caffeine citrate
Caffeine citrate (Cafcit) is a medication that works well for treating breathing problems in premature babies, but it's usually used for a short period of time. This medication is typically given to your baby in the neonatal intensive care unit (NICU). It's available as an injection into the vein (IV). There's also an oral solution form of caffeine citrate (Cafcit) for premature babies who have a feeding tube or can swallow. Sometimes, caffeine citrate (Cafcit) can cause side effects, like restlessness, jitteriness, faster heartbeat, and more diaper wetting (more urination).
What is Caffeine citrate (Cafcit)?
What is Caffeine citrate (Cafcit) used for?
Apnea (condition where breathing stops and restarts repeatedly) in premature babies
How Caffeine citrate (Cafcit) works
Caffeine citrate (Cafcit) is a central nervous system stimulant. It's not completely known how the medication works. But it's thought that caffeine citrate (Cafcit) helps open up the airways and control breathing. It might also help the diaphragm muscle work better to improve breathing. This might help premature babies breathe better.
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What are the side effects of Caffeine citrate (Cafcit)?
Common Side Effects
- Feeding problems (9%)
- Rash (9%)
Other Side Effects
- Irritability
- Restlessness
- Shakiness
- Fast heart rate
- Shortness of breath
- Dry skin
- More urination
Serious Side Effects
- Serious bacterial infection in the intestine: bloating of the stomach area, vomiting, bloody stools, loss of energy
- Accidentally getting too much caffeine (overdose): fever, fast heart rate, trouble sleeping, vomiting, shakiness, muscle problems, seizure
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
More common
dizziness
fast heartbeat
hyperglycemia, including blurred vision, drowsiness, dry mouth, flushed dry skin, fruit-like breath odor, increased urination, ketones in urine, loss of appetite, nausea, stomachache, tiredness, troubled breathing, unusual thirst, or vomiting (in newborn babies)
hypoglycemia, including anxious feeling, blurred vision, cold sweats, confusion, cool pale skin, drowsiness, excessive hunger, fast heartbeat, nausea, nervousness, restless sleep, shakiness, or unusual tiredness or weakness (in newborn babies)
irritability, nervousness, or severe jitters (in newborn babies)
nausea (severe)
trouble in sleeping
vomiting
Symptoms of overdose
Abdominal or stomach pain
agitation, anxiety, excitement, or restlessness
confusion or delirium
convulsions (seizures)—in acute overdose
dehydration
faster breathing rate
fast or irregular heartbeat
headache
increased sensitivity to touch or pain
irritability
muscle trembling or twitching
nausea and vomiting, sometimes with blood
overextending the body with head and heels bent backward and body bowed forward
painful, swollen abdomen or vomiting (in newborn babies)
ringing or other sounds in ears
seeing flashes of "zig-zag" lights
whole-body tremors (in newborn babies)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this time, check with your doctor if you notice any of the following side effects:
More common
dizziness
headache
irritability
muscle tension
nervousness
unusual tiredness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Caffeine citrate (Cafcit)
Pros
First choice to treat abnormal breathing in premature babies
Maintenance dose is typically given only once a day.
Available as an injection and oral solution form
Cons
Can cause irritability or feeding problems in your baby
Must be careful when using the medication for babies with kidney, liver, or heart problems because of risk of side effects
Not clear how safe it is or how well it works when it's used for more than 12 days
Pharmacist tips for Caffeine citrate (Cafcit)
Typically, the care team will give your baby caffeine citrate (Cafcit) treatment for their breathing problem in the neonatal intensive care unit (NICU). Ask the care team if you have any questions or concerns about your baby's treatment.
In some situations, the care team might instruct you to give caffeine citrate (Cafcit) to your baby at home after getting discharged from the hospital. This will depend on your baby's condition. If this is the case, follow the care team's directions carefully to make sure you give your baby the medication properly. Ask the care team if you have any questions about how to give your baby caffeine citrate (Cafcit).
If you notice that your baby is still having brief pauses in breathing or their breathing gets worse at any point during treatment, contact your baby's provider right away.
Frequently asked questions about Caffeine citrate (Cafcit)
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What are the risks and warnings for Caffeine citrate (Cafcit)?
Caffeine citrate (Cafcit) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious bacterial infection in the intestine
In studies, some babies who were given caffeine citrate (Cafcit) developed a serious bacterial infection in the intestine during treatment. This infection can sometimes be life-threatening. Although it isn't clear if caffeine citrate (Cafcit) can cause this bacterial gut infection, it's important to be aware of the potential risk. Signs and symptoms of this bacterial gut infection include bloating of the stomach area, vomiting, bloody stools, feeding problems, and unstable breathing or heart rate. Your baby's provider will closely watch for these signs and symptoms as they treat your baby with caffeine citrate (Cafcit). Also let your baby's care team know if you notice these signs and symptoms when you're taking care of your baby.
Caution use in babies with seizures
Seizures can happen if too much caffeine citrate (Cafcit) is accidentally given to your baby. For this reason, your baby's provider will decide whether caffeine citrate (Cafcit) is safe for your baby if your baby has had seizures. If your baby is getting caffeine citrate (Cafcit), the provider will make sure that your baby is getting the right dose of medication.
Caution use in babies with kidney or liver problems
If your baby has kidney or liver problems, the care team will carefully use caffeine citrate (Cafcit) to treat your baby. The kidneys and liver work to break down and remove caffeine citrate (Cafcit) from the body. If your baby's kidneys and liver aren't working properly, your baby can't get rid of the medication from their body well. It can stay in the body longer, which can potentially raise the risk of side effects and toxicity.
Stress on the heart
From studies, caffeine citrate (Cafcit) doesn't appear to harm the heart. But, the medication can make the heart beat faster and work harder than normal. For this reason, the care team will carefully use caffeine citrate (Cafcit) to treat babies with heart problems.
Caffeine citrate (Cafcit) dosage forms
Typical dosing for Caffeine citrate (Cafcit)
Your baby's provider will calculate the right dose for your baby based on their body weight.
The loading (starting) dose of caffeine citrate (Cafcit) is 20 mg/kg of weight given into the vein (IV) for one dose. Then, your baby will continue the medication at a maintenance dose of 5 mg/kg of weight once daily (every 24 hours). The maintenance dose can be given into the vein, by mouth, or through a feeding tube. Your baby's provider will start the maintenance dose 24 hours after the IV loading dose.
Interactions between Caffeine citrate (Cafcit) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
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References
Best studies we foundAdbel-Hady, H., et al. (2015). Caffeine therapy in preterm infants. World Journal of Clinical Pediatrics.
Eichenwald, E. C., et al. (2016). Apnea of prematurity. Pediatrics.
Kumar, V. H. S., et al. (2019). Caffeine and clinical outcomes in premature neonates. Children.
MedlinePlus. (2021). Apnea of prematurity.
MedlinePlus. (2021). Necrotizing enterocolitis.
Pergolizzi, J., et al. (2022). Treating apnea of prematurity. Cureus.
Sun Pharmaceutical Industries, Inc. (2020). CAFFEINE CITRATE injection. CAFFEINE CITRATE solution [package insert]. DailyMed.
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