Koch G Datta AN Jost K Schulzke SM van den Anker J Pfister M 2017 OBJECTIVE To identify dosing strategies that will assure stable caffeine concentrations in preterm neonates despite changing caffeine clearance during the first 8 weeks of life. METHODS A 3-step simulation approach was used to compute caffeine doses that would achieve stable caffeine concentrations in the first 8 weeks after birth: (1) a mathematical weight change model was developed based on published weight distribution data; (2) a pharmacokinetic model was developed based on published models that accounts for individual body weight, postnatal, and gestational age on caffeine clearance and volume of distribution; and (3) caffeine concentrations were simulated for different dosing regimens. RESULTS A standard dosing regimen of caffeine citrate (using a 20 mg/kg loading dose and 5 mg/kg/day maintenance dose) is associated with a maximal trough caffeine concentration of 15 mg/L after 1 week of treatment. However, trough concentrations subsequently exhibit a clinically relevant decrease because of increasing clearance. Model-based simulations indicate that an adjusted maintenance dose of 6 mg/kg/day in the second week, 7 mg/kg/day in the third to fourth week and 8 mg/kg/day in the fifth to eighth week assures stable caffeine concentrations with a target trough concentration of 15 mg/L. CONCLUSIONS To assure stable caffeine concentrations during the first 8 weeks of life, the caffeine citrate maintenance dose needs to be increased by 1 mg/kg every 1-2 weeks. These simple adjustments are expected to maintain exposure to stable caffeine concentrations throughout this important developmental period and might enhance both the short- and long-term beneficial effects of caffeine treatment. https://sonar.ch/global/documents/232201 eng info:eu-repo/semantics/altIdentifier/doi/10.1016/j.jpeds.2017.08.064 info:eu-repo/semantics/altIdentifier/pmid/29173321 The Journal of pediatrics. - 2017 loading dose maintenance dose maturation pharmacokinetics Apnea Birth Weight Caffeine Central Nervous System Stimulants Citrates Dose-Response Relationship, Drug Drug Administration Schedule Drug Monitoring Female Humans Infant Infant, Newborn Infant, Premature Infant, Premature, Diseases Male Weight Gain Caffeine Citrate Dosing Adjustments to Assure Stable Caffeine Concentrations in Preterm Neonates. http://purl.org/coar/resource_type/c_6501