Neonatal Drug Therapy Manual

Caffeine

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated March 5, 2024 - 2:33pm

Alternate Name(s): 
Caffeine Injection , Peyona
Classification: 
Respiratory Stimulant
Original Date: 
March 1992
Revised Date: 
Dec 2023
Indications: 
  • Apnea of prematurity
Administration: 
  • IV
    • Loading dose: over 30 minutes
    • Maintenance dose:
      • over 10 minutes
  • PO
Dosage: 
  • Loading Dose: 10 mg/kg/dose (of caffeine base) IV/PO
  • Maintenance Dose: 2.5 - 5 mg/kg/dose (of caffeine base) IV/PO once daily

 

  • NOTE: caffeine citrate 20 mg = caffeine base 10 mg
Side Effects: 
  • CNS: jitteriness, irritability
  • CVS: tachycardia
  • GI: esophageal sphincter tone decrease
  • Renal: diuresis
Parameters to Monitor: 
  • HR
  • Number and severity  of apnea spells
  • Therapeutic drug levels (not routinely done):
    • Trough: (sampling time: 0 - 4 hours before next dose): 40-100 micromol/L
Reconstitution and Stability: 
  • N/A
Compatibility: 

- Solutions Compatible: Dextrose up D25W, 0.9% NaCl,  dextrose-saline combinations

- Y-Site Compatible: calcium gluconate, dobutamine, dopamine, epinephrine, fentanyl, heparin, morphine, KCl up 20 mmol/L, TPN, vancomycin

- Incompatible: acyclovir, cloxacillin, furosemide, lorazepam, pantoprazole, SMOF

Notes: 
  • Give daily dose in the morning.  If loading dose is given prior to midnight, give the first maintenance dose the following day.
References: 

- Taketomo CK, Hodding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

- Trissel LA. Handbook on Injectable Drugs. 19th Edition. Bethesda: American Society of health-System Pharmacists: 2017

- King JC. King Guide to Parenteral Admixtures. Internet Edition.

- Senarathna SMDKG, Strunk T, Petrovski M, Woodland S, Martinez J, Chuang VTG, Batty KT. Physical compatibility of lipid emulsions and intravenous medications used in neonatal intensive care settings. Eur J Hosp Pharm. 2023 Oct 23:ejhpharm-2023-00387

 

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