Caffeine/Caffeine and Sodium Benzoate (Monograph)
Brand names: Cafcit, No Doz, Vivarin
Drug class: Respiratory and CNS Stimulants
VA class: CN809
CAS number: 58-08-2
Introduction
CNS stimulant; a xanthine derivative.115 120 a
Uses for Caffeine/Caffeine and Sodium Benzoate
CNS Stimulation
Used orally as an aid in staying awake and to restore mental alertness in fatigued patients.117 118 a
Used in combination with antihistamines to overcome the sedative properties of antihistamines; however, efficacy and dosage required not adequately established.a
Caffeine and sodium benzoate injection has been used in conjunction with supportive measures to treat respiratory depression associated with overdosage of CNS depressant drugs (e.g., opiate analgesics, alcohol) and with electric shock.120 a However, most authorities believe caffeine and other analeptics should not be used in these conditions and recommend other supportive therapy because of caffeine’s questionable benefit and transient action.120 a
Apnea of Prematurity
Short-term (10–12 days) treatment (as oral or IV caffeine citrate) of apnea of prematurity in neonates who are 28 to <33 weeks of gestational age (designated an orphan drug by FDA for this use).115
Use only after other causes of apnea (e.g., CNS disorders, primary lung disease, anemia, sepsis, metabolic disturbances, cardiovascular abnormalities, obstructive apnea) have been ruled out or treated appropriately.115
Headache
Used in combination with ergotamine to prevent or abort vascular headaches (e.g., migraine and cluster headaches).116 a e However, there is conflicting evidence regarding efficacy of this combination in the treatment of acute migraine attacks.116
Used orally alone and in combination with analgesics (e.g., acetaminophen, aspirin) for treatment of headache,121 a d h l o including migraine attacks.116 g
Some evidence that analgesic-caffeine combinations may produce slightly more analgesia than analgesic agents alone and may have beneficial effect on mood; however, these results have not always been reproducible in well-controlled studies.a Additional studies needed to determine the role, if any, of caffeine as an analgesic adjuvant.a
Some experts state that the combination of acetaminophen, aspirin, and caffeine is a reasonable first-line therapy for mild to moderate migraine attacks or for severe migraine attacks that previously have responded to NSAIAs or nonopiate analgesics.116
Caffeine and sodium benzoate injection has been used for the symptomatic relief of headache following spinal puncture† [off-label].a
Other Uses
Safety and efficacy of caffeine citrate in the prevention of sudden infant death syndrome† [off-label] (SIDS) or prior to extubation in mechanically ventilated infants† [off-label] not established.115
Has been used orally alone and in combination with other drugs (e.g., analgesics, diuretics) to relieve tension, fatigue, and fluid retention associated with menstruation.a Usefulness is questionable because caffeine’s diuretic activity in patients with fluid retention is minimal.a
Caffeine/Caffeine and Sodium Benzoate Dosage and Administration
General
Apnea of Prematurity
-
Prior to initiating caffeine citrate therapy, determine baseline serum caffeine concentrations in neonates previously treated with theophylline (see Specific Drugs and Laboratory Tests under Interactions) and in infants born to mothers who consumed caffeine prior to delivery.115
-
May need to monitor serum caffeine concentrations periodically during therapy to avoid toxicity.115
Administration
Administer orally (caffeine tablets, caffeine citrate oral solution), by slow IV infusion (caffeine citrate), or by slow IV injection or IM or sub-Q† [off-label] injection (caffeine and sodium benzoate).115 117 118 120 a Administer rectally in combination with ergotamine tartrate.m
Consult manufacturer’s product labeling for complete directions for appropriate administration of preparations containing caffeine in combination with analgesics, antacids, antihistamines, antipyretics, antitussives, belladonna alkaloids, diuretics, ergotamine tartrate, expectorants, nasal decongestants, skeletal muscle relaxants, sympathomimetics, and vitamins.
