Methylxanthine (Apnoea of Prematurity) Pregnancy: C — not relevant (neonatal drug)

Caffeine Citrate

Brand names: Peyona

Adult dose

Dose: N/A — neonatal drug only

Route: N/A

Frequency: N/A

Not used in adults.

Paediatric dose

Dose: 20 mg/kg

Route: IV or Oral

Frequency: Loading dose then 5–10mg/kg/day

Max: 20mg/kg loading dose

Loading: 20mg/kg caffeine citrate IV/oral over 30 min. Maintenance: 5–10mg/kg OD starting 24h after loading. Continue until 33–34 weeks corrected gestational age.

Paediatric weight-based calculator

Patient weight (kg)

Loading: 20mg/kg caffeine citrate IV/oral over 30 min. Maintenance: 5–10mg/kg OD starting 24h after loading. Continue until 33–34 weeks corrected gestational age.

Clinical pearls

CAP trial: caffeine reduces BPD, cerebral palsy, and cognitive impairment in very preterm neonates
Caffeine citrate 20mg = caffeine base 10mg — do NOT confuse the two
Both IV and oral bioavailability equivalent — switch to oral when feeds tolerated
Continue until infant is apnoea-free for 5–7 days and ≥33 weeks corrected age
Also used to facilitate extubation from mechanical ventilation in preterms

Contraindications

Hypersensitivity
Concurrent use of other methylxanthines (theophylline)

Side effects

Tachycardia
Agitation and irritability
GI upset
Hypoglycaemia (rare)
Diuresis

Interactions

Phenobarbital — induces caffeine metabolism (may need higher dose)
Theophylline — do not use together (same class)

Monitoring

Heart rate (tachycardia)
Respiratory rate and apnoea monitor
Serum caffeine levels if toxicity suspected (target 15–35 mg/L)

Reference: BNFc; CAP trial (NEJM 2006); BAPM Caffeine Guidelines; BNF for Children. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways