Caffeine
Mechanism :
Caffeine is structurally related to other methylxanthines, theophylline and theobromine. It is a bronchial smooth muscle relaxant, a CNS stimulant, a cardiac muscle stimulant and a diuretic.
Indication :
Contraindications :
Caffeine and Sodium Benzoate solution in paediatrics.
Dosing :
Apnea of prematurity:
Loading dose:
10 to 20 mg/kg caffeine base (20 mg/kg caffeine citrate) orally or IV over 30 min.
Maintenance dose:
5-10 mg/kg caffeine base orally or IV OD.
Adverse Effect :
Tachycardia, extrasystole, palpitations, arrhythmias, insomnia, restlessness, excitement, nervousness, scintillating scotoma, tinnitus, muscular tremor, headache, light headedness, urticaria, dry skin, rash, vomiting, nausea, diarrhea, stomach pain, necrotizing enterocolitis, gastritis, diuresis, hyperglycemia.
Interaction :
Theophylline: Interconversion between caffeine and theophylline has been reported in preterm neonates.
Cimetidine, Disulfiram, Fluoroquinolones, Oral Contraceptives, Mexiletine and Ketoconazole: Decrease caffeine elimination.
Lithium: Decrease plasma levels of lithium.
Phenytoin: Decrease caffeine levels.
Hepatic Dose :
Dose adjustments may be needed in neonates with impaired hepatic function and should be guided by clinical response and serum caffeine levels.