"The US Food and Drug Administration (FDA) has expanded the indication for the short-acting beta-agonist albuterol sulfate inhalation powder (ProAir RespiClick, Teva) to children aged 4 to 11 years, the company announced today.
Overall, the reported number of adverse events in the double-blind period of the controlled trial was similar for the caffeine citrate and placebo groups. The following table shows adverse events that occurred in the double-blind period of the controlled trial and that were more frequent in caffeine citrate treated patients than placebo.
ADVERSE EVENTS THAT OCCURRED MORE FREQUENTLY IN
CAFFEINE CITRATE TREATED PATIENTS THAN PLACEBO DURING DOUBLE-BLIND THERAPY
|Adverse Event (AE)||Caffeine Citrate
N=39 n (%)
|BODY AS A WHOLE|
|Accidental Injury||1 (2.2)||0 (0.0)|
|Hemorrhage||1 (2.2)||0 (0.0)|
|Necrotizing Enterocolitis||2(4.3)||1 (2.6)|
|Gastritis||1 (2.2)||0 (0.0)|
|Gastrointestinal Hemorrhage||1 (2.2)||0 (0.0)|
|HEMIC AND LYMPHATIC SYSTEM|
|Disseminated Intravascular Coagulation||1 (2.2)||0 (0.0)|
|METABOLIC AND NUTRITIVE DISORDERS|
|Acidosis||1 (2.2)||0 (0.0)|
|Healing Abnormal||1 (2.2)||0 (0.0)|
|Cerebral Hemorrtiage||1 (2.2)||0 (0.0)|
|Dyspnea||1 (2.2)||0 (0.0)|
|Lung Edema||1 (2.2)||0 (0.0)|
|SKIN AND APPENDAGES|
|Dry Skin||1 (2.2)||0 (0.0)|
|Skin Breakdown||1 (2.2)||0 (0.0)|
|Retinopathy of Prematurity||1 (2.2)||0 (0.0)|
|Kidney Failure||1 (2.2)||0 (0.0)|
In addition to the cases above, three cases of necrotizing enterocolitis were diagnosed in patients receiving caffeine citrate during the openlabel phase of the study.
Three of the infants who developed necrotizing enterocolitis during the trial died. All had been exposed to caffeine. Two were randomized to caffeine, and one placebo patient was “rescued” with open-label caffeine for uncontrolled apnea. Adverse events described in the published literature include: central nervous system stimulation (i.e ., irritability, restlessness, jitteriness), cardiovascular effects ( i.e . , tachycardia, increased left ventricular output, and increased stroke volume), gastrointestinal effects (i.e., increased gastric aspirate, gastrointestinal in to lerance), alterations in serum glucose (hypoglycemia and hyperglycemia) and renal effects (increased urine flow rate, increased creatinine clearance, and increased sodium and calcium excretion). Published long-term follow-up studies have not shown caffeine to adversely affect neurological development or growth parameters.
To report SUSPECTED ADVERSE REACTIONS, contact Sagent Pharmaceuticals, Inc., at 1-866-625-1618 or FDA at 1-800-FD A-1088 or www.fda.gov/medwatch .
Read the Cafcit (caffeine citrate) Side Effects Center for a complete guide to possible side effects
Cytochrome P450 1A2 (CYP1A2) is known to be the major enzyme involved in the metabolism of caffeine. Therefore, caffeine has the potential to interact with d rugs that are substrates for CYP1A2, inhibit CYP1A2, or induce CYP1A2.
Few data exist on drug interactions with caffeine in preterm neonates. Based on adult data, lower doses of caffeine may be needed following co-administration of drugs which are reported to decrease caffeine elimination (e.g., cimetidine and ketoconazole) and higher caffeine doses may be needed following co-administration of drugs that increase caffeine elimination (e.g., Phenobarbital and phenytoin).
Caffeine administered concurrently with ketoprofen reduced the urine volume in 4 healthy volunteers. The clinical significance of this interaction in preterm neonates is not known. Interconversion between caffeine and theophylline has been reported in preterm neonates. The concurrent use of these drugs is not recommended.
Read the Cafcit Drug Interactions Center for a complete guide to possible interactions
Last reviewed on RxList: 7/1/2016
Additional Cafcit Information
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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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