Home Drug Guide Caffeine Citrate

Drug Guide

Generic Name

Caffeine Citrate

Brand Names Cafcit

Classification

Therapeutic: Stimulant, Respiratory agent

Pharmacological: Xanthine derivative

FDA Approved Indications

Apnea of premature infants

Mechanism of Action

Caffeine citrate primarily acts as an antagonist of adenosine receptors in the central nervous system, leading to increased neuronal activity and stimulation of the respiratory center in the brain.

Dosage and Administration

Adult: Typically not used in adults; neonatal dosing is standard for apnea of prematurity.

Pediatric: Initial dose: 20 mg/kg IV loading dose, followed by maintenance doses of 5-10 mg/kg every 24 hours.

Geriatric: Not specifically indicated; use cautiously if applied.

Renal Impairment: Adjust dose due to decreased clearance; monitor levels.

Hepatic Impairment: Adjust dose; metabolized in the liver, but less data available.

Pharmacokinetics

Absorption: Rapidly absorbed intravenously.

Distribution: Widely distributed, crosses blood-brain barrier.

Metabolism: Metabolized in the liver, primarily by CYP1A2.

Excretion: Excreted mainly via the kidneys.

Half Life: 3-7 hours in neonates, shorter in older children and adults.

Contraindications

Known hypersensitivity to caffeine or other xanthines.

Precautions

Use cautiously in infants with cardiac arrhythmias, seizure disorders, or hepatic impairment. Monitor serum levels in prolonged use.

Adverse Reactions - Common

Insomnia (Common)
Increased heart rate (Common)
Gastrointestinal upset (Less common)

Adverse Reactions - Serious

Arrhythmias (Rare)
Seizures (Rare)

Drug-Drug Interactions

Certain antibiotics (e.g., ciprofloxacin) may increase caffeine levels.
Sympathomimetic agents may potentiate cardiovascular effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, heart rate, and serum caffeine levels if applicable.

Diagnoses:

Risk for impaired gas exchange
Ineffective breathing pattern

Implementation: Administer IV slowly, monitor for adverse reactions and efficacy, especially in neonates.

Evaluation: Assess for resolution of apnea episodes, monitor for adverse effects.

Patient/Family Teaching

Inform caregivers about potential side effects such as irritability or feeding difficulties.
Advise on the importance of monitoring for jitteriness or unconventional breathing patterns.

Special Considerations

Black Box Warnings:

Use with caution due to potential for toxicity; overdose can cause serious cardiac and neurological effects.

Genetic Factors: Some individuals may metabolize caffeine faster or slower depending on genetic factors affecting CYP1A2.

Lab Test Interference: May interfere with certain clinical laboratory tests, including serum catecholamine levels.

Overdose Management

Signs/Symptoms: Seizures, cardiac arrhythmias, severe caffeine intoxication including hyperactivity, tremors, vomiting.

Treatment: Supportive care, activated charcoal if ingestion recent, monitoring and managing arrhythmias, seizure control as needed.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended storage conditions.