<html> <head> <meta charset="UTF-8"/> <meta name="tikaGenerated" content="true"/> <meta name="date" content="2022-03-28T06:19:25Z"/> <meta name="xmp:CreatorTool" content="Microsoft® Word for Microsoft 365"/> <meta name="Keywords" content="Neonatal Medication Guideline, Caffeine citrate, apnoea, facilitation of extubation"/> <meta name="subject" content="Neonatal Medication Guideline"/> <meta name="dc:creator" content="SA Maternal, Neonatal and Gynaecology Community of Practice"/> <meta name="dcterms:created" content="2022-03-28T06:19:25Z"/> <meta name="Last-Modified" content="2022-03-28T06:19:25Z"/> <meta name="dcterms:modified" content="2022-03-28T06:19:25Z"/> <meta name="title" content="Caffeine citrate"/> <meta name="Last-Save-Date" content="2022-03-28T06:19:25Z"/> <meta name="meta:save-date" content="2022-03-28T06:19:25Z"/> <meta name="dc:title" content="Caffeine citrate"/> <meta name="modified" content="2022-03-28T06:19:25Z"/> <meta name="cp:subject" content="Neonatal Medication Guideline"/> <meta name="Content-Type" content="application/pdf"/> <meta name="creator" content="SA Maternal, Neonatal and Gynaecology Community of Practice"/> <meta name="meta:author" content="SA Maternal, Neonatal and Gynaecology Community of Practice"/> <meta name="dc:subject" content="Neonatal Medication Guideline, Caffeine citrate, apnoea, facilitation of extubation"/> <meta name="meta:creation-date" content="2022-03-28T06:19:25Z"/> <meta name="created" content="Mon Mar 28 16:49:25 ACDT 2022"/> <meta name="xmpTPg:NPages" content="3"/> <meta name="Creation-Date" content="2022-03-28T06:19:25Z"/> <meta name="meta:keyword" content="Neonatal Medication Guideline, Caffeine citrate, apnoea, facilitation of extubation"/> <meta name="Author" content="SA Maternal, Neonatal and Gynaecology Community of Practice"/> <meta name="producer" content="Microsoft® Word for Microsoft 365"/> </head> <body> <pre> 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 & History Developed by: SA Maternal, Neonatal & 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 & Neonatal Clinical Network Original version </pre> </body> </html>