caffeine (Cafcit, NoDoz, ReCharge, Vivarin)

Dosing and uses of Cafcit, NoDoz (caffeine)

• Adult
• Pediatric

 

Adult dosage forms and strengths

injectable solution

• 20mg/mL

oral solution

• 20mg/mL

tablets

• 200mg

capsules

• 200mg

lozenges

• 75mg

 

Fatigue & Drowsiness

100-200 mg PO q3-4hr; not later than 6 hours before bedtime

 

Respiratory Failure

Caffeine and sodium benzoate: 250 mg IV/IM once; may repeat PRN; alternatively, 500 mg in 1 L IV over 4 hr; not to exceed 2500 mg/24hr

CAUTION: Use strongly discouraged

 

Stimulant Diuretic (Off-label)

500 mg IV/IM; 1 g maximum single dose

 

Pediatric dosage forms and strengths

injectable solution

• 10mg/mL

oral solution

• 10mg/mL

tablets

• 200mg

capsules

• 200mg

lozenges

• 75mg

 

Drowsiness or Fatigue

< 12 years: Not recommended

>12 years: 100-200 mg PO q3-4hr; not later than 6 hours before bedtime

Potential toxic dose <6 years old: 15 mg/kg

 

Neonatal Apnea

Load: 10-20 mg/kg IV/PO once

Maintenance: 5-10 mg/kg IV/PO qDay

Potential toxic dose <6 years old: 15 mg/kg

 

Cafcit, NoDoz (caffeine) adverse (side) effects

Frequency not defined

Tachycardia

Palpitations (dose dependent)

Insomnia

Irritability

Nervousness

Restlessness

Tremor

Tinnitus

Regular and decaffeinated coffee increase gastric acid & pepsin secretion

Nausea

Vominting

Diarrhea

Diuresis

Withdrawal symptoms

• Anxiety
• depression
• Fatigue
• Headache (can last up to 7 days)
• Muscle tension
• Nausea
• Runny nose

 

Warnings

Contraindications

Hypersensitivity

 

Cautions

May increase severity of fibrocystic breast disease, PMS, increase risk of bladder, ovary, colon & pancreatic cancer

Not for use in patients with anxiety, agitation, or tremor

Caution in patients with history of peptic ulcer, hepatic impairment, renal impairment, seizure disorder, or cardiovascular disease

Avoid use in symptomatic arrhythmias and/or palpitations

See Caffeine OD for caffeine content of specific foods & drinks

 

Pregnancy and lactation

Pregnancy category: C (crosses placenta, can remain in fetus/neonate 64-300 hr)

Lactation: enters breast milk; use with caution

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Cafcit, NoDoz (caffeine)

Mechanism of action

Methylxanthine; promotes cAMP accumulation by inhibiting phosphodiesterase; increases medullary respiratory center sensitivity to carbon dioxide; may prevent apnea by acting as an adenosine receptor antagonist

 

Pharmacokinetics

Half-Life: 72-96hr (neonates); 5 hr (>9 months and adults); decreased in tobacco user

Peak plasma time:  30-120 min

Peak plasma concentration: 1.5-1.8 mcg/mL

Protein Bound: 17-36%

Vd: 0.6-0.9 L/kg

Metabolism: hepatic CYP1A2

Excretion: Urine