What is the standard loading and maintenance dosing range for caffeine citrate used to prevent apnea of prematurity?

• A. Loading 2 mg/kg; maintenance 0.5–1 mg/kg/day.
• B. Loading 100 mg/kg; maintenance 50 mg/kg/day.
• C. Loading ~20 mg/kg; maintenance 5–10 mg/kg/day.
• D. Loading 1 mg/kg; maintenance 2–4 mg/kg/week.

Answer: (C)

The main idea being tested is the standard dosing regimen for caffeine citrate used to prevent apnea of prematurity. Caffeine citrate works by blocking adenosine receptors in the brain, which stimulates respiration and reduces apnea events in preterm infants. To quickly reach therapeutic levels, the recommended loading dose is about 20 mg/kg. After that, a daily maintenance dose of roughly 5–10 mg/kg keeps the drug effective to prevent apnea while minimizing toxicity. This approach takes advantage of caffeine’s long half-life in preterm infants, allowing once-daily dosing. Patterns that use a much smaller loading dose, an excessively high initial dose, or a weekly maintenance schedule would not reliably sustain therapeutic levels or could raise safety concerns.