Oral Administration
Caffeine Citrate Oral Solution
Available as preservative-free oral solution in single-use vials; discard any unused portion.115
To administer a dose, remove the rubber stopper from the vial and then withdraw and administer the appropriate dose using a 1-mL or other appropriate syringe to ensure accurate measurement.115
IV Administration
For solution and drug compatibility information, see Compatibility under Stability.
Caffeine citrate is available as a preservative-free injection in single-use vials; discard any unused portion.115 Use a syringe infusion pump to administer caffeine citrate injection to neonates.115
Rate of Administration
Caffeine citrate: For treatment of apnea of prematurity, administer loading dose by slow IV infusion over 30 minutes; infuse maintenance doses by slow IV infusion over 10 minutes.115 a
Caffeine and sodium benzoate: Administer by slow IV injection.120 a
Dosage
Available as caffeine, caffeine citrate, and caffeine and sodium benzoate; dosage of caffeine (alone or in fixed combination with sodium benzoate) expressed in terms of anhydrous caffeine; dosage of caffeine citrate expressed in terms of the salt.115 117 118 120 a
Caffeine also is commercially available in combination with analgesics, antacids, antihistamines, antipyretics, antitussives, belladonna alkaloids, diuretics, ergotamine tartrate, expectorants, nasal decongestants, skeletal muscle relaxants, sympathomimetics, and vitamins; consult manufacturer’s product labeling for appropriate dosage of the specific preparation.
Pediatric Patients
CNS Stimulation
Oral
Caffeine: 100–200 mg administered no more frequently than every 3–4 hours in children ≥12 years of age.117 118 a
IV† [off-label], IM†, or Sub-Q†
Caffeine and sodium benzoate injection: 8 mg/kg (maximum 500 mg) (4 mg/kg when expressed in terms of anhydrous caffeine) or 250 mg/m2 (125 mg/m2 when expressed in terms of anhydrous caffeine) administered up to every 4 hours if necessary has been recommended;a however, most clinicians strongly discourage analeptic use of caffeine.120 a
Apnea of Prematurity
Loading Dose of Caffeine Citrate
Oral†Loading dose of 10–20 mg/kg† (5–10 mg/kg when expressed in terms of anhydrous caffeine) as a single dose has been used.106 107 108 109 110
IVLoading dose of 20 mg/kg (10 mg/kg when expressed in terms of anhydrous caffeine) as a single dose.115
Alternatively, loading dose of 10–20 mg/kg† (5–10 mg/kg when expressed in terms of anhydrous caffeine) as a single dose has been used.105 106 107 108 109 110
IM†Loading dose of 10–20 mg/kg† (5–10 mg/kg when expressed in terms of anhydrous caffeine) as a single dose has been used.105 106 107 108 109 110
Maintenance Therapy with Caffeine Citrate
Oral5 mg/kg (2.5 mg/kg when expressed in terms of anhydrous caffeine) every 24 hours for no longer than 10–12 days, beginning 24 hours after loading dose.115 (See Prescribing Limits under Dosage and Administration.)
Alternatively, 5–10 mg/kg† (2.5–5 mg/kg when expressed in terms of anhydrous caffeine) once daily, beginning 24 hours after loading dose, has been used.105 106 107 108 109 110 Adjust maintenance dosage according to the patient’s response and tolerance and plasma caffeine concentrations.105 106 107 108 109 110
IV5 mg/kg (2.5 mg/kg when expressed in terms of anhydrous caffeine) every 24 hours for no longer than 10–12 days, beginning 24 hours after loading dose.115 (See Prescribing Limits under Dosage and Administration.)
