Caffeine Citrate

How it works

It stimulates the respiratory centre and increases sensitivity to carbon dioxide, largely through antagonism of adenosine receptors, reducing apnoeic episodes.

Prescribing in practice

• It has a narrow therapeutic range in neonates and can cause tachycardia, cardiac arrhythmias, jitteriness and feed intolerance if exposure is excessive.
• Dosing in this vulnerable population should follow a children's formulary, and care is needed to distinguish caffeine citrate from caffeine base when prescribing.
• Treatment is usually continued until the infant has been free of apnoea for a sustained period before discontinuation is considered.

Monitoring

Monitor heart rate, frequency of apnoeic episodes and feeding tolerance, with plasma levels checked only if toxicity or treatment failure is suspected.

Counselling the patient

• This medicine helps your baby's breathing by reducing pauses in breathing.
• The team will watch your baby's heart rate and feeding while on treatment.
• Let staff know if you notice your baby becoming very jittery or unsettled.

Evidence & guidelines

The CAP trial showed caffeine therapy for apnoea of prematurity reduced bronchopulmonary dysplasia and improved neurodevelopmental outcomes.