Caffeine citrate is a medication employed in medical settings, particularly for premature infants. It is a pharmaceutical compound that combines caffeine with citric acid and sodium citrate. This specific formulation allows for its controlled and effective use as a therapeutic agent.
Understanding Caffeine Citrate
Caffeine citrate is a unique chemical compound consisting of anhydrous caffeine, citric acid monohydrate, and sodium citrate dihydrate. The presence of citric acid forms a salt in solution, enhancing its solubility and making it more readily absorbed by the body in a medical context.
This formulation allows for precise dosing and consistent therapeutic effects, which are important in treating sensitive patient populations. This makes caffeine citrate a preferred choice for medical applications where controlled delivery and absorption are necessary.
Primary Medical Use
Caffeine citrate is used to treat apnea of prematurity in infants born before 35 weeks gestation or weighing less than 2 kilograms. Apnea of prematurity is a condition where premature infants experience pauses in breathing lasting 15 to 20 seconds or shorter pauses accompanied by a slow heart rate or low oxygen levels. This condition arises because the central nervous system, which controls breathing, is not yet fully developed in these infants.
It helps reduce the frequency of these apneic episodes, which can lead to respiratory failure and other complications. Studies have shown that caffeine citrate treatment significantly reduces apnea events, often showing improvements within two days of treatment. This medication also offers long-term benefits for premature infants, including improved neurodevelopmental outcomes and a reduced risk of conditions like bronchopulmonary dysplasia.
Mechanism of Action
Caffeine citrate functions as a central nervous system stimulant. Its mechanism involves acting as an adenosine receptor antagonist, meaning it blocks the actions of adenosine at specific receptors in the brain. Adenosine typically has a depressant effect on the central nervous system, and by blocking its binding, caffeine citrate helps to increase alertness and stimulate respiratory centers.
This stimulation leads to an increased respiratory drive, helping premature infants maintain more consistent breathing patterns. Caffeine citrate also enhances the release of neurotransmitters such as dopamine and norepinephrine, further contributing to its stimulating effects.
Administration and Safety
Caffeine citrate is administered to premature infants either intravenously or orally, often through a feeding tube. The standard loading dose for infants between 28 and 33 weeks gestational age is 20 mg/kg, given intravenously over approximately 30 minutes. Following this, a maintenance dose of 5 mg/kg is administered orally or intravenously every 24 hours. Some clinical practices may use higher maintenance doses, ranging from 10 to 20 mg/kg per day, particularly for very low birth weight infants.
Medical supervision and monitoring are important during treatment, as caffeine citrate is a prescription medication. Common side effects can include restlessness, jitteriness, increased heart rate, and increased urine output. Less common but more serious side effects may involve feeding problems, vomiting, bloating, or changes in blood sugar levels. While the drug has a wide therapeutic window, serum caffeine levels may be monitored periodically, especially if there are concerns about toxicity, with serious toxicity generally reported when levels exceed 50 mg/L. Caution is advised for infants with seizure disorders, or impaired kidney or liver function, as these conditions can affect drug metabolism and excretion.