Caffeine Citrate for the Prevention of Apnea Associated With Alprostadil Infusions

• Published in: The journal of pediatric pharmacology and therapeutics Vol. 25; no. 3; pp. 235 - 240
• Main Authors: Higgins, Kristi L, Buck, Marcia L
• Format: Journal Article
• Language: English
• Published: United States Pediatric Pharmacy Advocacy Group 2020
• Subjects: Clinical Investigations; apnea; congenital heart disease; alprostadil; neonate; caffeine citrate
• ISSN: 1551-6776; 2331-348X
• DOI: 10.5863/1551-6776-25.3.235

To evaluate the incidence of apnea and requirement for positive pressure ventilation in patients who received caffeine for prevention while receiving alprostadil compared with those who did not receive caffeine.
This was a single-center, retrospective study of patients who received alprostadil over a 7-year time frame. Patients were divided into 2 groups based on whether they received caffeine for prevention of apnea while receiving alprostadil. The incidence of apnea and requirements for positive pressure ventilation were recorded.
A total of 64 patients who received alprostadil were included for review. Thirty-two patients received caffeine for the prevention of apnea, and 32 patients received alprostadil only. Alprostadil doses were similar between the 2 groups (0.04-0.05 mcg/kg/min). Seven patients had a documented apneic event; 3 in the group given caffeine and 4 in the control group. One patient in each group required intubation because of apnea. All patients with documented apnea were on low-dose alprostadil therapy (<0.05 mcg/kg/min). Three patients had apnea after dose reductions had been made. Six out of the seven patients experienced apnea within the first 24 hours after the infusion. Only 1 patient experienced multiple apneic events.
In this small sample, there was no difference in incidence of apnea between patients on low-dose alprostadil who received caffeine for prevention and those who did not. Despite the use of low-dose alprostadil therapy and dose reductions, the incidence of apnea remains low, and most patients did not have repeated apneic events or require intubation.