Alternatively, 5–10 mg/kg† (2.5–5 mg/kg when expressed in terms of anhydrous caffeine) once daily, beginning 24 hours after loading dose, has been used.105 106 107 108 109 110 Adjust maintenance dosage according to the patient’s response and tolerance and plasma caffeine concentrations.105 106 107 108 109 110
IM†5–10 mg/kg† (2.5–5 mg/kg when expressed in terms of anhydrous caffeine) once daily, beginning 24 hours after loading dose, has been used.105 106 107 108 109 110 Adjust maintenance dosage according to the patient’s response and tolerance and plasma caffeine concentrations.105 106 107 108 109 110
Headache
Oral
Caffeine in fixed combination with analgesics (e.g., acetaminophen, aspirin, salicylamide) for self-medication: Combinations and dosage strengths vary; consult manufacturer’s product labeling for appropriate dosage of the specific preparation.d h l o
Tension Headache
OralButalbital, acetaminophen, and caffeine in children ≥12 years of age: 1 or 2 capsules or tablets (each containing butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg) every 4 hours (up to 6 capsules or tablets daily).c p Alternatively, 1 capsule or tablet (containing butalbital 50 mg, acetaminophen 500 mg, and caffeine 40 mg) every 4 hours in children ≥12 years of age.b i Avoid extended and repeated use.b c i p
Butalbital, aspirin, and caffeine in children ≥12 years of age: 1 or 2 tablets (each containing butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg) every 4 hours (up to 6 tablets daily).f Avoid extended and repeated use.f
Adults
CNS Stimulation
Mild CNS Stimulation
OralCaffeine: 100–200 mg administered no more frequently than every 3–4 hours.117 118 120 a
Emergency Respiratory Failure
IVCaffeine and sodium benzoate: 500 mg–1 g (250–500 mg when expressed in terms of anhydrous caffeine); however, most clinicians strongly discourage analeptic use of caffeine.120 a
Respiratory Depression Associated with Overdosage of CNS Depressants and with Electric Shock
IMCaffeine and sodium benzoate: 500 mg–1 g (250–500 mg when expressed in terms of anhydrous caffeine); however, most clinicians strongly discourage analeptic use of caffeine.120 a
Headache
Oral
Caffeine in fixed combination with analgesics (e.g., acetaminophen, aspirin, salicylamide) for self-medication: Combinations and dosage strengths vary; consult manufacturer’s product labeling for appropriate dosage of the specific preparation.d h l o
Tension Headache
OralButalbital, acetaminophen, and caffeine: 1 or 2 capsules or tablets (each containing butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg) every 4 hours (up to 6 capsules or tablets daily).c p Alternatively, 1 capsule or tablet (containing butalbital 50 mg, acetaminophen 500 mg, and caffeine 40 mg) every 4 hours.b i Avoid extended and repeated use.b c i p
Butalbital, aspirin, and caffeine: 1 or 2 capsules or tablets (each containing butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg) every 4 hours (up to 6 capsules or tablets daily).f j Avoid extended and repeated use.f
Butalbital, acetaminophen, caffeine, and codeine phosphate: 1 or 2 capsules (each containing butalbital 50 mg, acetaminophen 325 mg, caffeine 40 mg, and codeine phosphate 30 mg) every 4 hours (up to 6 capsules daily).121 Avoid extended and repeated use.121
Butalbital, aspirin, caffeine, and codeine phosphate: 1 or 2 capsules (each containing butalbital 50 mg, aspirin 325 mg, caffeine 40 mg, and codeine phosphate 30 mg) every 4 hours (up to 6 capsules daily).k Avoid extended and repeated use.k
Vascular Headache
OralAcetaminophen, aspirin, and caffeine: 2 tablets (each containing acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg) for treatment of migraine.g
Ergotamine and caffeine: 2 tablets (each containing ergotamine tartrate 1 mg and caffeine 100 mg) initially, followed by 1 tablet at 30-minute intervals until attack has abated (maximum 6 tablets per attack).e
RectalErgotamine and caffeine: 1 suppository (containing ergotamine tartrate 2 mg and caffeine 100 mg) initially;m if necessary, may give a second dose (1 suppository) in 1 hour.m
In some patients with cluster headaches in the morning, 1–2 suppositories may be given at bedtime on a short-term basis.m n
Prescribing Limits
Pediatric Patients
CNS Stimulation
Oral
Caffeine in children ≥12 years of age: Maximum 200 mg every 3–4 hours.117 118 a
IV†, IM†, or Sub-Q†
Caffeine and sodium benzoate injection: Maximum 500 mg (250 mg when expressed as anhydrous caffeine) per dose.a
Apnea of Prematurity
Maintenance Therapy with Caffeine Citrate
Oral, IV, or IM†Safety and efficacy of dosing periods exceeding 10–12 days not established.115
Headache
Tension Headache
OralButalbital, acetaminophen, and caffeine in children ≥12 years of age: Maximum 6 capsules or tablets (each containing butalbital 50 mg, acetaminophen 325 or 500 mg, and caffeine 40 mg) daily.b c i p
Butalbital, aspirin, and caffeine in children ≥12 years of age: Maximum 6 tablets (each containing butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg) daily.f
Adults
CNS Stimulation
Mild CNS Stimulation
OralCaffeine: Maximum 200 mg every 3–4 hours.117 118 a
Emergency Respiratory Failure
IVCaffeine and sodium benzoate: Maximum 1 g (500 mg when expressed in terms of anhydrous caffeine) as a single dose.120 a Maximum 2.5 g (1.25 g when expressed in terms of anhydrous caffeine) daily.120
Respiratory Depression Associated with Overdosage of CNS Depressants and with Electric Shock
IMCaffeine and sodium benzoate: Maximum 1 g (500 mg when expressed in terms of anhydrous caffeine) as a single dose.120 a Maximum 2.5 g (1.25 g when expressed in terms of anhydrous caffeine) daily.120
Headache
Tension Headache
OralButalbital, acetaminophen, and caffeine: Maximum 6 capsules or tablets (each containing butalbital 50 mg, acetaminophen 325 or 500 mg, and caffeine 40 mg) daily.b c i p
Butalbital, aspirin, and caffeine: Maximum 6 capsules or tablets (each containing butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg) daily.f j
Butalbital, acetaminophen, caffeine, and codeine phosphate: Maximum 6 capsules (each containing butalbital 50 mg, acetaminophen 325 mg, caffeine 40 mg, and codeine phosphate 30 mg) daily.121
Butalbital, aspirin, caffeine, and codeine phosphate: Maximum 6 capsules (each containing butalbital 50 mg, aspirin 325 mg, caffeine 40 mg, and codeine phosphate 30 mg) daily.k
Vascular Headache
OralAcetaminophen, aspirin, and caffeine: Maximum 2 tablets (each containing acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg) within any 24-hour period unless otherwise directed by a clinician.g
Ergotamine and caffeine: Maximum 6 tablets (each containing ergotamine tartrate 1 mg and caffeine 100 mg) per attack or 10 tablets per week.e
RectalErgotamine and caffeine: Maximum 2 suppositories (each containing ergotamine tartrate 2 mg and caffeine 100 mg) per attack and 5 suppositories per week.m
Special Populations
Hepatic Impairment
Apnea of Prematurity
Oral or IV
Adjust caffeine citrate dosage to avoid toxicity; use with caution and monitor serum caffeine concentrations.115
Renal Impairment
Apnea of Prematurity
Oral or IV
Adjust caffeine citrate dosage to avoid toxicity; use with caution and monitor serum caffeine concentrations.115
Cautions for Caffeine/Caffeine and Sodium Benzoate
