Pronunciation
ka-FEENSI-trate [Pronunciation]

Trade Name(s)

• Cafcit

Pregnancy Category
Category C

Ther. class.
central nervous system stimulants

Pharm. class.
respiratory stimulants

Short-term treatment of idiopathic apnea of prematurity in infants between 28 and <33 wk gestational age.

• Increases levels of cyclic AMP by inhibiting phosphodiesterase.

• Acts as a bronchial smooth muscle relaxant.

• Suggested mechanisms of action include:

» Stimulation of the respiratory center,

» Increased minute ventilation,

» Decreased threshold to hypercapnea,

» Increased response to hypercapnea,

» Increased skeletal muscle tone,

» Decreased diaphragmatic fatigue,

» Increased metabolic rate,

» Increased oxygen consumption.

Therapeutic Effect(s):
Decrease in periods of apnea.

Absorption: IV administration results in complete bioavailability; also absorbed after oral administration.

Distribution: Rapidly distributes to the brain; CSF levels in neonates are similar to plasma levels.

Metabolism and Excretion: Mostly metabolized by the liver (cytochrome P450 1A2) enzymes; 3–8% converted to theophylline.

Half-life: Infants >9 mo, Children, and Adults: 5 hr; Neonates—3–4 days.

TIME/ACTION PROFILE

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	24 hr
PO	rapid	30 min–2 hr	24 hr

Contraindicated in:
Hypersensitivity.

Use Cautiously in:

• History of seizure disorders;

• History of cardiovascular disease;

• Pedi: Increased risk of toxicity in neonates with impaired hepatic or renal function.

CNS: insomnia, irritability, jitteriness, restlessness.

CV: tachycardia.

GI: NECROTIZING ENTEROCOLITIS, feeding intolerance, gastritis, GI bleeding.

GU: increased urine output.

Derm: dry skin, rash, skin breakdown.

Endo: hypoglycemia, hyperglycemia.

MS: muscle tremors, twitches.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Drug-Drug

• Cimetidine , fluconazole , and ketoconazole ↓ metabolism (dose reduction of caffeine may be necessary).

• Phenobarbital and phenytoin may ↑ caffeine metabolism (↑ doses of caffeine may be necessary).

• Because caffeine is a significant metabolite of theophylline , concurrent administration is not recommended.

• IV (Neonates): Loading dose—20 mg/kg caffeine citrate (10 mg/kg caffeine base)..

• IV, PO (Neonates): Maintenance dose—starting 24 hr after loading dose 5 mg/kg caffeine citrate (2.5 mg/kg caffeine base) q 24 hr..

• Solution for injection: 20 mg/mL caffeine citrate (10 mg/mL caffeine base) in 3-mL vials

• Oral solution: 20 mg/mL caffeine citrate (10 mg/mL caffeine base) in 3-mL vials

• Assess respiratory status frequently throughout therapy.

• Monitor patient for signs of necrotizing enterocolitis (abdominal distension, vomiting, bloody stools, lethargy). May be fatal.

Lab Test Considerations

• Monitor serum caffeine levels before and periodically during therapy in infants previously treated with theophylline or in infants whose mothers consumed caffeine before delivery.

» Monitor serum glucose levels. May cause hypoglycemia or hyperglycemia.

• Therapeutic range: 8–20 mcg/mL.

Toxicity and Overdose

• Serum caffeine levels of >50 mcg/mL have been associated with serious toxicity. Monitor serum levels and adjust dose in neonates with impaired hepatic or renal function to avoid toxicity.

• Ineffective breathing pattern (Indications)

PO: Maintenance doses may also be administered orally.

IV Adminstration:

• pH:
4.7.

• Intermittent Infusion:
Solution should be clear, without particulate matter.

• Rate:
Initial loading dose should be administered over 30 min. Maintenance doses may be administered over 10 min every 24 hr beginning 24 hr after loading dose. Syringe pump should be used to ensure accurate delivery.

• Syringe Compatibility:

» alprostadil

» amikacin

» aminophylline

» calcium gluconate

» cefotaxime

» cimetidine

» clindamycin

» dexamethasone

» dobutamine

» dopamine

» epinephrine

» fentanyl

» gentamicin

» heparin

» isoproterenol

» lidocaine

» metoclopramide

» morphine

» nitroprusside

» pancuronium

» penicillin G

» phenobarbital

» phenylephrine

» sodium bicarbonate

» vancomycin

• Syringe Incompatibility:

» acyclovir

» furosemide

» lorazepam

» nitroglycerin

» oxacillin

» pantoprazole

• Y-Site Compatibility:

» doxapram

» levofloxacin

• Additive Compatibility:

» amino acids

» calcium gluconate

» D5W

» D50W

» dopamine

» fat emulsion

» heparin

» fentanyl

• Instruct parent on correct technique for administration. Measure oral dose accurately with a 1-mL syringe. If apnea events continue, consult health care professional; do not increase dose.

• Advise parent to consult health care professional immediately if signs of necrotizing enterocolitis occur.

Decrease in apneic episodes in premature infant.