastritis, gastrointestinal hemorrhage, acidosis, cerebral hemorrhage, breathing difficulty, lung edema, dry skin, rash, skin damage, and renal failure.

Pregnancy Category C. Caffeine passes into breast milk. Mothers breastfeeding infants treated with caffeine citrate should avoid consuming caffeine-containing foods, drinks, or medications.

Caffeine citrate should be used carefully in infants with seizure disorders, cardiovascular conditions, or impaired kidney or liver function. Monitoring of serum caffeine levels is recommended, and dosage adjustments should be made to prevent toxicity.

Toxicity is associated with serum caffeine levels above 50 mg/L. Symptoms of overdose in premature infants include fever, rapid breathing, insomnia, tremors, increased muscle tone, seizures, vomiting, high blood sugar, elevated blood urea nitrogen, and increased white blood cell count. Caffeine levels may decrease after exchange transfusion. Seizures may be treated with intravenous diazepam or barbiturates such as pentobarbital sodium.

Painkiller Muscle Relaxant

Store below 30°C. Protect from light and keep out of reach of children.