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2775243 
Journal Article 
Unit-dosing caffeine sodium benzoate to prevent neonatal toxicities: case report and stability study 
Iglesias, AT; Lopez-Samblas, AM; Binion, K 
1991 
0 
ASHP Midyear Clinical Meeting Symposium Highlights
ISSN: 1557-0606 
IPA/92/990375 
VOL 26 ISS Dec 1991 
REF 
English 
IPA COPYRIGHT: ASHP Caffeine is gaining popularity in the United States as an alternative to theophylline for the treatment of apnea of prematurity. Although caffeine has a wider therapeutic index than theophylline, intoxications have been previously published. A case is presented in which a premature neonate experienced caffeine toxicity due to a dilution error. Symptoms of toxicity included jitteriness, tachycardia, tachypnea, retractions, vomiting, and gastrointestinal bleed. A serum level of 205 mcg/mL confirmed caffeine toxicity and a dilution error was suspected. The caffeine was put on hold and the clinical status of the patient improved with treatment over the next few days. Since information is not available in commonly utilized references, we conducted a stability study on 1:10 dilutions of the commercially available caffeine sodium benzoate injection (500 mg/2 mL) in preservative-free sterile water for injection. Triplicate samples were analyzed at time 0, 1, and 2 days utilizing a published HPLC methodology. Results showed no more than five percent difference between samples. A 1:10 dilution of caffeine sodium benzoate is stable for at least 48 hours at room temperature (25DGC). Preparation of caffeine in a unit-dose form is recommended since it can minimize the potential for medication errors in the neonatal population.