Contraindications
Warnings/Precautions
Warnings
Necrotizing Enterocolitis
Potentially fatal necrotizing enterocolitis reported in neonates receiving caffeine citrate.115 Careful monitoring for the development of necrotizing enterocolitis (as is recommended for all preterm infants) is recommended for those receiving caffeine citrate.115
General Precautions
Cardiac Effects
Tachycardia, extrasystoles, and possibly other cardiac arrhythmias may be associated with large doses;115 117 120 generally recommended that caffeine be avoided in patients with symptomatic cardiac arrhythmias and/or palpitations and during the first several days to weeks after an AMI.100
Use with caution in infants with cardiovascular disease.115
Nervous System Effects
Large doses may result in insomnia, restlessness, nervousness, mild delirium, headache, excitement, agitation, a condition resembling anxiety neurosis, scintillating scotoma, hyperesthesia, tinnitus, and muscle tremors or twitches. 115 120
Seizures reported with caffeine overdosage; use with caution in infants with seizure disorders.115
Overly vigorous treatment with caffeine and sodium benzoate may increase CNS depression in already depressed patients.a
GI Effects
Chronic administration in animals associated with gastric ulceration; causal relationship in humans not adequately established.a Use with caution in patients with history of peptic ulcer.a
Blood Glucose Abnormalities
Hypoglycemia and hyperglycemia reported in patients receiving caffeine; periodic monitoring of blood glucose concentrations may be necessary in neonates receiving caffeine citrate.115 a
Self-medication
Intended for occasional use only; should not be used as a substitute for sleep.117 118
Use of Fixed Combinations
When used in fixed combination with other drugs (see Preparations), consider the cautions, precautions, and contraindications associated with the concomitant agent(s).121 e g
Specific Populations
Pregnancy
Lactation
Distributed into milk;119 a milk-to-plasma ratios of 0.5–0.76 reported.119 Amount of caffeine ingested from usual quantities of caffeinated beverages is considered compatible with breast-feeding; caffeine may accumulate in nursing infants following moderate to heavy maternal consumption.119
Pediatric Use
Use of caffeine tablets for self-medication in children <12 years of age is not recommended.117 118 Possible increased severity of CNS effects in children compared with adults.a (See Nervous System Effects under Cautions.)
Avoid use of caffeine and sodium benzoate injection in neonates; sodium benzoate may produce kernicterus.a
Use caffeine citrate with caution in premature neonates with impaired renal or hepatic function, cardiovascular disease, or seizure disorders (see Cardiac Effects and also Nervous System Effects, under Cautions; also see Special Populations under Dosage and Administration).115 Consider possible need for monitoring serum caffeine concentrations (see General under Dosage and Administration).115 Monitor blood glucose concentrations periodically; hypoglycemia and hyperglycemia reported in neonates.115
Long-term follow-up studies have not shown caffeine administration in premature neonates to adversely affect neurologic development or growth.115
Hepatic Impairment
Pharmacokinetics of caffeine citrate not evaluated in premature neonates with hepatic impairment; use with caution.115 (See Hepatic Impairment under Dosage and Administration.)
Renal Impairment
Pharmacokinetics of caffeine citrate not evaluated in premature neonates with renal impairment; use with caution.115 (See Renal Impairment under Dosage and Administration.)
