caffeine citrate
caffeine citrate
(ka-feensi-trate) caffeinecitrate,Cafcit
(trade name)Classification
Therapeutic: central nervous system stimulantsPharmacologic: respiratory stimulants
Indications
Action
- Stimulation of the respiratory center,
- Increased minute ventilation,
- Decreased threshold to hypercapnea,
- Increased response to hypercapnea,
- Increased skeletal muscle tone,
- Decreased diaphragmatic fatigue,
- Increased metabolic rate,
- Increased oxygen consumption.
Therapeutic effects
Pharmacokinetics
Time/action profile
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
IV | rapid | end of infusion | 24 hr |
PO | rapid | 30 min–2 hr | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- insomnia
- irritability
- jitteriness
- restlessness
Cardiovascular
- tachycardia
Gastrointestinal
- necrotizing enterocolitis (life-threatening)
- feeding intolerance
- gastritis
- GI bleeding
Genitourinary
- increased urine output
Dermatologic
- dry skin
- rash
- skin breakdown
Endocrinologic
- hypoglycemia
- hyperglycemia
Musculoskeletal
- muscle tremors
- twitches
Interactions
Drug-Drug interaction
Cimetidine, fluconazole, and ketoconazole ↓ metabolism (dose reduction of caffeine may be necessary).Phenobarbital and phenytoin may ↑ caffeine metabolism (↑ doses of caffeine may be necessary).Because caffeine is a significant metabolite of theophylline, concurrent administration is not recommended.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Assess respiratory status frequently throughout therapy.
- Monitor patient for signs of necrotizing enterocolitis (abdominal distension, vomiting, bloody stools, lethargy). May be fatal.
- Lab Test Considerations: Monitor serum caffeine levels before and periodically during therapy in infants previously treated with theophylline or in infants whose mothers consumed caffeine before delivery.
- Monitor serum glucose levels. May cause hypoglycemia or hyperglycemia.
- Lab Test Considerations: Therapeutic range: 8–20 mcg/mL. Serum caffeine levels of >50 mcg/mL have been associated with serious toxicity. Monitor serum levels and adjust dose in neonates with impaired hepatic or renal function to avoid toxicity.
Potential Nursing Diagnoses
Ineffective breathing pattern (Indications)Implementation
- Oral: Maintenance doses may also be administered orally.
Intravenous Administration
- pH: 4.7.
- Intermittent Infusion: Solution should be clear, without particulate matter.
- Rate: Initial loading dose should be administered over 30 min. Maintenance doses may be administered over 10 min every 24 hr beginning 24 hr after loading dose. Syringe pump should be used to ensure accurate delivery.
- Syringe Compatibility: alprostadil, amikacin, aminophylline, calcium gluconate, cefotaxime, cimetidine, clindamycin, dexamethasone, dobutamine, dopamine, epinephrine, fentanyl, gentamicin, heparin, isoproterenol, lidocaine, metoclopramide, morphine, nitroprusside, pancuronium, penicillin G, phenobarbital, phenylephrine, sodium bicarbonate, vancomycin
- Syringe Incompatibility: acyclovir, furosemide, lorazepam, nitroglycerin, oxacillin, pantoprazole
- Y-Site Compatibility: doxapram, levofloxacin
- Additive Compatibility: amino acids, calcium gluconate, D5W, D50W, dopamine, fat emulsion, heparin, fentanyl
Patient/Family Teaching
- Instruct parent on correct technique for administration. Measure oral dose accurately with a 1-mL syringe. If apnea events continue, consult health care professional; do not increase dose.
- Advise parent to consult health care professional immediately if signs of necrotizing enterocolitis occur.
Evaluation/Desired Outcomes
- Decrease in apneic episodes in premature infant.