Dj%252520citral

# Dj Citral (Citrate Salts / Citrated Caffeine) *Note: "Dj Citral" is not a standard pharmaceutical nomenclature. This entry addresses **Citrated Caffeine**, the standard clinical caffeine formulation.* ## Overview Citrated Caffeine is a central nervous system stimulant used primarily in neonatology. It functions as an adenosine receptor antagonist, stimulating the respiratory center to reduce episodes of apnea of prematurity. ## Primary Indications * Treatment of apnea of prematurity in infants between 28 and <33 weeks gestational age. ## Adult Dosing * **Not indicated/No standard clinical use.** ## Pediatric Dosing * **Loading Dose:** 20 mg/kg (equivalent to 10 mg/kg caffeine base) administered as a 30-minute IV infusion. * **Maintenance Dose:** 5 mg/kg (equivalent to 2.5 mg/kg caffeine base) administered once daily IV or PO, starting 24 hours after the loading dose. * **Dose adjustments:** Follow institutional protocols; plasma concentrations may be required for dose titration. ## Dose Adjustments * **Hepatic/Renal Impairment:** Clearance is primarily hepatic; use with caution in neonates with severe hepatic or renal dysfunction. Monitor plasma levels closely. ## Contraindications * Hypersensitivity to caffeine or its components. ## Adverse Effects * **Common:** Tachycardia, jitteriness, feeding intolerance, vomiting, increased urine output. * **Serious:** Necrotizing enterocolitis (NEC), seizures (overdose), arrhythmias, hyperglycemia. ## Key Drug Interactions * **CYP1A2 Inhibitors (e.g., Cimetidine, Ketoconazole):** May decrease caffeine clearance, increasing risk of toxicity. * **CYP1A2 Inducers (e.g., Phenobarbital, Phenytoin):** May increase caffeine clearance, potentially rendering therapy subtherapeutic. * **Theophylline:** Synergistic effects; do not co-administer as both are methylxanthines. ## Monitoring * **Cardiac:** Continuous ECG monitoring for tachycardia or arrhythmias. * **Serum Levels:** Therapeutic range is typically 5–20 mcg/mL. Levels should be checked if the patient shows signs of toxicity or inadequate response. * **Clinical:** Monitor for signs of irritability, tremors, and gastrointestinal distress (NEC symptoms). ## Clinical Pearls * **Transitioning:** IV to oral dosing is generally 1:1, as oral bioavailability is high. * **Toxicity:** Excessive dosing may cause tachycardia, vomiting, and tremors. If toxicity occurs, hold dose and consider caffeine levels. * **Duration:** Therapy is typically discontinued when the patient remains free of apnea for 5–7 days or reaches 34–37 weeks post-menstrual age. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical protocols and safety data may change. Always verify current prescribing information, institutional guidelines, and weight-based calculations via verified clinical resources (e.g., Lexicomp, Micromedex) before prescribing or administering medication.