Common Adverse Effects
CNS stimulation (e.g., insomnia, restlessness, nervousness, mild delirium), GI irritation (e.g., nausea, vomiting, gastric irritation).a
In neonates with apnea of prematurity: Rash, feeding intolerance, sepsis, necrotizing enterocolitis.115
Drug Interactions
Appears to be metabolized principally by CYP1A2.115
Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes
Pharmacokinetic interactions likely with drugs metabolized by CYP1A2 or with CYP1A2 inducers or inhibitors.115
Specific Drugs and Laboratory Tests
Drug or Test |
Interaction |
Comments |
---|---|---|
Anticonvulsants (phenobarbital, phenytoin) |
Possible increased elimination of caffeine and decreased serum caffeine concentrations115 Possible increased metabolism of phenobarbital120 |
Increased caffeine dosage may be required115 |
β-Adrenergic agonists |
||
Cimetidine |
Possible decreased elimination of caffeine and increased serum caffeine concentrations115 |
Reduced caffeine dosage may be required115 |
Disulfiram |
Potential inhibition of caffeine metabolism and substantially decreased clearance of caffeine;103 possible exaggerated or prolonged caffeine effects103 104 |
|
Ketoconazole |
Possible decreased elimination of caffeine and increased serum caffeine concentrations115 a |
|
Ketoprofen |
Possible decreased urine volume115 |
Clinical importance unknown115 |
Tests for serum urate |
False-positive elevations of serum urate as measured by the Bittner method120 a |
|
Tests for urinary 5-hydroxyindoleacetic acid (5-HIAA) |
||
Tests for urinary catecholamines and vanillylmandelic acid (VMA) |
Slight increase in urine concentrations of VMA and catecholamines; possible false-positive results on tests for pheochromocytoma and neuroblastoma120 a |
Avoid caffeine intake during test120 |
Theophylline |
Interconversion between caffeine and theophylline reported in premature neonates115 |
Concurrent use not recommended in premature neonates115 Monitor serum caffeine concentrations prior to initiating caffeine therapy in neonates previously treated with theophylline115 |
Caffeine/Caffeine and Sodium Benzoate Pharmacokinetics
Absorption
Caffeine and caffeine citrate are well absorbed following oral administration.a
Absorption following oral administration may be more rapid than that following IM injection of caffeine and sodium benzoate.a
Absolute bioavailability of orally administered caffeine in preterm neonates not fully determined.115
Onset
Following oral administration of 100 mg of caffeine (as coffee), peak plasma concentrations reached after 50–75 minutes.a
Following oral administration of 10 mg/kg of caffeine to preterm neonates, mean time to peak plasma concentration was 0.5–2 hours.115
Food
Feeding formula does not affect time to peak plasma concentration in infants.115
Plasma Concentrations
Serum caffeine concentrations >50 mcg/mL associated with serious toxicity.115
Distribution
Extent
Rapidly distributed into body tissues; readily crosses the blood-brain barrier.115 120
Concentrations in the CSF of preterm neonates approximates plasma concentration.115
Readily crosses the placenta and is distributed into milk.115 a
Mean volume of distribution in infants is slightly larger than that in adults (0.6 L/kg).115
Plasma Protein Binding
Approximately 17–36% in adults; data not available for neonates or infants.115 120
Elimination
Metabolism
Metabolized in the liver, principally via CYP1A2, to 1-methyluric acid, 1-methylxanthine, and 7-methylxanthine.115 120 May induce own metabolism; clinical importance of autoinduction is unknown.120 a
Neonates: Limited hepatic metabolism due to immature hepatic enzyme systems.115 Interconversion between caffeine and theophylline reported.115 (See Specific Drugs and Laboratory Tests under Interactions.)
Metabolism of caffeine by 9 months of age approximates that seen in adults.115
Elimination Route
Adults: Excreted principally in urine as metabolites (<1% recovered in urine as unchanged drug).120 a
Neonates: Excreted principally in urine as unchanged drug (approximately 86%).115 Mean fraction excreted unchanged in urine in infants is inversely related to gestational/postconceptional age;115 by 9 months of age, fraction excreted as unchanged drug approximates that seen in adults.115
Half-life
Neonates: Approximately 3–4 days.115 Elimination slower in young infants than in adults because of immature hepatic and/or renal function.115 Mean half-life in infants is inversely related to gestational/postconceptional age;115 by 9 months of age, half-life approximates that seen in adults.115
