Journal article
Caffeine Citrate Dosing Adjustments to Assure Stable Caffeine Concentrations in Preterm Neonates.
- Koch G Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland. Electronic address: gilbert.koch@ukbb.ch.
- Datta AN Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
- Jost K Department of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
- Schulzke SM Department of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
- van den Anker J Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Division of Clinical Pharmacology, Children's National Health System, Washington, DC.
- Pfister M Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Quantitative Solutions a Certara Company, Princeton, NJ.
- 2017-11-28
Published in:
- 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
English
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.
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.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jpeds.2017.08.064
- PMID 29173321
- Persistent URL
- https://sonar.ch/global/documents/232201
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