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South Australian Neonatal Medication Guidelines 

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

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

 

INFORMAL COPY WHEN PRINTED  Page 1 of 3 

OFFICIAL 
 
 

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 base is equivalent to 2mg caffeine citrate 

 

Neonatal Apnoea 

Facilitation of Extubation 

Intravenous, Oral  

Loading Dose 

Loading dose 20mg/kg 

Maintenance Dose 

5 to 20mg/kg/dose every 24 hours, commencing 24 hours after the loading dose 

  



South Australian Neonatal Medication Guidelines 

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

 

 
INFORMAL COPY WHEN PRINTED  Page 2 of 3 

OFFICIAL 
 

 

Preparation and Administration 

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, gastric irritation 

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 
 

 

 
INFORMAL COPY WHEN PRINTED  Page 3 of 3 

OFFICIAL 
 

 

Monitoring 

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

beats/minute 

? Cardiorespiratory 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 cardiorespiratory 

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 

? Use with caution in neonates with impaired renal or hepatic function, seizure disorders, 

cardiovascular disease or congenital heart disease 

  

Document Ownership &amp; History 

Developed by: SA Maternal, Neonatal &amp; Gynaecology Community of Practice 

Contact: Health.NeoMed@sa.gov.au 

Endorsed by:  Commissioning and Performance, SA Health 

Next review due:  28/03/2027 

ISBN number:  978-1-76083-397-8 

CGSQ reference:  NMG 017 

Policy history: Is this a new policy (V1)?  N 

 Does this policy amend or update and existing policy?   Y 

 If so, which version? V2.0 

 Does this policy replace another policy with a different title?  N 

 If so, which policy (title)? 

 

Approval 
Date 

Version 
Who approved New/Revised 
Version 

Reason for Change 

28/3/2022 V3.0 
Domain Custodian, Clinical 
Governance, Safety and Quality 

Formal review 

4/2017 V2.0 
SA Health Safety and Quality Strategic 
Governance Committee 

Complete review 

11/2012 V1.0 
SA Maternal &amp; Neonatal Clinical 
Network 

Original version 

 
 
 



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