Special Populations
Pharmacokinetics in neonates with renal or hepatic insufficiency not evaluated.115
Stability
Storage
Oral
Tablets
Solution
15–30°C.115 Caregivers should store vials of the oral solution in the child-resistant container provided by the manufacturer.115
Parenteral
Caffeine Citrate Injection
15–30°C.115
Caffeine and Sodium Benzoate Injection
15–30°C.120
Compatibility
Parenteral
Solution Compatibility (for Caffeine Citrate)
Compatible |
---|
Amino acids 8.5% |
Dextrose 5 or 50% in water |
Fat emulsion 20%, IV |
Drug Compatibility (for Caffeine Citrate)
Compatible |
---|
Calcium gluconate |
Dopamine HCl |
Fentanyl citrate |
Heparin sodium |
Actions
-
Competitively inhibits phosphodiesterase, the enzyme that degrades cyclic 3′,5′-adenosine monophosphate (AMP), increasing levels of intracellular cyclic AMP.120 a
-
Stimulates all levels of the CNS.120 a Stimulates the cerebral cortex and produces a more rapid and clearer thought flow, wakefulness or arousal in fatigued patients; also improves psychomotor coordination.a
-
Stimulates medullary vagal, vasomotor, and respiratory centers in slightly larger doses, promoting bradycardia, vasoconstriction, and increased respiratory rate.120 a
-
Produces a positive inotropic effect on the myocardium and a positive chronotropic effect at the SA node, causing transient increases in heart rate, force of contraction, cardiac output, and heart work.115 120 a
-
Constricts cerebral vasculature; also directly dilates peripheral blood vessels, decreasing peripheral vascular resistance.120 a Overall effect on heart rate and BP depends on whether CNS or peripheral effects predominate.120 a
-
Stimulates voluntary skeletal muscle, increasing the force of contraction and decreasing muscular fatigue.120 a
-
Increases renal blood flow and GFR; decreases proximal tubular reabsorption of sodium and water, resulting in mild diuresis.120 a
Advice to Patients
-
Risk of adverse CNS and cardiac effects if excessive doses are taken.115
-
Risk of necrotizing enterocolitis in premature infants; importance of informing clinician if signs of GI intolerance (e.g., abdominal distention, vomiting, bloody stools) or lethargy develops.115 a
-
Importance of informing clinician if premature infant continues to experience apneic events despite caffeine therapy; do not increase dosage without advice of clinician.115 a
-
Importance of adhering to directions for use of caffeine citrate oral solution, including directions for storage, measurement and withdrawal of the prescribed dose, and administration.115 Provide copy of manufacturer’s patient information.115
-
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses (e.g., cardiovascular disease).115
-
Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.a
-
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Oral |
Tablets, film-coated |
200 mg* |
No Doz Maximum Strength Caplets (with povidone and propylene glycol) |
Novartis |
Vivarin |
GlaxoSmithKline |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Parenteral |
Injection |
250 mg/mL (equivalent to caffeine anhydrous 125 mg/mL and sodium benzoate 125 mg/mL)* |
Caffeine and Sodium Benzoate Injection |
American Regent |
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Oral |
Solution |
20 mg/mL (equivalent to 10 mg/mL caffeine anhydrous) |
Cafcit |
MeadJohnson |
Caffeine Citrate Oral Solution |
Paddock |
|||
Parenteral |
Injection |
20 mg/mL (equivalent to 10 mg/mL caffeine anhydrous) |
Cafcit |
MeadJohnson |
Caffeine Citrate Injection |
American Regent |
|||
Bulk |
Powder |
AHFS DI Essentials™. © Copyright 2024, Selected Revisions November 20, 2012. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
100. Council on Scientific Affairs. Caffeine labeling. JAMA. 1984; 252:803-6. http://www.ncbi.nlm.nih.gov/pubmed/6748182?dopt=AbstractPlus
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102. Robertson D, Hollister AS, Kincaid D et al. Caffeine and hypertension. Am J Med. 1984; 77:54-60. http://www.ncbi.nlm.nih.gov/pubmed/6377891?dopt=AbstractPlus
103. Beach CA, Mays DC, Guiler RC et al. Inhibition of elimination of caffeine by disulfiram in normal subjects and recovering alcoholics. Clin Pharmacol Ther. 1986; 39:265-70. http://www.ncbi.nlm.nih.gov/pubmed/3948467?dopt=AbstractPlus
