Usual Pediatric Dose for Apnea of Prematurity

Caffeine Citrate:
28 Weeks to Less Than 33 Weeks Gestational Age:

• Loading Dose: 20 mg/kg IV over 30 minutes one time.
• Maintenance Dose: 5 mg/kg orally or IV over 10 minutes every 24 hours.
• Treatment Duration: Safety and efficacy of this drug for treatment of apnea of prematurity have not been established beyond 12 days.

Renal Dose Adjustments

Caffeine Citrate: Use with caution in infants with impaired renal function; monitor serum drug concentrations and adjust dose accordingly to avoid toxicity.

Liver Dose Adjustments

Caffeine Citrate: Use with caution in infants with impaired hepatic function; monitor serum drug concentrations and adjust dose accordingly to avoid toxicity.

Precautions

Safety and efficacy of caffeine citrate for treatment of apnea of prematurity have only been established in pediatric patients 28 weeks to less than 33 weeks gestational age.

Consult WARNINGS section for additional precautions.

Dialysis

Caffeine Citrate: Data not available.

Other Comments

Caffeine Citrate:
Administration Advice:

• Begin the maintenance dose 24 hours after the loading dose.
• Use a syringe infusion pump for IV administration.
• Dose tapering on treatment cessation is unnecessary due to the slow drug elimination in this patient population.
• Do not administer this drug by intramuscular, subcutaneous, intrathecal, or intraperitoneal injection.
• Discard any unused portion of the medication, and oral solution vials containing discolored solution or visible particulate matter.

• Consult the manufacturer product information.

• Consult the manufacturer product information.

• The dose of caffeine base is one-half the dose when expressed as caffeine citrate (e.g., 10 mg of caffeine base = 20 mg of caffeine citrate).
• Caffeine levels associated with clinical benefit ranged from 8 to 30 mg/L and there are normally no safety concerns with plasma levels below 50 mg/L.
• Caffeine has been shown to significantly increase respiratory rate and significantly reduces the number of short and prolonged apnea attacks in premature infants.
• Caffeine has demonstrated the ability to reduce pulmonary resistance and increase lung compliance with a concomitant reduction in the requirement for inspired oxygen in preterm infants.
• No withdrawal symptoms have been reported following caffeine citrate treatment of less than 3 weeks.
• Overdosage: Caffeine levels have been shown to decrease after exchange transfusions. Convulsions may be treated with IV diazepam or a barbiturate (e.g., pentobarbital sodium).

• Prior to treatment initiation of caffeine citrate, measure baseline serum levels of caffeine in infants previously treated with theophylline and those born to mothers who consumed caffeine prior to delivery.
• Monitor patients for approximately one week after treatment cessation of caffeine citrate due to risk of apnea recurrence.
• Obtain blood samples for monitoring caffeine levels just before the next dose of caffeine citrate in the case of inadequate patient response and 2 to 4 hours after the previous dose when suspecting toxicity.

• Consult a healthcare provider if your baby continues to have apnea events; do not increase the dose of caffeine citrate without medical consultation.

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