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Version control and change history 
 
Version Date from Date to Amendment 
1.0 November 2012 April 2017 Original version 
2.0 28 April 2017 Current Complete review 
    
    

  Department for Health and Ageing, Government of South Australia. All rights reserved. 

 

Clinical Guideline 
Caffeine Citrate 
 
 
Policy developed by: SA Maternal &amp; Neonatal Clinical Community of Practice       
Approved by  
Safety &amp; Quality Strategic Governance Committee on:  28 April 2017 
Next review due:         30 April 2020 
 
 

  
 
 

Summary The purpose of the Caffeine Citrate Neonatal Medication Guideline 
is to guide nursing, medical and pharmacy staff in the dosing and 
administration of caffeine citrate  
 
 

Keywords Caffeine citrate, neonatal medication guideline, caffeine, apnoea, 
neonatal apnoea, tachycardia, agitation, clinical guideline,  
Caffeine Citrate Neonatal Medication Guideline 
 

Policy history Is this a new policy?   N 
Does this policy amend or update an existing policy?  Y v1.0 
Does this policy replace an existing policy?  N 
If so, which policies?   
 

Applies to All Health Networks 
CALHN, SALHN, NALHN, CHSALHN, WCHN 
 

Staff impact All Clinical, Medical, Midwifery, Nursing,  Students, Allied Health, 
Emergency, Mental Health, Pathology, Pharmacy 
  

PDS reference CG016 
 

Neonatal Medication Guideline                                                             
 

 



South Australian Neonatal Medication Guidelines 

caffeine citrate   
 40mg/2mL injection, 20mg/mL oral solution 

  Department of Health, Government of South Australia. All rights reserved 

 

ISBN number:  978-1-74243-385-1 
Endorsed by:                         South Australian Maternal, Neonatal &amp; Gynaecology Clinical Reference Group 
Last Revised: 27/04/2017 
Contact: South Australian Neonatal Medication Guidelines Workgroup at: 

 Health:NeoMed@sa.gov.au  Page 1 of 3 
 

Note 
 
This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  

Information in this statewide guideline is current at the time of publication.  

SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 

Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 

If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 

This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 
 
 

 

Dose and Indications 

All doses must be prescribed as caffeine citrate. 

1mg of caffeine is equivalent to 2mg caffeine citrate 

Neonatal Apnoea  

Facilitation of Extubation 

Intravenous, Oral 

Loading Dose 

Loading dose 20mg/kg. A loading dose of up to 80mg/kg has been used. 

Maintenance Dose 

5 to 10mg/kg/dose every 24 hours, commencing 24 hours after the loading dose 

Maintenance doses of up to 20mg/kg have been used. 

 

 

Preparation and Administration 



South Australian Neonatal Medication Guidelines 

 caffeine citrate   
 40mg/2mL injection, 20mg/mL oral solution 

 

ISBN number:  978-1-74243-385-1 
Endorsed by:                         South Australian Maternal, Neonatal &amp; Gynaecology Clinical Reference Group 
Last Revised: 27/04/2017 
Contact: South Australian Neonatal Medication Guidelines Workgroup at: 

 Health:NeoMed@sa.gov.au  Page 2 of 3 
 

Intravenous 

To ensure clear orders ALWAYS prescribe dose as milligrams of caffeine citrate. The 

intravenous injection contains 20mg/mL caffeine citrate 

Dose 5mg 10mg 15mg 20mg 25mg 

Volume 0.25mL 0.5mL 0.75mL 1mL 1.25mL 

Administer intravenous loading doses as an infusion over at least 30 minutes.  

Administer intravenous maintenance doses as a bolus injection over at least 3 minutes. 

Intravenous doses may be given undiluted, or diluted with compatible fluid for ease of 

administration. 

 

Oral 

To ensure clear orders ALWAYS prescribe dose as milligrams of caffeine citrate. The oral 

solution contains 20mg/mL caffeine citrate. 

Dose 5mg 10mg 15mg 20mg 25mg 

Volume 0.25mL 0.5mL 0.75mL 1mL 1.25mL 

Give with feeds to minimise gastrointestinal irritation.  

Compatible Fluids 

Glucose 5%, glucose 10% 

Adverse Effects 

Common 

Diuresis, tachycardia, agitation 

Rare 

Hypertonia, severe hyperglycaemia, heart failure and seizures 

No obvious cardiovascular, neurologic toxicity has been observed at plasma caffeine 

concentrations below 50microg/mL 



South Australian Neonatal Medication Guidelines 

 caffeine citrate   
 40mg/2mL injection, 20mg/mL oral solution 

 

ISBN number:  978-1-74243-385-1 
Endorsed by:                         South Australian Maternal, Neonatal &amp; Gynaecology Clinical Reference Group 
Last Revised: 27/04/2017 
Contact: South Australian Neonatal Medication Guidelines Workgroup at: 

 Health:NeoMed@sa.gov.au  Page 3 of 3 
 

Version control and change history 

PDS reference: OCE use only 

 
Version Date from Date to Amendment 

1.0 November 2012 April 2017 Original version 

2.0 April 2017 Current Complete review 

    

    

 
 

Monitoring  

? Monitor heart-rate. Withhold dose and notify prescriber if the heart rate exceeds 180 

beats/minute 

? Cardio respiratory monitoring of all neonates is required for 3 to 5 days after caffeine 

citrate therapy has been ceased 

? If neonate is not on a monitor at the time of ceasing the medication, then cardio respiratory 

monitoring must be performed from 24 hours after the last dose of caffeine citrate 

? Caffeine citrate should be dosed according to clinical response. Caffeine citrate has a wide 

therapeutic range and therefore therapeutic drug monitoring is not usually recommended. 

Therapeutic response has been achieved at around 10-35microg/mL.  

Practice Points 

? Caffeine half-life and clearance vary linearly with postnatal age. When caffeine is used for 

older infants the frequency of administration should be increased: refer to Paediatric 

Dosing Guidelines 

Reference 

1. Gray PH, Flenady VJ,Charles BG, Steer PA on behalf of the Caffeine Collaborative Study 

Group. Caffeine citrate for very preterm infants: Effects on development, temperament and 

behaviour. Journal of Paediatrics and Child Health 2011;47: 167-172 

2. Steer et al. High dose caffeine citrate for extubation of preterm infants: a randomised 

controlled trial. Arch Dis Child Fetal Neonatal Ed 2004 Nov; 89(6): 499-503 

 


	Caffeine Citrate_Neo_Cover_v2
	Clinical Guideline
	Caffeine Citrate
	Policy developed by: SA Maternal &amp; Neonatal Clinical Community of Practice
	Approved by
	Safety &amp; Quality Strategic Governance Committee on:  28 April 2017
	Next review due:         30 April 2020

	Caffeine Citrate_Neo_v2

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