104. Mangini RJ, ed. Drug interaction facts. St. Louis: JB Lippincott Co; 1986(Jul):123a.
105. Aranda JV, Cook CE, Gorman W. Pharmacokinetic profile of caffeine in the premature newborn infant with apnea. J Pediatr. 1979; 94:663-8. http://www.ncbi.nlm.nih.gov/pubmed/430317?dopt=AbstractPlus
106. Murat I, Moriette G, Blin MC et al. The efficacy of caffeine in the treatment of recurrent idiopathic apnea in premature infants. J Pediatr. 1981; 99:984-9. http://www.ncbi.nlm.nih.gov/pubmed/7310594?dopt=AbstractPlus
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111. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414), to June 28, 1996. Rockville, MD; 1996 Jul.
112. Cerulli J, Lomaestro BM, Malone M. Update on the pharmacotherapy of obesity. Ann Pharmacother. 1998; 32:88-102. http://www.ncbi.nlm.nih.gov/pubmed/9475827?dopt=AbstractPlus
113. Astrup A, Toubro S, Christensen NJ et al. Pharmacology of thermogenic drugs. Am J Clin Nutr. 1992; 55:246-8S.
114. Food and Drug Administration. Dietary supplements containing ephedrine alkaloids. Proposed rule. [21 FR Part 111] Fed Regist. 1997; 62:30678-724.
115. Mead Johnson and Co. Cafcit (caffeine citrate) injection and oral solution prescribing information. Evansville, IN: 2003 May.
116. Matchar DB, Young WB, Rosenberg JH et al. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management of acute attacks. St. Paul, MN; 2001. From the American Academy of Neurology web site. http://www.aan.com
117. GlaxoSmithKline Consumer Healthcare. Vivarin (caffeine) tablets patient information. Pittsburgh, PA; 2003. From website. Accessed 2007 May 17. http://www.vivarin.com
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b. Forest Pharmaceuticals, Inc. Esgic-Plus (butalbital, acetaminophen, and caffeine) capsules prescribing information. St. Louis, MO; 2002 Aug.
c. Mikart, Inc. Butalbital, acetaminophen, and caffeine tablets prescribing information. Atlanta, GA; 2002 Aug.
d. Novartis Consumer Health, Inc. Excedrin Tension Headache (acetaminophen and caffeine) tablets patient information. Parsippany, NJ; 2007.
e. Mikart, Inc. Ergotamine tartrate and caffeine tablets prescribing information. Atlanta, GA; 2005 Feb.
f. Actavis Elizabeth LLC. Butalbital, aspirin, and caffeine tablets prescribing information. Elizabeth, NJ; 2006 Jan.
g. Novartis Consumer Health, Inc. Excedrin Migraine (acetaminophen, aspirin, and caffeine) tablets patient information. Parsippany, NJ; 2007.
h. GlaxoSmithKline. Original Formula BC (aspirin, caffeine, and salicylamide) powder patient information. Pittsburgh, PA; 2007.
i. Mikart, Inc. Butalbital, acetaminophen, and caffeine tablets prescribing information. Atlanta, GA; 2002 Aug.
j. Watson Laboratories, Inc. Butalbital, aspirin, and caffeine capsules prescribing information. Corona, CA; 2006 Mar.
k. Watson Laboratories, Inc. Butalbital, aspirin, caffeine, and codeine phosphate capsules prescribing information. Corona, CA; 2007 Jan.
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m. Novartis Pharmaceuticals Corporation. Cafergot (ergotamine tartrate and caffeine) suppositories prescribing information. East Hanover, NJ. Undated. Available from website. Accessed 2007 Dec 5. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1862
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o. Insight Pharmaceuticals. Anacin Max Strength (aspirin and caffeine) tablets patient information. Langhorne, PA. Undated. Available from website. Accessed 2007 Dec 12. http://www.anacin.com
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